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Background: Idiopathic Intracranial Hypertension (IIH) is a rare disorder, linked to severe obesity. The study aimed to evaluate long-term effects of metabolic and bariatric surgery (MBS) on IIH outcomes. Methods: Retrospective study of patients with IIH and severe obesity who underwent MBS. Data were retrieved from prospectively maintained databases of two bariatric surgeons. Results: Thirteen patients were included, of them 12 women. Median age was 36 (interquartile range;IQR 21,47) years and body mass index (BMI) was 40.4 (IQR 37.8,41.8) kg/m2. All patients had visual disturbances,12/13 had headaches, and 6/13 had tinnitus. The mean opening pressure on lumbar puncture was 45 cmH2O, and 11/13 patients had papilledema. Medications for IIH were consumed by 11/13 patients, and 2/13 patients had prior surgical intervention for IIH. MBS types included sleeve gastrectomy (n=7), adjustable gastric banding (n=2), roux-en-y gastric bypass (n=2), one anastomosis gastric bypass (n=1), duodenal switch (n=1). At a median follow-up of 10 years (IQR 8,13), the median BMI and total weight loss were 29.7 kg/m2 and 27%, respectively. Remission of symptoms was achieved in 9/13 patients. Conclusions: MBS results in significant and sustainable weight loss, with subsequent resolution or improvement of IIH. It may be considered as a preventive measure for IIH in patients with severe obesity. [ABSTRACT FROM AUTHOR]

Background: Vitamin D deficiency is a common consequence of bariatric surgery (BS). However, few studies have evaluated influential factors and to date there are no studies investigating individual ultraviolet B (UVB) radiation levels in BS patients. This study aimed to evaluate vitamin D deficiency and its associated factors, including UVB radiation, in Roux-Y gastric bypass (RYGB) patients. Methods: This study included 104 adults (90.4% female) at least 5 years after RYGB. Patients underwent surgery in private hospitals (Private; n = 47) or in two public hospitals, one with ongoing outpatient care (Active; n = 17), and the other with discontinued service for BS (Discontinued; n = 40). 25-hydroxyvitamin D (25(OH)D) concentrations were analyzed by chemiluminescence, individual UVB radiation levels by dosimeter badges. Vitamin D intake, anthropometric, skin phototype, sociodemographic and lifestyle patterns were also assessed. Results: Mean age was 49.6 ± 9.1 years and post-operative period 8.7 ± 2.2 years. The prevalence of 25(OH)D deficiency and insufficiency was 25.0% and 51.9% respectively. 25(OH)D concentration differed among the hospitals (private = 26.2 ± 8.5; active = 28.7 ± 11.4; discontinued = 23.5 ± 6.5 ng/mL; p = 0.038). A total of 26.2% of the variance observed in 25(OH)D concentrations was explained by daily UVB radiation levels (β = 0.224; p = 0.032) and vitamin D intake (β = 0.431; p < 0.001), controlling for age and BMI. Conclusion: A quarter of the evaluated patients presented vitamin D deficiency, which was associated with the discontinuation of the health care, higher BMI, lower vitamin D intake, and lower individual UVB radiation levels. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes is considered to be a surgically correctable illness. As glycemic control begins soon after surgery, the cessation of anti-diabetic medications is early. Patients believe that their diabetes has been "cured" and the need for blood sugar monitoring is forgotten, leading to undiagnosed hyperglycemia and risk of diabetes-related complications. Aims: To study the effect of bariatric surgery on long-term glycemic control and identify the patients with undiagnosed hyperglycemia. Methods: All patients with type 2 diabetes who underwent bariatric surgery at our center from January 2012 to December 2013 were included in the study. For each patient, demographic, preoperative, and postoperative data were retrospectively reviewed. Results: Out of the total 119 patients with diabetes, 91 patients underwent sleeve gastrectomy and 28 underwent Roux-en-Y gastric bypass. Diabetes status at 7 years of follow-up was possible in 53 (44.5%) patients: 44 (48.4%) in SG and 9 (32.2%) in RYGB groups. Overall, complete remission at 7 years was seen in 17 (32.1%) patients and partial remission in 12 (22.6%) patients. Amongst non-remitters (n = 24, 45.3%), 7 (13.2%) patients were on medications with good glycemic control (A1C < 6.5) while 8 (15.1%) patients had poor control (A1C > 6.5) despite ongoing medications. Additionally, 9 (17%) patients had poor glycemic control (A1C > 6.5) and were not receiving any anti-diabetic medications. Patients in whom follow-up A1C was unavailable and their diabetes status remain unknown were 66 (55.5%) at 7 years. Conclusion: Our study clearly demonstrates high risk of undiagnosed hyperglycemia. Regular long-term follow-up in diabetic patients is even more desirable than amongst patients undergoing bariatric surgery for weight loss alone. [ABSTRACT FROM AUTHOR]

