Obesity Surgery

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Optifast VLCD Shake Chocolate 18 x 53g
A low-profile valve was installed 14 days later and aspiration of gastric contents was performed approximately 20 minutes after meals 3 times per day. The intragastric balloon also known as the silicone intragastric balloon or SIB has been developed as a temporary aid for obese patients who have had unsatisfactory results in their clinical treatment for obesity and super obese patients with higher surgical Fernandes et al, The authors concluded that the most common reason for conversion was chronic leak. Clinically significant obstructive sleep apnea i. For the assessment of the eligible articles, the Newcastle-Ottawa quality assessment scale was used. Each year people die or are injured by diseases that could

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Our Program

Many plans and products offer rapid weight loss as a quick fix, but keeping the weight off turns out to be the bigger challenge. With the Kaiser Permanente Medical Weight Management Program, you'll have an entire team by your side to help you achieve the lasting changes you want. A group of experienced physicians and educators will provide you with medical supervision, behavioral and nutritional advice, and weekly group support sessions.

Plus, once you enter the Long-Term Maintenance phase of the program, you can attend weekly group sessions to help you keep on track and stay motivated. Your team of Kaiser Permanente medical and weight loss professionals will be on hand to monitor your health and progress.

This includes periodic checkups and lab tests. The shakes, powders, and bars are healthy, provide full nutrition, and have been shown to aid in a 1- to 3-pound average weekly weight loss. The average weight loss is Details of this may be found on the following DHS website:. You may be eligible for an early release of superannuation to pay for necessary medical treatment or medical transport expenses for yourself or your dependant if either of you have:.

You will need the Adobe Reader to view and print these documents. Scientific Evidence for Obesity. Please use the following Out Of Pocket fees as a guide: Your initial consulatation is a very detailed discussion with Dr Hatzifotis, specifically tailored to you, and covers your medical and dietary history, and a comprehensive discussion around the weightloss procedure you decide upon. He will discuss in detail all of the advantages and disadvantages of your chosen procedure and the various risks involved, as well as answer any questions you may have.

Michael Hatzifotis you will be charged a Health Management fee. For privately insured patients this fee will cover: After the first 12 months, appointments are then annually. All band adjustments including needles and consumables Any further procedures should any complications arise. Administration fee The Professional Health Management fees, for privately insured patients, are as follows: Prior to your weight loss procedure you will be required to commence a low calorie meal replacement diet Optifast or Optislim.

You will need to purchase these meal replacements. In 13 patients both pre- and post-operative CSF pressures were recorded, with an average post-operative pressure decrease of mm H 2 O. Changes in weight loss and BMI varied depending on the reported post-operative follow-up interval.

The authors concluded that the published Class IV evidence suggested that bariatric surgery may be an effective treatment for IIH in obese patients, both in terms of symptom resolution and visual outcome. They stated that prospective, controlled studies are needed for better elucidation of its role.

Levin and colleagues stated that IIH occurs most frequently in young, obese women. Gastric bypass surgery has been used to treat morbid obesity and its co-morbidities, and IIH has recently been considered among these indications. These investigators presented a case report of a year old female with a maximum BMI of She also developed migraine headaches. After a waxing and waning course and various medical treatments, the patient underwent laparoscopic Roux-en-Y gastric bypass surgery with anterior repair of hiatal hernia.

Dramatic improvement in IIH headaches occurred by 4 months post-procedure and was maintained at 1 year, when she reached her weight plateau with a BMI of This added to the small number of case reports and retrospective analyses of the successful treatment of IIH with gastric bypass surgery, and brought this data from the surgical literature into the neurological domain.

It offered insight into an early time course for symptom resolution, and explored the impact of weight-loss surgery on migraine headaches. The authors concluded that this treatment modality should be further investigated prospectively to analyze the rate of headache improvement with weight loss, the amount of weight loss needed for clinical improvement, and the possible correlation with improvement in papilledema.

