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Diseases associated with obesity such as type 2 diabetes mellitus (T2D), hypertension and dyslipidemia are common and defined as metabolic syndrome (MetS). The aim of this study was to evaluate long-term effects of laparoscopic Roux-en-Y gastric bypass (RYGB) in morbidly obese patients with MetS. Material and methods This was a retrospective study of data from a prospective database in a single center from 2005-2013 including 3795 RYGB operated obese patients. Metabolic syndrome was defined according to IDF Consensus Definition of Metabolic Syndrome from 2006. Results 79% of the patients were females, preoperative median age 42.4 years, and median body mass index (BMI, kg/m2) 40.9. MetS was diagnosed in 60% of the patients (2275/3795), with increased frequency in males, higher age, higher BMI and greater waist circumference. 27.5% of patients had impaired glucose metabolism, 40% hypertension and 30% dyslipidemia. Postoperative follow-up rate more than 5 years was 71% (595/839). 86.2% had resolution of MetS. After 5-9 years complete remission of T2D was achieved in 78%, hypertension in 51% and dyslipidemia in 89%. Mean excess BMI loss was significantly lower for patients with MetS (73.1%) compared to patients without MetS (75.6%) (p<0.01). Early complications (leakage/hemorrhage) occurred in 1.2% (48/3975) and internal hernia in 7.8% (310/3975). Presence of MetS did not increase complication rates. Conclusions RYGB in obese patients is associated with a significant and sustained reduction in excessive weight. 86.2% of patients with MetS achieved complete remission and complication rates are low. Early bariatric surgery should be considered in patients with obesity and concurrent MetS. [ABSTRACT FROM AUTHOR]

Obesity surgery is the most effective treatment for morbid obesity and one of the fastest growing areas in surgery. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the gold standard procedure in many countries. Optimization of the treatment process is important in order to keep the morbidity rate down and the cost of treatment as low as possible. Material and methods In September 2005 we established a single-center high-volume bariatric surgery program. Until February 2014, 8000 patients underwent LRYGB. Clinical pathways were established with focus on safety, fast track methodology and training of surgeons. Time recordings from all parts of the treatment as well as clinical outcome were prospectively registered. Results Time consumption for the total procedure in the operating theater was reduced from 102 minutes to 49 minutes (p<0.001). With only 7 minutes turnover between patients the total time for one patient has been reduced to 56 minutes, enabling us to perform six-eight operations in a single operating theater during ordinary daytime. Early complications rate was 2.3% and mean hospital stay was 1.7 days. We were able to double the patients treated in 2010 compared to 2007 with only 7% increase in staff. Five surgeons were trained during the period into fully qualified senior bariatric surgeons. Conclusions Multimodal evidence-based care within the fast-track methodology and routine time recordings was successful in order to increase the production volumes and reduce costs, without compromising the safety or quality for the patients. This kind of approach and experience may be transferred to other types of standardized surgery. [ABSTRACT FROM AUTHOR]