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Short and long term results of gastric bypass

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Short and long term results of gastric bypass

  1. 1. Short and Long-Term Results of Gastric Bypass<br />Samer G. Mattar, MD, FRCS, FACS<br />Associate Professor of Surgery<br />Indiana University<br />
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  3. 3. BOLD <br />57,918 patients<br />> 800 surgeons in > 450 facilities.<br />31,668 patients (54.7%) had gastric bypass.<br />Complication rate = 14.9%<br />All mortality rate = 0.14%<br />DeMaria EJ et al. SurgObesRelDis 2010;6(4):347-55<br />
  4. 4. Long-Term Weight Loss for Gastric Bypass<br />Mean BMI: 52<br />Follow-up >90%<br />Nadir Wt. Loss: 65% EWL<br />Mean Wt. Loss at 14 years: 49% EWL<br />
  5. 5. COMPARISON OF BARIATRIC OPERATIONS<br />n = 22,094 patients; 2738 citations 1990-2002<br />Buchwald, et al JAMA 2004;292:1724-1737<br />Brethauer et al. SOARD 2009 (4): 469-475<br />
  6. 6. LONG-TERM SURVIVAL CANADA<br />Rel. Risk = 0.11 (.04-.27)<br />89% reduction in risk ofdeath over 5 years<br />Christou et al. Ann Surg 2004;240:416-424<br />
  7. 7. Results:Five Year Comorbidity<br />*<br />*<br />*<br />*<br />*<br />*p<0.001<br />Christou et al. Ann Surg 2004;240:416-424<br />
  8. 8. Results:Five Year Comorbidity<br />*<br />*<br />*<br />Christou et al. Ann Surg 2004;240:416-424<br />
  9. 9. Swedish Obese Subjects Study SOS<br />Prospective matched controlled study.<br />641 surgically treated subjects and 627 obese controls.<br />10 year follow up.<br />Surgical therapies consisted of:<br /> - fixed or variable banding<br /> - vertical banded gastroplasty<br /> - gastric bypass<br />Sjostrom et al, NEJM 2004; 351(26): 2683-93<br />
  10. 10. 10 years results of Bariatric Surgery<br />n=1268 (641 surgery)<br />Sjöström et al. N Eng J M Dec 2004;351(26):2751-3 <br />
  11. 11. EFFECT OF GBP ONTYPE 2 DIABETES MELLITUS*<br /> Before After Operation Operation<br />Glucose Impaired 53 0 <br />Type 2 Diabetes 88 2<br /> Receiving Insulin 20 10<br /> Oral Agent 13 0 <br />Pories WJ et al. Ann Surg 1995;222:339-50<br />
  12. 12. Observations in DM2<br />Early surgical intervention is the most effective treatment for T2DM <br />Results in significant reduction in medication requirement <br />Resolution dependent on preoperative duration and severity of T2DM, and on ultimate weight loss<br />
  13. 13. Conclusions<br />Gastric bypass continues to be the dominant weight loss operation in the US.<br />Center of Excellent data demonstrates a morbidity rate of 14% and an overall mortality rate of 0.14%.<br />The effects of gastric bypass are durable.<br />Gastric bypass results in 89% reduction in risk of early death.<br />Early surgical intervention is the most effective treatment for DM2<br />
  14. 14. Thank you!<br />

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