Handley et al systematically reviewed the effect of bariatric weight reduction surgery as a treatment for IIH. These investigators performed a comprehensive literature search using the following databases: No restrictions were placed on these searches, including the date of publication.

A total of 85 publications were identified, and after initial appraisal, 17 were included in the final review. Post-operative lumbar puncture opening pressure was shown to decrease by an average of The authors concluded that bariatric surgery for weight loss is associated with alleviation of IIH symptoms and a reduction in intracranial pressure. Furthermore, an improvement was observed in patients where conventional treatments, including neurosurgery, were ineffective.

They stated that further prospective randomized studies with control groups and a larger number of participants are lacking within the published studies to date.

Pujol Gebelli et al stated that laparoscopic gastric plication is a new technique derived from sleeve gastrectomy. Plication of the greater curvature produces a restrictive mechanism that causes weight loss. The results of the first cases where this technique has been applied in this hospital were presented.

Plication of the gastric greater curvature was performed under general anesthetic and by laparoscopy using 3 lines of sutures and with an orogastric probe as a guide. Results of the morbidity, mortality and weight loss were presented. A total of 13 patients were operated on 7 women. The maximum BMI varied between The most frequently found morbidity was nausea and vomiting.

The authors concluded that laparoscopic gastric plication is a new surgical technique which gives equivalent short-term results as vertical gastrectomy. It is a reproducible and reversible technique with results and indications still to be validated. Brethauer et al presented the results of a feasibility study using laparoscopic gastric plication for weight loss achieved without stapling or banding. After institutional review board approval, 2 methods were used to achieve laparoscopic gastric volume reduction.

In the 1st group anterior plication [AP] , the anterior gastric wall was folded inward from the fundus to the antrum using 2 rows of running sutures. The greater and lesser curvatures were approximated to create an intraluminal fold of the stomach. In the 2nd group greater curvature plication [GCP] , the short gastric vessels were divided, and the greater curvature was folded inward, with 2 suture lines to reduce the gastric capacity by a large intraluminal gastric fold.

The average pre-operative body mass index was Of the 15 patients, 9 underwent AP. For the 9 patients who underwent AP, the 6- and month endoscopic evaluations demonstrated comparable-size plications over time, except for in 1 patient, who had a partially disrupted fold.

Of the 6 patients who underwent GCP, the 6- and month follow-up endoscopic examinations demonstrated a durable intraluminal fold, except for in 1 patient, with a partial disruption at the distal fold owing to a broken suture.

For patients completing 1 year of follow-up, the percentage of excess weight loss was No bleeding or infectious complications developed. The 1st patient in the GCP group required re-operation and plication reduction owing to gastric obstruction.

The early weight loss results have been encouraging, with better weight loss in patients who underwent GCP. Both cases were corrected by reoperation. No mortality was observed. The authors concluded that laparoscopic adjustable gastric banded plication provides both restrictive and reductive effects and is reversible. The technique is safe, feasible, and reproducible and can be used as an alternative bariatric procedure.

Ji et al conducted a systematic review of the currently available literature regarding the outcomes of laparoscopic gastric plication LGP for the treatment of obesity. The authors' systematic review yielded 14 studies encompassing 1, LGP patients. Peri-operative data were collected from each study and recorded. Mean pre-operative BMI ranged from Operative time ranged from 50 to Hospital stay varied from 0.

The authors concluded that early reports with LGP were promising with a favorable short-term safety profile. However, it remains unclear if weight loss following LGP is durable in the long-term. They stated that additional prospective comparative trials and long-term follow-up are needed to further define the role of LGP in the surgical management of obesity.

In a prospective study, Zeinoddini evaluated safety and effectiveness of LGP on adolescents. Laparoscopic gastric plication was performed in 12 adolescents 9 females and 3 males. Mean SD age of the patients was Mean pre-operative weight and BMI were All medical co-morbidities were improved after LGP.

There were no deaths. One patient required replication 4 days post-operatively due to obstruction at the site of the last knot. No other major complications were observed. No patient required re-hospitalization. The authors concluded that LGP has the potential of being an ideal weight loss surgery for adolescents, resulting in excellent weight loss and minimal psychological disruption.

