[show abstract][hide abstract] ABSTRACT: Since February 1, 1980, the identical standardized Greenville Gastric Bypass has been performed in 397 morbidly obese patients with an operative mortality rate of 0.8%. The operation effectively controlled weight and maintained satisfactory weight loss even after 6 years (mean weights and ranges: Preoperative: 290 lbs (196-535); 18 months: 175 lbs (110-300); 72 months: 205 lbs (140-320). The gastric bypass favorably affected non-insulin-dependent diabetes (NIDDM), hypertension, physical and role functioning, and several measures of mental health. Rigorous follow-up (97.5% over 6 years) revealed that health problems were common in postoperative patients; there were nine late deaths. Abnormal glucose metabolism was present in 141 (36%) of 397 patients before surgery: NIDDM was present in 88 patients (22%) and 53 patients (14%) were glucose impaired. Of these, all but two became euglycemic within 4 months after surgery without any diabetic medication or special diets. The most recent 42 morbidly obese patients with NIDDM were studied intensively. In that cohort, fasting blood glucose, fasting insulin, and glycosylated hemoglobin returned to normal after surgery; insulin release, insulin resistance, and utilization of glucose improved sharply. The normalization of glucose metabolism after gastric bypass may not be related solely to weight loss and restriction of caloric intake, but may also be due to the bypass of the antrum and duodenum.
Annals of Surgery 10/1987; 206(3):316-23. · 6.33 Impact Factor
[show abstract][hide abstract] ABSTRACT: Observational studies suggest that surgically induced loss of weight may be effective therapy for type 2 diabetes.
To determine if surgically induced weight loss results in better glycemic control and less need for diabetes medications than conventional approaches to weight loss and diabetes control.
Unblinded randomized controlled trial conducted from December 2002 through December 2006 at the University Obesity Research Center in Australia, with general community recruitment to established treatment programs. Participants were 60 obese patients (BMI >30 and <40) with recently diagnosed (<2 years) type 2 diabetes.
Conventional diabetes therapy with a focus on weight loss by lifestyle change vs laparoscopic adjustable gastric banding with conventional diabetes care.
Remission of type 2 diabetes (fasting glucose level <126 mg/dL [7.0 mmol/L] and glycated hemoglobin [HbA1c] value <6.2% while taking no glycemic therapy). Secondary measures included weight and components of the metabolic syndrome. Analysis was by intention-to-treat.
Of the 60 patients enrolled, 55 (92%) completed the 2-year follow-up. Remission of type 2 diabetes was achieved by 22 (73%) in the surgical group and 4 (13%) in the conventional-therapy group. Relative risk of remission for the surgical group was 5.5 (95% confidence interval, 2.2-14.0). Surgical and conventional-therapy groups lost a mean (SD) of 20.7% (8.6%) and 1.7% (5.2%) of weight, respectively, at 2 years (P < .001). Remission of type 2 diabetes was related to weight loss (R2 = 0.46, P < .001) and lower baseline HbA1c levels (combined R2 = 0.52, P < .001). There were no serious complications in either group.
Participants randomized to surgical therapy were more likely to achieve remission of type 2 diabetes through greater weight loss. These results need to be confirmed in a larger, more diverse population and have long-term efficacy assessed.
actr.org Identifier: ACTRN012605000159651.
JAMA The Journal of the American Medical Association 02/2008; 299(3):316-23. · 29.98 Impact Factor
[show abstract][hide abstract] ABSTRACT: Variations in the techniques of bariatric surgery, coupled with the lack of a common database, has led to variable and, sometimes negative, outcomes from bariatric surgery. Thus, in November 2003, the American Society for Bariatric Surgery established Surgical Review Corporation (SRC) as an independent nonprofit entity for quality control of bariatric surgery and as a resource for data collection and analysis.
In November 2003, the leadership of the American Society for Bariatric Surgery founded SRC as an independent nonprofit entity for quality control of bariatric surgery and as resource for research. A national set of standards for the Bariatric Surgery Centers of Excellence program was developed using a meta-analysis of the relevant published English language data, a consensus conference at Georgetown University, and participation by stakeholders from industry, third-party payors, and malpractice carriers. A software program was developed to provide uniformity in data collection and ease of analysis.
SRC developed standards that have been accepted by the bariatric surgical community and put in place. A system was developed for the designation of two levels for the centers, provisional and full. The growth of the Centers of Excellence program has been rapid. At present, 135 hospitals and 265 surgeons have achieved full approval. The centers for Medicare and Medicaid Services have recognized the program. On the basis of the reports of 55,567 patients from the first 176 applicants for full approval and confirmed by SRC during site inspections, the 90-day operative mortality rate was 0.35%.
The first phase of development has gone well. Future steps include the development of a network of bariatric physicians and the development of a consortium for research.
Surgery for Obesity and Related Diseases 01/2006; 2(5):497-503; discussion 503. · 4.12 Impact Factor
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