Background: Grazing behavior is common in patients undergoing bariatric surgery (BS); however, little is known about grazing behavior in operated patients in the long term. We aimed to estimate grazing frequency and its association with weight loss and surgery response in patients who had undergone BS. Methods: This cross-sectional study included 109 patients who had undergone Roux-en-Y gastric bypass at least 5 years previously. They answered questions about socioeconomic factors, surgical information, and adherence to treatment/follow-up. The Rep(eat) questionnaire was used for grazing assessment. Student's t-test and Pearson's chi-square test were used to evaluate differences between groups. Analysis of covariance and partial correlation were used to investigate grazing behavior, and weight loss outcomes were controlled for the elapsed time since BS, healthcare service type, current psychologist care status, and the presence of a constriction ring. Results: The mean elapsed time since BS was 9.97 ± 2.39 years. Patients with grazing behavior (67%) comprised fewer surgery responders (p = 0.019), had lower total (%TWL, p = 0.005) and excess weight loss (%EWL, p = 0.029), and received less psychological counseling (45.5% vs. 54.5%, p = 0.042). Correlations were found between the presence of grazing and its subtypes and %EWL and %TWL (T = − 0.382, T = − 0.361, p < 0.001; compulsive grazing: T = − 0.358, T = − 0.342, p < 0.001, p = 0.001; non-compulsive grazing: T = − 0.333, T = − 0.311, p = 0.001, p = 0.003). No significant difference between patients with and without grazing behavior was found for previous/current diagnoses of psychological diseases or dietitian counseling. Conclusion: Grazing behavior is common in the long-term among patients who have undergone BS and is negatively related to weight loss parameters. [ABSTRACT FROM AUTHOR]

Background: The most appropriate procedure for the treatment of super obesity (BMI > 50 kg/m2) is unknown. We aimed to evaluate the safety, long-term (> 5 years) weight loss, and adverse events between three commonly performed procedures, sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB) in super-obese patients. Methods: Between January 2002 and December 2015, 498 successive patients with super morbid obesity (BMI > 50), who underwent SG or RYGB or OAGB, were recruited. Surgical outcome, weight loss, resolution of co-morbidities, and late complications were followed and compared between the 3 groups. All data derived from a prospective bariatric database and a retrospective analysis was conducted. Results: The average patient age was 32.1 ± 10.4 years, with a mean body mass index (BMI) of 56.0 ± 6.7 kg/m2. Of them, 190 (38.9%) underwent SG, 62 (12.4%) RYGB, and 246 (49.4%) OAGB. There was no difference in basic characters between the 3 groups except SG had fewer diabetic patients. RYGB group had higher intraoperative blood loss, longer operating time, and hospital stay than the other 2 groups. RYGB had a higher 30-days post-operative major complication rate (4.8%) than SG (0.5%) and OAGB (0.8%). The follow-up rate at 1 and 5 years was 89.4% and 52.0%. At post-operative 5 years, OAGB had a higher total weight loss (40.8%) than SG (35.1%), but not RYGB (37.2%). SG had a lower remission rate in dyslipidemia comparing to OAGB and RYGB, but T2DM remission rate was no different between the groups. The overall revision rate is 5.4% (27/498) of the whole group, and SG had a lower revision rate (2.6%) than RYGB (8.1%) and OAGB (6.9%). Conclusion: SG is an effective and durable primary bariatric procedure for the treatment of super obesity and metabolic disorders. OAGB had a similar operation risk to SG but resulted in a better weight loss than SG. [ABSTRACT FROM AUTHOR]