It is associated with a minimal risk of leakage, bleeding, and nutritional deficiency. However, they stated that large well-designed studies with long-term follow-up are needed. It is thought that these patients lose restriction because of the dilated gastrojejunostomy and thus overeat. Surgeons have tried endoscopic injection of sclerosing agents to create scar and a smaller anastomosis, with variable effects.

In , Loewen and Barba evaluated the injection of morrhuate sodium as sclerotherapy to decrease the diameter of the gastrojejunostomy anastomosis following gastric bypass. A total of 71 patients underwent sclerotherapy at their gastrojejunostomy from July to August A retrospective review was performed of this group, including chart review, follow-up data with weight checks, and telephone interview findings. The average age of the patients was 45 years and all but 4 patients were women.

Sclerotherapy was done an average of 2. The starting weight at endoscopy was an average of lb lb heavier than the average nadir weight. The average diameter of the gastrojejunostomy was 2.

An average of 13 mL morrhuate sodium was injected circumferentially. No hospital admissions or complications occurred in relation to the procedure. The analysis showed a high body mass index at endoscopy to be the only predictive factor for successful weight maintenance or loss.

In a article, Spaulding, Osler and Patlak studied endoscopic sclerotherapy with sodium morrhuate of a dilated gastrojejunostomy in gastric bypass patients. Their weight trends before and after treatment were assessed by paired t test.

A total of 32 patients who were gaining weight after gastric bypass underwent sclerotherapy of their dilated gastrojejunostomy. The timing of treatment ranged from 10 to months average 56 after Roux-en-Y gastric bypass. Before sclerotherapy, patients were gaining weight at a rate of.

After treatment, they were losing weight at a rate of. Endoscopic duodenal-jejunal bypass is the endoscopic placement of a duodenal-jejunal bypass sleeve eg, EndoBarrier which lines the first section of the small intestine causing food to be absorbed further along the intestine. Once implanted, the device is purported to influence gastrointestinal hormones and satiety. It is suggested to promote weight loss in individuals who are potential candidates for bariatric surgery, but are too heavy to safely undergo the procedure.

An UpToDate review on " Bariatric surgical operations for the management of severe obesity: The EndoBarrier is cm long and it extends from the proximal duodenum to the mid-jejunum and thus mimics a duodenojejunal bypass.

The ValenTx is a cm barrier device that extends from the gastroesophageal junction to the jejunum. The EndoBarrier, an endoscopically delivered duodeno-jejunal bypass liner DJBL , is a plastic flexible tube that is placed in the duodenal bulb, directly behind the pylorus. It extends from the duodenum to the proximal jejunum. Recent studies have suggested that the use of EndoBarrier has resulted in significant weight reduction in comparison to control-diet patients.

Schouten et al noted that the endoscopically placed duodenal-jejunal bypass sleeve or EndoBarrier Gastrointestinal Liner has been designed to achieve weight loss in morbidly obese patients. These researchers reported on the first European experience with this device.

A multi-center, randomized clinical trial was performed. A total of 41 patients were included and 30 underwent sleeve implantation; 11 patients served as a diet control group. All patients followed the same low-calorie diet during the study period. The purpose of the study was to determine the safety and effectiveness of the device.

A total of 26 devices were successfully implanted. In 4 patients, implantation could not be achieved. The remaining patients all completed the study. Mean procedure time was 35 mins range of 12 to for a successful implantation and 17 mins range of 5 to 99 for explantation.

There were no procedure related adverse events. Initial mean BMI was Mean excess weight loss after 3 months was Absolute change in BMI at 3 months was 5. Type 2 diabetes mellitus was present at baseline in 8 patients of the device group and improved in 7 patients during the study period lower glucose levels, HbA1c, and medication requirements.

