Bariatric Surgery: A Systematic Review and Meta-analysis

Department of Surgery, University of Minnesota, Minneapolis 55455, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 30.39). 11/2004; 292(14):1724-37. DOI: 10.1001/jama.292.14.1724
Source: PubMed

ABSTRACT About 5% of the US population is morbidly obese. This disease remains largely refractory to diet and drug therapy, but generally responds well to bariatric surgery.
To determine the impact of bariatric surgery on weight loss, operative mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea).
Electronic literature search of MEDLINE, Current Contents, and the Cochrane Library databases plus manual reference checks of all articles on bariatric surgery published in the English language between 1990 and 2003. Two levels of screening were used on 2738 citations.
A total of 136 fully extracted studies, which included 91 overlapping patient populations (kin studies), were included for a total of 22,094 patients. Nineteen percent of the patients were men and 72.6% were women, with a mean age of 39 years (range, 16-64 years). Sex was not reported for 1537 patients (8%). The baseline mean body mass index for 16 944 patients was 46.9 (range, 32.3-68.8).
A random effects model was used in the meta-analysis. The mean (95% confidence interval) percentage of excess weight loss was 61.2% (58.1%-64.4%) for all patients; 47.5% (40.7%-54.2%) for patients who underwent gastric banding; 61.6% (56.7%-66.5%), gastric bypass; 68.2% (61.5%-74.8%), gastroplasty; and 70.1% (66.3%-73.9%), biliopancreatic diversion or duodenal switch. Operative mortality (< or =30 days) in the extracted studies was 0.1% for the purely restrictive procedures, 0.5% for gastric bypass, and 1.1% for biliopancreatic diversion or duodenal switch. Diabetes was completely resolved in 76.8% of patients and resolved or improved in 86.0%. Hyperlipidemia improved in 70% or more of patients. Hypertension was resolved in 61.7% of patients and resolved or improved in 78.5%. Obstructive sleep apnea was resolved in 85.7% of patients and was resolved or improved in 83.6% of patients.
Effective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery. A substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement.

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    • "Bariatric surgery is considered the only effective means to achieve an effective and sustained weight loss, maintained in the long term, and associated with a high rate of resolution of obesity-related co-morbidities [8] [9] [10] [11]. The Roux-en-Y gastric bypass (RYGB), currently considered by most surgeons as the gold standard of bariatric procedures, is effective at achieving a 60%–70% excess weight loss, which is maintained in the long term [8] [9] [12]. Furthermore, RYGB has been found to be effective at reversing systemic low-grade inflammation, IR, T2DM, and other obesity-related co-morbidities [10]. "
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    ABSTRACT: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is effective in reversing the metabolic syndrome (MS) in up to 90% of patients. The aim of this study was to determine predictors of MS persistence 1 year after LRYGB. University Hospital, France. Ninety-one patients with a mean age of 44.4 years and a mean body mass index (BMI) of 43.1 kg/m² meeting the criteria for MS were enrolled in this prospective study. Anthropometric, metabolic, and inflammatory biological parameters were assessed before and 1 year after LRYGB. Patients were divided into 2 groups according to the persistence (MS nonresponders) or resolution of MS (MS responders) 1 year after LRYGB and a comparison was performed at baseline and 1 year after surgery. Sixty-nine patients (75.8%) underwent remission, while 22 (24.2%) showed persistence of MS 1 year after LRYGB. At baseline the MS nonresponders group presented significantly higher values of fasting plasma glucose (7.8 versus 5.3 mmol/L, P = .004), glycosylated hemoglobin (HbA1c, 7.3% versus 5.9%, P = .0004), triglycerides (TG, 2.37 versus 1.33 mmol/L, P = .006), and homeostasis model assessment of insulin resistance (HOMA-IR, 442.5 versus 256, P = .006). The rate of diabetes was significantly higher in this group (68.2% versus 36.8%, P = .0086), as well as the number of MS components per patient. One year after LRYGB, the MS nonresponders showed a significantly lower excess BMI lost (EBMIL) (56.1% versus 82.4%, P = .00008). On multivariate analysis, baseline levels of TG, glucose metabolism markers and EBMIL were associated with the persistence of MS. Baseline levels of TG, plasma fasting glucose, and HbA1c, as well as history of type 2 diabetes and EBMIL, represent predictors of MS persistence 1 year after LRYGB. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
    Surgery for Obesity and Related Diseases 02/2015; DOI:10.1016/j.soard.2015.02.019 · 4.94 Impact Factor
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    • "An extensive and systematic meta - analysis including thousands of patients confirmed the effect of bariatric surgery on weight loss and glycemic control ( Buchwald et al . , 2004 ) . Addressing specifically the question of diabetes remission after bariatric surgery , a more recent meta - analysis concluded that a complete resolution of the clinical manifestations of diabetes , e . g . fasting glycemia <100 mg / dl and glycated hemoglobin ( HbA1c ) <6% without medication , occurred in 78 . 1% of patients ( Buchwa"
    02/2015, Degree: PhD, Supervisor: Francisco Castro e Sousa
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    • "Whereas obesity complicated by obstructive sleep apnoea is associated with several metabolic derangements including defects in lipid metabolism [22], bariatric surgery is associated with immediate reduction in continuous positive airway pressure requirements [23]. In keeping with recent literature, we also observed significant improvements in OSA, blood pressure and lipid profiles [5] [14] [21] [23] [24]. "
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    ABSTRACT: Background: Despite the high prevalence of morbid obesity, the global frequency of bariatric surgery in men is significantly lower than in women. It is unclear if this is due to the perception of poorer outcomes in men. Objectives: Compare weight loss and metabolic outcomes in men vs. women after bariatric surgery. Setting: University teaching hospital in North West England. Methods: We performed an observational cohort analysis of 79 men matched to 79 women for baseline age (±5 years), body mass index (BMI; ±2 kg/m2), bariatric procedure (69 gastric bypass and 10 sleeve gastrectomy each), type 2 diabetes (33 each), and continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA; 40 each). Results: Overall mean (95% confidence interval) reduction in BMI was 17.5 (15.7–19.4) kg/m2 (P < 0.001) at 24 months. There was no significant difference between men and women in mean percentage excess BMI loss (65.8% vs. 72.9%) at 24 months. Likewise, there were significant reductions in blood pressure, glycosylated haemoglobin and total cholesterol-to-high density lipoprotein cholesterol overall but no significant gender differences. Postoperatively, 77.5% of men and 90.0% of women with OSA discontinued CPAP therapy (non-significant). Conclusions: Weight loss and metabolic outcomes after bariatric surgery are of similar magnitude in men compared to women. The use of bariatric surgery in eligible men should be encouraged.
    European Journal of Internal Medicine 11/2014; 25(10). DOI:10.1016/j.ejim.2014.10.020 · 2.30 Impact Factor
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