Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Interactive:
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Quiz
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Exams
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions

General Surgery


Answer 1
  1. Average 30-day mortality ranges from 0.1% to 1.1%. Surgeries for morbid obesity are rapidly increasing in the United States as the prevalence of obesity increases and surgical outcomes improve due to laproscopy. In a recent meta-analysis, the 30-day mortality rate was found to range from 0.1% for purely restrictive operations to 1.1% for biliopancreatic diversion or duodenal switch.1 Most comorbid conditions associated with morbid obesity, including obstructive sleep apnea, were either improved or resolved after surgery.1 Although many case series have supported the effectiveness of laparoscopic gastric bypass, only a few prospective randomized studies have compared it with the open approach. At 3-year follow-up, Puzziferri et al2 found a higher rate of postoperative incisional hernia after open surgery as compared with the laparoscopic approach (39% versus 5%;
    P < 0.01), but no differences were observed in the percentage of weight loss between the 2 groups (77% for laparoscopic versus 67% for open). Although biliopancreatic diversion is associated with a higher postoperative complication rate than purely restrictive operations, the associated 1.1% average postoperative mortality rate is considered acceptable in exchange for a highly effective treatment in patients with body mass indices exceeding 50 kg/m2. Adjustable gastric banding is a safe alternative to the more complex bariatric operations but is associated with excess weight loss exceeding 50% in only 50% to 60% of patients.3

    REFERENCES
    1. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery:
    a systemic review and meta-analysis. JAMA 2004; 292:1724-37.

    2. Puzziferri N, Austrheim-Smith IT, Wolfe BM, et al. Three-year follow-up of a prospective randomized trial comparing laparoscopic versus open gastric bypass. Ann Surg 2006;243:181-8.

Click here to return to the questions

 

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 1/04/08 • kkj