The authors concluded that the EndoBarrier Gastrointestinal Liner is a feasible and safe non-invasive device with excellent short-term weight loss results. The device also has a significant positive effect on type 2 diabetes mellitus.

Moreover, they stated that long-term randomized and sham studies for weight loss and treatment of diabetes are necessary to determine the role of the device in the treatment of morbid obesity. Escalona et al evaluated safety, weight loss, and cardio-metabolic changes in obese subjects implanted with the DJBL for 1 year.

Morbidly obese subjects were enrolled in a single-arm, open-label, prospective trial and implanted with the DJBL.

Primary endpoints included safety and weight change from baseline to week Secondary endpoints included changes in waist circumference, blood pressure, lipids, glycemic control, and metabolic syndrome. Three subjects could not be implanted due to short duodenal bulb. There were no procedure-related complications and there were 15 early endoscopic removals. In the week completer population, total body weight change from baseline was There were also significant improvements in waist circumference, blood pressure, total and low-density lipoprotein cholesterol, triglycerides, and fasting glucose.

The authors concluded that the DJBL is safe when implanted for 1 year, and results in significant weight loss and improvements in cardio-metabolic risk factors.

They stated that these results suggested that this device may be suitable for the treatment of morbid obesity and its related comorbidities. Verdam et al stated that the prevalence of obesity is increasing worldwide.

Its primary treatment consists of lifestyle changes. Operations such as the placement of a gastric band or a gastric bypass can, however, lead to complications and necessitate secondary interventions.

In search of less invasive treatments, placement of the EndoBarrier duodenal jejunal bypass liner appears to be a promising, safe and effective method for facilitating weight loss. Concomitant positive effects on cardiovascular risk factors including diabetes type 2 were observed. The authors noted that a multi-center trial is currently underway to examine the mechanism behind these effects.

Mathus-Vliegen stated that the EndoBarrier is a unique concept that starts to ameliorate the symptoms of diabetes mellitus type 2, soon after positioning. Sufficient implant training is required, but problems can still occur e. The stability of the anchors and the tolerability of the device still leave much to be desired.

Only 7 studies on the EndoBarrier are available and these are mostly small in size, short-term and with limited follow-up, and many questions regarding the safety and long-term effects of the device remain. The author concluded that this calls for a large, long-term, randomized, placebo-controlled, double-blind trial.

Lessons should have been learned from the disastrous results with intra-gastric balloon implantation before commercializing another such product. Bolton et al stated that weight regain secondary to VBG pouch dilation is a typical referral for bariatric surgeons. A retrospective review was completed for patients with a previous VBG presenting with weight regain between to Complications following RYGB include: The median length of stay following RYGB was 6 days compared to 1.

The authors concluded that the findings of this study suggested that while RYGB revision may achieve greater weight loss, the complication rates and severity is discouraging. StomaphyX may be a safe alternative. Moreover, they stated that further technical modifications of the device and longer follow-up may clarify the role of this approach.

Goyal et al examined if endoluminal reduction of gastric pouch and stoma using StomaphyX results in sustained weight loss in patients who regain weight after gastric bypass. Retrospective chart review was performed on 59 post-gastric bypass patients who underwent revision of gastric pouch using StomaphyX from to Post-procedure weight at 1 week, 1 month, and 6 months follow-up as well as weight at the time of the review was recorded for each patient.

Average weight loss and excess body weight loss EBWL were 2. At the time of review, the average follow-up was 41 months, average weight loss was 1. Endoscopy in 12 patients at average 18 months follow-up showed no sustained reduction in pouch and stoma size. The authors concluded that StomaphyX resulted in weight loss that is not sustained on long-term follow-up.

Pouch and stoma tend to regain their pre-procedure size on follow-up. They stated that StomaphyX cannot be recommended as a weight loss strategy in post-gastric bypass patients who regain weight. There is currently no well-defined management protocol for this complication. Through systematic review, these investigators analyzed the results of endoscopic dilation in patients with stenosis, including complication and success rates.

