Clinical Question: by what means e...

Clinical Question: by what means effective is bariatric surgery in the extended term?

Setting: Population-based

application of mind Design: Nonrandomized controlled trial

Allocation: Unconcealed

Synopsis: According to the ensues of a recent meta-analysis, bariatric surgery favorably treats many of the comorbid conditions associated with obesity. However, greatest in number of the studies were of les than brace years' duration (Buchwald H, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA October 13 2004;292:1724-37)

In the circulating study, Swedish researchers invited patients to experience bariatric surgery. Of 8,966 patients who met age and weight-for-height criteria, 4047 eventually underwent surgery at individual of 25 centers. The decision to have surgery was made by the agency of the patient after consultation with a surgeon; patients choosing not to have surgery became part of a bridle pool. The type of surgery was determined by the agency of the physicians at the center At the time of surgery each patient was matched with a patient from the superintendence pool based on age, obesity, comorbidities, and other clinical factors. Patients were then followed for up to 10 years. Thus, this was not a randomized trial.

The operative mortality rate was 025 percent and the rate of serious surgical complications was 13 percent Weight los peaked after united year in the surgery collection (38 percent for gastric bypass, 27 percent for vertical banded gastroplasty, and 21 percent for banding). Weight los at sum of two units years was an average of 23 percent for the surgery disposes compared with a 0.1 percent weight gain in the curb group. After 10 years, weight los was les dramatic (25 16 and 13 percent for the three different procedures) nevertheless still better than the 16 percent gain in the bridle group.

At brace and 10 years, surgical patients were significantly more likely than ascendency patients to have recovered from diabetes (36 versus 13 percent) hypertension (19 versus 11 percent) and hypertriglyceridemia (46 versus 24 percent) There was no difference at sum of two units or 10 years in the rate of convalescence from elevated total cholesterol. The principally important out-come, however, was all-cause mortality. The authors did not give these flows because the study is continuing beneath the supervision of a data-monitoring committee, which hints that there are no important differences among the arranges so far.

Bottom Line: Bariatric surgery helps patients fail to win weight and reverse diabetes, hyperten-sion, and a hyperlipidemias. It is still unknown whether it affects all-cause mortality. (Level of Evidence: 2c)

application of mind Reference: Sjostrom L, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery N Engl J M December 23 2004;351:2683-93

Used with permission from Ebell M Bariatric surgery effective for wt los and DM HTN at 10 yr Accessed online January 25 2005 at: http://www.InfoPOEMs.com.

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