Background: The long-term effectiveness of Roux-en-Y gastric bypass (RYGB) and single-anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S) is unknown. Purpose: Compare the long-term outcomes. Setting: Single private institute, USA. Materials and Methods: Data from 1254 patients who underwent primary RYGB or SADI-S were used for a retrospective matched cohort. Data were obtained by matching every RYGB patient to a SADI-S patient of the same sex, body mass index (BMI), and weight. Only patients out 5 years and had at least one > 5-year follow-up visit were included. Results: The matched cohort included 61 RYGB and 61 SADI-S patients. There was no statistical, demographic difference between the two groups. At 5 years, a 100% follow-up was available in each group. The intraoperative outcomes were significantly better with SADI-S. The 30-day readmission, reoperation, emergency department (ED) visits, and complication rates were statistically similar between the two groups. The long-term complication rates, Clavien-Dindo grade IIIb complications, and number of patients with more than one complication were significantly lower with SADI-S. Weight loss was significantly greater in the SADI-S group at 5 years. The long-term weight-loss failure rate was significantly higher in the RYGB group. The SADI-S procedure was associated with fewer reintervention through 6 years (14.7% patients vs. 39.3% patients, p = 0.001). Conversion or reversal of the procedure was required only in the RYGB group. There also was no significant difference in nutritional outcomes between the two procedures. Conclusions: This study showed that problems, including long-term complications, reinterventions, weight-loss failure, and conversion, were more often associated with RYGB than with SADI-S. The SADI-S may be considered one of the viable alternatives to RYGB. [ABSTRACT FROM AUTHOR]

Purpose: Laparoscopic Roux-en-Y gastric bypass (RYGB) is the oldest and most widely performed bariatric surgery worldwide. There is, however, a scarcity of mid- to long-term data of RYGB, especially from the Indian subcontinent. Materials and Methods: The study was a single-center, retrospective analysis from patients who underwent RYGB between January 2009 and November 2014 from a tertiary care center in India. Percent of total weight loss (%TWL) was taken as the primary outcome of the study. Secondary outcomes included type 2 diabetes mellitus (T2DM) remission, comorbidity resolution, revisional surgeries, and complications related to RYGB at 1 year, at 3 years, and during the long term, following surgery. Postoperative visits took place at 1 and 3 years, while the long-term outcome was at median 8.3 years (range 5.4–11.2 years), with a follow-up of 92.4% (488/528), 80.5% (424/527) and 69.5% (363/522), respectively. Results: Out of 528 patients studied, 56% were females. The mean body mass index (BMI) was 40.6 ± 6.9 kg/m2. The %TWL in the long-term follow-up was 21.8 ± 11.3%. T2DM remission rates at 1 year, at 3 years, and during the long term were 84.5%, 70.0%, and 60.0%, respectively. Preoperative HBA1c (p = 0.002) and insulin usage (p = 0.016) had a significant predictive effect on T2DM remission. Gastroesophageal reflux disease (GERD) improved significantly (p < 0.001). Early (< 30 days) and late (> 30 days) complications were observed in 2.3% and 4.3% of the patients, respectively. Conclusion: Weight loss during mid to long-term follow-up was maintained in the majority of the patients after RYGB. However, a small proportion had significant weight regain in the long term. T2DM, GERD, and other comorbidities were well improved after RYGB. [ABSTRACT FROM AUTHOR]