The PubMed database was searched for relevant studies published each year from to , and 23 studies were identified for analysis. Only papers describing the treatment of anastomotic stricture after RYGB were included, and case-reports featuring less than 3 patients were excluded.

The mean age of the trial populations was Through-the-scope balloons were used in 16 studies Other complications were also reported: The authors concluded that endoscopic treatment of stenosis is safe and effective; however, further high-quality randomized controlled trials are needed to confirm these findings.

Thompson et al stated that weight regain or insufficient loss after RYGB is common. This is partially attributable to dilatation of the gastro-jejunostomy, which diminishes the restrictive capacity of RYGB.

Endoluminal interventions for GJ reduction are being explored as alternatives to revision surgery. These researchers performed a randomized, blinded, sham-controlled trial to evaluate weight loss after sutured transoral outlet reduction TORe.

Intra-operative performance, safety, weight loss, and clinical outcomes were assessed. Subjects who received TORe had a significantly greater mean percentage weight loss from baseline 3. As-treated analysis also showed greater mean percentage weight loss in the TORe group than controls 3. The groups had similar frequencies of adverse events.

These results were achieved using a superficial suction-based device; greater levels of weight loss could be achieved with newer, full-thickness suturing devices. These researchers stated that TORe is one approach to avoid weight regain; moreover, they noted that a longitudinal multi-disciplinary approach with dietary counseling and behavioral changes are needed for long-term results.

Jirapinyo et al evaluated the technical feasibility, safety, and early outcomes of a procedure using a commercially available endoscopic suturing device to reduce the diameter of the GJA.

An endoscopic suturing device was used to place sutures at the margin of the GJA in order to reduce its aperture. On chart review, clinical data were available at 3, 6, and 12 months. Average anastomosis diameter was The mean weight loss in successful cases was There were no major complications. The authors concluded that this case series demonstrated the technical feasibility, safety, and effectiveness of performing GJ reduction using a commercially available endoscopic suturing device.

They stated that this technique may represent an effective and minimally invasive option for the management of weight regain in patients with RYGB. Dakin and colleagues noted that weight recidivism after RYGB is a challenging problem for patients and bariatric surgeons alike.

Traditional operative strategies to combat weight regain are technically challenging and associated with a high morbidity rate. Endoluminal interventions are thus an attractive alternative that may offer a good combination of results coupled with lower peri-procedure risk that might one day provide a solution to this increasingly prevalent problem.

These investigators systematically reviewed the available literature on endoluminal procedures used to address weight regain after RYGB, with specific attention to the safety profile, effectiveness, cost, and current availability. This retrospective review focused only on endoluminal procedures that were performed for weight regain after RYGB, as opposed to primary endoluminal obesity procedures. Several methods of endoluminal intervention for weight regain were reviewed, ranging from injection of inert substances to suturing and clipping devices.

The literature review showed the procedures on the whole to be well-tolerated with limited effectiveness. The majority of the literature was limited to small case-series. Most of the reviewed devices were no longer commercially available. The authors concluded that endoluminal therapy represents an intriguing strategy for weight regain after RYGB. However, the current and future technologies must be rigorously studied and improved such that they offer durable, repeatable, cost-effective solutions.

Pauli et al stated that despite advances in many areas of therapeutic endoscopy, the development of an effective endoscopic suturing device has been elusive. These researchers evaluated the safety and effectiveness of a suturing device to place and secure sutures within normal, in-vivo human colonic tissue prior to surgical resection.

Patients undergoing elective colectomy were enrolled in this treat-and-resect model. The OverStitch endoscopic suturing device Apollo Endosurgery, Austin, TX was used to place sutures in healthy colonic tissue during a min, time-limited period. Clinical and operative data were recorded. Seven sutures were successfully placed, incorporating a total of 10 tissue bites in a mean of On inspection of the explanted tissue, all sutures were found to be located sub-serosal no full thickness bites were taken.

The suture and cinch elements were judged to be effective in the majority of cases. One device-related issue did not inhibit the ability to oppose tissue or place the cinch.

