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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

    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.

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