Purpose: Marginal ulcer (MU) is well-known complication in bariatric surgery. Several studies are available in Roux-en-Y gastric bypass (RYGBP), while data on the incidence in duodenal switch (DS) is limited. We aimed to compare the incidence of MU between DS and RYGBP in a well-defined cohort and to identify associative factors. Methods: A cohort of 732 patients with BMI ≥ 48 who had undergone primary DS or RYGBP during 2008–2018 received a questionnaire concerning ulcers, PPI therapy, and smoking habits; hereafter, patient charts were reviewed. Incidence rates (IRs) for MU were calculated in our survey and on previous registered data in the national quality register for bariatric surgery (SOReg). A multivariate regression analysis was performed to identify predictive risk factors for MU. Results: After a mean follow-up of 6.1 years, 472 (64%) patients responded (47 ± 11 years old, 65% women and 42% DS). Of 41 MUs identified, 23 were endoscopically verified. Gastrointestinal bleeding, abdominal pain, and dysphagia were the most common symptoms. IR for MU was 1.4% (DS 1.3% and RYGBP 1.5%) per patient-year, compared with 0.9% according to SOReg-data. Persisting PPI treatment was seen in about three quarter of former MU patients (OR 11.2 [3.6–34.7], p < 0.001), but no other associative factors were found. Conclusion: The overall risk for MU was low, about 1% per patient-year, without difference between DS and RYGBP. Ongoing PPI treatment was frequent in many former MU patients. This study on MU after DS provides reassuring results for future bariatric surgery candidates. [ABSTRACT FROM AUTHOR]

Background: One-anastomosis gastric bypass (OAGB) has gradually gained in popularity. Evidence of the validity of the technique and the quality of life in the longer term is scarce. The aim of this study was to retrospectively evaluate the longitudinal (≥ 5 years) safety, weight-loss efficacy, comorbid disease improvement, and quality of life of patients following OAGB. Methods: Data from patients who underwent OAGB from January 2009 to December 2011 were retrospectively reviewed. Preoperative clinical characteristics and data through 8 years were analyzed. Results: A total of 163 patients completed 5 to 8 years of follow-up with a mean age of 41 ± 11.4 years (22–65). Ninety-four patients (57.6%) had undergone prior bariatric surgery (gastric band). Mean body mass index (BMI, kg/m2) at the time of OAGB was 41.2 ± 6.5 (range 30.1–50.6). Twenty-one patients (13.0%) suffered from type 2 diabetes mellitus (T2DM), 59 (36.2%) hypertension, 31 osteoarthritis (19.0%), and 24 had obstructive sleep apnea (14.7%). At 5, 6, 7, and 8 years of follow-up, respective mean BMI reduction was 12.6 (n = 163), 11.8 (n = 100), 10.7 (n = 82), and 8.8 (n = 40). Respective mean excess weight loss was 81.8 ± 23.6%, 75.9 ± 20.8%, 69.1 ± 20.4%, and 62.3 ± 23.4%. All obesity-related comorbidities decreased significantly at follow-up time points. Five patients (3%) underwent laparoscopic reoperation within 90 days after surgery. Incidence of recurrent reflux was 14.0%. At a mean follow-up of 92 months (76–111), improved or greatly improved quality of life was reported by 86.0% of patients. Conclusion: OAGB provided very good weight loss, comorbidity improvement, and quality of life at follow-up of ≥ 5 years. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed metabolic surgery worldwide. There are few mid- to long-term studies for LSG, especially from the Indian subcontinent. Objective: The primary outcome of the study was percent total weight loss (%TWL), and secondary outcomes included type 2 diabetes mellitus remission (T2DM) rates, comorbidity resolution rates, revisional surgeries, and complications related to LSG, 3 and 5 years after surgery. Method: The study was a single-center, retrospective analysis from patients who underwent primary as well as revisional LSG between January 2012 and December 2013 from a tertiary care center in India. We included patients who completed a minimum follow-up of 5 years. Details of the patients were collected from outpatient and inpatient case sheet records, during their follow-up. Results: Out of a total of 284 patients, 57% were females. Mean baseline body mass index (BMI) was 44.9 ± 7.9 kg/m2. The diabetic population comprised 14.8% of the total patients. Mean %TWL at 5 years was 26.0 ± 9.9%. T2DM remission at 1, 3, and 5 years were 78.5%, 71.4%, and 66.6%, respectively. Preoperative BMI (p = 0.02), glycosylated hemoglobin (HbA1c) (p = 0.04), duration of diabetes in years (p = 0.04), and preoperative insulin usage (p = 0.04) were the preoperative predictors for T2DM remission. Early (< 30 days) and late (> 30 days) complications were seen in 4.5% and 0.7% of the population, respectively. Conclusion: Weight loss after LSG was maintained in the majority of the patients, while a small proportion has significant weight regain at 5 years. T2DM resolution and other comorbidity resolutions were well supported after LSG. [ABSTRACT FROM AUTHOR]