There were no intra-operative or post-operative complications. The authors concluded that the OverStitch permitted safe and effective suturing in an in-vivo human colon model.

The sutures were placed at a consistent sub-serosal depth and at no point risked iatrogenic injury to adjacent structures. Technical issues with the device were infrequent and did not inhibit the ability to place sutures effectively.

This clinical trial is designed to study the Apollo OverStitch endoscopic suturing device that has already been approved by the FDA as an option for bariatric surgery revision without having to re-operate on the patient. The investigators believe that the endoscopic technique may be able to provide weight loss without having to re-operate on the patient. A total of 22 obese patients mean age of After dissecting the greater omentum and short gastric vessels, the gastric greater curvature plication with 2 rows of non-absorbable suture was performed under the guidance of a F bougie.

The data were collected during follow-up examinations performed at 1, 3, 6, and 12 months post-operatively. All procedures were performed laparoscopically.

The mean operative time was There were no deaths or post-operative major complications that needed re-operation. Decreases in the index for homeostasis model assessment of insulin resistance HOMA-IR and in insulin and glucose concentrations were observed. The authors concluded that the early outcomes of LGCP as a novel treatment for obese Chinese with a relatively low BMI were satisfactory with respect to the effectiveness and low incidence of major complications. They stated that additional long-term follow-up and prospective, comparative trials are still needed.

In a pilot study, Legner et al examined the effectiveness of transoral mucosal excision sutured gastroplasty for the treatment of gastro-esophageal reflux disease GERD and obesity. Obese patients BMI greater than 35 underwent a psychological evaluation and tests for co-morbidities. Under general anesthesia, a procedure was performed at the gastro-esophageal junction including mucosal excision, suturing of the excision beds for apposition, and suture knotting.

One patient with micrognathia could not undergo the required pre-procedural passage of a 60 F dilator and was excluded. The first 2 GERD patients had incomplete procedures due to instrument malfunction. The subsequent 5 subjects had a successfully completed procedure.

Four patients were treated for obesity and had an average excess weight loss of Of these patients, 1 had an 8-mm outlet at the end of the procedure recognized on video review -- a correctable error -- and another vomited multiple times post-operatively and loosened the gastroplasty sutures. The treated GERD patient had resolution of reflux-related symptoms and is off all anti-secretory medications at 2-year follow-up.

Her DeMeester score was 8. The authors concluded that the initial human clinical experience showed promising results for effective and safe GERD and obesity therapy. Georgiadou et al summarized the available evidence about the efficacy and safety of laparoscopic mini-gastric bypass LMGB. These investigators performed a systematic search in the literature, and PubMed and reference lists were scrutinized end-of-search date: For the assessment of the eligible articles, the Newcastle-Ottawa quality assessment scale was used.

A total of 10 eligible studies were included in this study, reporting data on 4, patients. Moreover, resolution or improvement in all major associated medical illnesses and improvement in overall Gastrointestinal Quality of Life Index score were recorded.

Major bleeding and anastomotic ulcer were the most commonly reported complications. The latter were conducted due to a variety of medical reasons such as inadequate or excessive weight loss, malnutrition, and upper gastro-intestinal bleeding.

The authors concluded that LMGB represents an effective bariatric procedure; its safety and minimal post-operative morbidity seem remarkable. They stated that randomized comparative studies seem mandatory for the further evaluation of LMGB. These researchers included 10 studies with a total of patients that primarily investigated a prototype of the DJBL. In high-grade obese patients, short-term excess weight loss was observed.

For the remaining patient-relevant endpoints and patient populations, evidence was either not available or ambiguous. The authors do not yet recommend the device for routine use.

Parikh et al compared bariatric surgery versus intensive medical weight management MWM in patients with type 2 diabetes mellitus T2DM who do not meet current National Institutes of Health criteria for bariatric surgery and examined if the soluble form of receptor for advanced glycation end products sRAGE is a biomarker to identify patients most likely to benefit from surgery.

A total of 57 patients with T2DM and BMI 30 to 35, who otherwise met the criteria for bariatric surgery were randomized to MWM versus surgery bypass, sleeve or band, based on patient preference. The primary outcomes assessed at 6 months were change in homeostatic model of insulin resistance HOMA-IR and diabetes remission.

The surgery group lost more weight 7. There were no mortalities. Baseline sRAGE may predict patients most likely to benefit from surgery. However, they stated that these findings need to be confirmed with larger studies. Sjostrom et al noted that short-term studies showed that bariatric surgery causes remission of diabetes. The long-term outcomes for remission and diabetes-related complications are not known. These researchers determined the long-term diabetes remission rates and the cumulative incidence of microvascular and macrovascular diabetes complications after bariatric surgery.

The Swedish Obese Subjects SOS is a prospective matched cohort study conducted at 25 surgical departments and primary health care centers in Sweden.

Of patients recruited between September 1, , and January 31, , of 2, control patients and of 2, surgery patients had type-2 diabetes at baseline. For the current analysis, diabetes status was determined at SOS health examinations until May 22, Information on diabetes complications was obtained from national health registers until December 31, For diabetes assessment, the median follow-up time was 10 years interquartile range [IQR], 2 to 15 and 10 years IQR, 10 to 15 in the control and surgery groups, respectively.

For diabetes complications, the median follow-up time was Main outcome measures were diabetes remission, relapse, and diabetes complications.

The diabetes remission rate 2 years after surgery was At 15 years, the diabetes remission rates decreased to 6. With long-term follow-up, the cumulative incidence of microvascular complications was Macrovascular complications were observed in The authors concluded that in this very long-term follow-up observational study of obese patients with type 2 diabetes, bariatric surgery was associated with more frequent diabetes remission and fewer complications than usual care.

Moreover, they stated that these findings require confirmation in randomized trials. Yu et al evaluated the long-term effects of bariatric surgery on type 2 diabetic patients. Randomized controlled trials RCTs and cohort studies of bariatric surgery for diabetes patients that reported data with more than 2 years of follow-up were included.

They used rigorous methods to screen studies for eligibility and collected data using standardized forms.

Where applicable, these investigators pooled data by meta-analyses. A total of 26 studies, including 2 RCTs and 24 cohort studies that enrolled 7, patients, proved eligible. Despite the differences in the design, those studies consistently showed that bariatric surgery offered better treatment outcomes than non-surgical options.

Pooling of cohort studies showed that BMI decreased by Diabetes was improved or in remission in The authors noted that bariatric surgery may achieve sustained weight loss, glucose control, and diabetes remission. Moreover, they stated that large randomized trials with long-term follow-up are warranted to demonstrate the effect on outcomes important to patients e.

There are a growing number of unblinded trials comparing bariatric surgery with medical therapy for the treatment of type 2 diabetes …. Despite these impressive metabolic results, concerns remain about acute post-operative complications including need for re-operations and re-hospitalizations and rare, but potentially severe, adverse events; the long-term success rates in maintaining weight loss; and the reproducibility of the results in patients with an extensive history of diabetes or with a different surgical team.

Some weight regain is typical within two to three years of bariatric procedures, and different bariatric procedures result in different levels of weight loss and corresponding reductions in glycemia.

The electrical impulses are purported to block vagus nerve signals in the abdominal region, inhibiting gastric motility and increasing satiety. However, there is currently insufficient evidence to support the VBLOC vagal nerve blocking therapy for the treatment of obesity. In an open-label, 3-center study, Camilleri et al evaluated the effects of vagal blocking VBLOC therapy on excess weight loss EWL , safety, dietary intake, and vagal function. Electrodes were implanted laparoscopically on both vagi near the esophago-gastric junction to provide electrical block.

Patients were followed for 6 months for body weight, safety, electrocardiogram, dietary intake, satiation, satiety, and plasma pancreatic polypeptide PP response to sham feeding. To specifically assess device effects alone, no diet or exercise programs were instituted.