Obesity can negatively influence walking cadence, reducing the overall intensity of daily activities and increasing the risk of weight gain. Purpose: Objectively describe the walking cadence of individuals' long-term post-bariatric surgery. Methods: Fifty-eight participants, 51.2 ± 8.9 years old, with a BMI of 34.6 ± 10.1 kg/m2, 10.0 ± 3.1 years post-surgery wore an activPAL accelerometer for 7 consecutive days. Data was analyzed using participants' current BMI, dichotomized by obesity status, < or ≥ 30 kg/m2. Results: On average, participants walked 5124 ± 2549 steps/day on weekdays and 6097 ± 2786 steps/day on weekend days (p =.003). Participants spent the majority (75%) of their daily steps at a slow-walking average cadence (non-obese: week = 65.3 ± 5.0 steps/min and weekend = 63.8 ± 6.7 steps/min; obese: week = 67.8 ± 8.2 steps/min and weekend = 63.3 ± 6.9 steps/min), with no difference between groups for week or weekend days (p =.153 and.774). The cadence of participants with obesity was significantly lower on weekends compared to weekdays for walking events > 30 s (p =.002) and > 60 s (p =.008) in duration. Weekday cadence of participants without obesity was similar to weekend day cadence across all walking event durations. The majority of walking events occurred below 30 s in duration for all participants. Conclusions: Long-term post-bariatric surgery, movement occurs in short duration bouts at a slow-walking cadence for the majority of movement. Individuals without obesity had similar movement patterns from week to weekend days while participants with obesity significantly lowered their cadence on weekend days. [ABSTRACT FROM AUTHOR]

Introduction: Durability is a key requirement for the broad acceptance of bariatric surgery. We report on durability at and beyond 10 years with a systematic review and meta-analysis of all reports providing data at 10 or more years and a single-centre study of laparoscopic adjustable gastric banding (LAGB) with 20 years of follow-up.Methods: Systematic review with meta-analysis was performed on all eligble reports containing 10 or more years of follow-up data on weight loss after bariatric surgery. In addition, a prospective cohort study of LAGB patients measuring weight loss and reoperation at up to 20 years is presented.Results: Systematic review identified 57 datasets of which 33 were eligible for meta-analysis. Weighted means of the percentage of excess weight loss (%EWL) were calculated for all papers included in the systematic review. Eighteen reports of gastric bypass showed a weighted mean of 56.7%EWL, 17 reports of LAGB showed 45.9%EWL, 9 reports of biliopancreatic bypass +/− duodenal switch showed 74.1%EWL and 2 reports of sleeve gastrectomy showed 58.3%EWL. Meta-analyses of eligible studies demonstrated comparable results. Reoperations were common in all groups. At a single centre, 8378 LAGB patients were followed for up to 20 years with an overall follow-up rate of 54%. No surgical deaths occurred. Weight loss at 20 years (N = 35) was 30.1 kg, 48.9%EWL and 22.2% total weight loss (%TWL). Reoperation rate was initially high but reduced markedly with improved band and surgical and aftercare techniques.Conclusion: All current procedures are associated with substantial and durable weight loss. More long-term data are needed for one-anastomosis gastric bypass and sleeve gastrectomy. Reoperation is likely to remain common across all procedures. [ABSTRACT FROM AUTHOR]

Background: Single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) is a modification of Roux-en-Y duodenal switch (RYDS). Long-term data on this operation is lacking in the literature. We reviewed our mid-term data of this RYDS modification.Purpose: To analyze the outcomes with SADI-S at 4 years.Methods: Data from patients who underwent a primary SADI-S procedure performed by three surgeons at a single institution from June 2013 through February 2018 were retrospectively reviewed. All revision bariatric surgeries were excluded. Regression analyses were performed for all follow-up weight loss data.Results: There were 437 patients in our database. The pre-operative mean body mass index (BMI) was 49.8 ± 8.8 kg/m2. The 30-day complication rate was 7.7%. The 30-day readmission, reoperation, and mortality rates were 1.8, 1.3, and 0.2%, respectively. The long-term complication rate was 10.9%. Seventy-nine patients were 4 years post SADI-S surgery and follow-up was possible for 44 patients (55.7%). At 4 years, patients had an average change in BMI of 18.1 ± 6 units with an excess weight loss (EWL) of 85.7 ± 27.3%. At 4 years, 97.6% patients were able to maintain HbA1c < 6% with or without the use of diabetic medication. There was a statistically significant difference between most of the pre-operative and post-operative nutritional data.Conclusions: SADI-S is a safe and effective procedure in both short- and mid-term data points. Diabetes resolution and weight loss appear similar to traditional RYDS and better than RYGB. [ABSTRACT FROM AUTHOR]

Background: The C3 complement component (C3c) is increasingly recognized as a cardiometabolic risk factor, but how it is affected after weight loss through gastric bypass is a question yet to be answered. Methods: A total of 66 obese patients underwent laparoscopic gastric bypass. Anthropometric parameters, total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc), glucose, insulin, HOMA-IR, liver enzymes, high-sensitivity C-reactive protein (hsCRP), and C3c levels were evaluated at baseline and at 1 and 5 years post-surgery. Results: All anthropometric and biochemical parameters improved significantly after surgery, although a deterioration was detected with respect to the percentage of excess of weight loss, insulin, TC, LDLc, and lactate dehydrogenase 5 years post-surgery. Despite this, a remission rate of 84 % was observed in the presence of metabolic syndrome after 5 years follow-up. hsCRP and C3c were reduced significantly after surgery and maintained throughout the experimental period. In addition, C3c was correlated with BMI and insulin at all time points. The multivariate regression model, in which C3c was a dependent variable, revealed that aspartate aminotransferase and BMI were independent variables at baseline, alkaline phosphatase and insulin were independent at 1 year post-surgery, and insulin, BMI, and TC were independent at 5 years post-surgery. Conclusions: C3c may be a marker of the chronic inflammatory process underlying insulin resistance. Its association with BMI and liver enzymes supports a major role in metabolic activity, although future research is needed to clarify the nature of the molecular mechanisms involved and the physiological significance of these findings. [ABSTRACT FROM AUTHOR]

Background: Despite some reports about the long-term metabolic outcomes after laparoscopic adjustable gastric banding (LAGB) in the Western populations, there are few reports on the Asian population whose body size and fat distribution are different. Therefore, this study was conducted to evaluate the medium-term effects of LAGB on weight loss and metabolic outcomes of obese patients with different body mass index (BMI) in China. Methods: A retrospective study was performed to review the 5-year follow-up data of 56 patients (18 males, 38 females) who received LAGB from November 2003 to May 2013 at the Shanghai Changhai Hospital. The patients were evaluated at years 1, 3, and 5 after operation in the outpatient clinic, and the weight loss, metabolic parameters, and remission of comorbidities were measured. Results: The 56 patients preoperatively had BMI of 37.4 ± 6.0 kg/m, with BMI < 35 kg/m in 19 patients (BMI <35 kg/m group), and BMI ≥ 35 kg/m in 37 patients (BMI ≥ 35 kg/m group). The percentages of excess weight loss (%EWL) of the BMI < 35 kg/m group at years 1, 3, and 5 were 65.2, 65.6, and 65.7 %, respectively, indicating the majority of metabolic parameters were significantly improved ( P < 0.05). However, in the BMI ≥ 35 kg/m group, the %EWL were 37.9, 34.8, and 26.5 %, respectively, except at year 1 when the metabolic parameters improved significantly ( P < 0.05), those at year 3 and year 5 did not significantly improve compared with the preoperative levels. Similar results were observed in the improvement of comorbidities. Conclusions: Relatively low medium-term weight loss, metabolic improvement, and resolution or remission of obesity-related comorbidities and high reoperation rate were observed in our population of patients with BMI ≥ 35 kg/m who underwent LAGB. [ABSTRACT FROM AUTHOR]

Surgical interventions have proven to be more effective than other measures in the treatment of morbid obesity. The short-term outcomes of the various surgical interventions have been well documented in the literature, with fewer reports on long-term outcomes. The reported long-term outcome of the vertical-banded gastroplasty (VBG) is conflicting. The aim of the present study was to evaluate our long-term experience with VBG. A retrospective review of a prospectively maintained database was conducted. Records of patients who underwent VBG five or more years ago were retrieved. An analysis of the long-term weight changes and reported complications was conducted. The study included 150 patients: 43 males (29 %) and 107 females (71 %). Their mean age was 30 years old (12-53), and the mean body mass index (BMI) was 47 ± 8.4 kg/m. Patients were followed up for an average of 8 years (5-11). More than 60 % of patients had good long-term weight loss (EWL > 50 %). A significant negative correlation was found between the excess weight loss percent (EWL%) and the pre-operative BMI ( p < 0.05). The differences in EWL% between males and females were not significant ( p = 0.061). Nevertheless, the change in EWL% over time for both males and females was significant ( p = 0.004). Revision surgery was required in seven patients (4.7 %). Five patients had conversion of VBG to gastric bypass (3.3 %), while two patients (1.3 %) had reversal of the procedure. Late complications included mesh erosion in three cases, staple line dehiscence in two patients, and stomal stenosis in six patients. VBG could be a long-term effective intervention for the treatment of morbid obesity. Good selection is the cornerstone for long-term success. Late complication rate is acceptable after VBG. VBG is a specifically useful tool under stringent financial circumstances. [ABSTRACT FROM AUTHOR]

Background: Overweight and obesity independently increase cardiovascular risk, while even modest weight loss can result in clinically significant improvements in cardiovascular risk and reduce long-term mortality. Lowering the body mass index (BMI) threshold for bariatric surgery to those with moderate obesity might be one way to lower the burden of this disease. The aim of this study was to evaluate the efficacy and safety of laparoscopic adjustable silicone gastric banding (LAGB) in moderately obese subjects with or without obesity-related co-morbidities. Methods: Thirty-four patients with BMI between 30 and 35 kg/m (5 males/29 females, mean age 36 ± 10 years, mean preoperative weight 87.9 ± 7.1 kg, mean BMI 32.6 ± 1.6 kg/m and mean percentage excess weight 48.7 ± 9 %) who underwent LAGB via pars flaccida between June 1, 2002 and August 31, 2010 were included. Good response was defined as BMI <30 kg/m or percentage estimated weight loss (%EWL) >50. Poor response was defined as BMI >30 kg/m or %EWL less than 50 after a minimum of 1 year. Results: Mean weight, BMI and %EWL were recorded at 1, 3, 5 and 7 years and were 77.4 ± 7.6, 69.9 ± 10.8, 70.9 ± 9.3 and 73.3 ± 12.0 kg; 28.8 ± 2.9, 26.4 ± 3.2, 26.5 ± 3.4 and 27.4 ± 5.0 kg/m; and 36 ± 23, 46.1 ± 33.8, 58.6 ± 31.5 and 45 ± 57, respectively ( p < 0.01). Co-morbidities were diagnosed in 17/34 (50 %) patients at baseline and underwent remission or improvement in all cases after 1 year. Conclusions: LAGB in a safe and effective procedure in patients with a BMI <35 kg/m. [ABSTRACT FROM AUTHOR]