Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention Lifestyle intervention favorably affects weight loss and maintenance following obesity surgery. National Surgical Quality Improvement Program analysis of bariatric operations: modifiable risk factors contribute to bariatric surgical adverse outcomes. Surgery for Obesity - An Update of a Randomized Trial Effects of intentional weight loss in patients with obesity and heart failure: a systematic review. Results of the surgical treatment of obesity. A pilot study of long-term effects of a novel obesity treatment: omentectomy in connection with adjustable gastric banding Evaluation of the biochemical, inflammatory and oxidative profile of obese patients given clinical treatment and bariatric surgery. Bariatric Surgery versus Lifestyle Interventions for Morbid Obesity—Changes in Body Weight, Risk Factors and Comorbidities at 1 Year Bariatric Surgery May Improve Employment Status in Unemployed, Underserved, Severely Obese Patients Impact of Body Mass Index on Perioperative Outcomes in Patients Undergoing Major Intra-abdominal Cancer Surgery Impact of obesity on short-term results of laparoscopic rectal cancer resection Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Gastric bypass surgery for severe obesity: what can be achieved? Does cognitive behavioral therapy strengthen the effect of bariatric surgery for obesity? Design and methods of a randomized and controlled study. Impact of Obesity on Operation Performed, Complications, and Long-term Outcomes in Terms of Restoration of Intestinal Continuity for Patients With Mid and Low Rectal Cancer Obesity in general elective surgery
Objective Weight reduction improves several obesity-related health conditions . We aim ed to compare the effect of bariatric surgery and comprehensive lifestyle intervention on type 2 diabetes and obesity-related cardiovascular risk factors . Design One-year controlled clinical trial ( Clinical Trials.gov identifier NCT00273104 ) . Methods Morbidly obese subjects ( 19–66 years , mean ( s.d . ) body mass index 45.1 kg/m2 ( 5.6 ) , 103 women ) were treated with either Roux-en-Y gastric bypass surgery ( n=80 ) or intensive lifestyle intervention at a rehabilitation centre ( n=66 ) . The dropout rate within both groups was 5 % . Results Among the 76 completers in the surgery group and the 63 completers in the lifestyle group , mean ( s.d . ) 1-year weight loss was 30 % ( 8) and 8 % ( 9 ) respectively . Beneficial effects on glucose metabolism , blood pressure , lipids and low- grade inflammation were observed in both groups . Remission rates of type 2 diabetes and hypertension were significantly higher in the surgery group than the lifestyle intervention group ; 70 vs 33 % , P=0.027 , and 49 vs 23 % , P=0.016 . The improvements in glycaemic control and blood pressure were mediated by weight reduction . The surgery group experienced a significantly greater reduction in the prevalence of metabolic syndrome , albuminuria and electrocardiographic left ventricular hypertrophy than the lifestyle group . Gastrointestinal symptoms and symptomatic postpr and ial hypoglycaemia developed more frequently after gastric bypass surgery than after lifestyle intervention . There were no deaths . Conclusions Type 2 diabetes and obesity-related cardiovascular risk factors were improved after both treatment strategies . However , the improvements were greatest in those patients treated with gastric bypass surgery The present study was design ed to evaluate the 3 year effects of a lifestyle intervention on weight loss and maintenance , dietary , and physical activity habits and eating behavior of patients following vertical b and ed gastroplasty ( VBG ) . Thirty severely obese female volunteers were included in the study and they were r and omly assigned to one of two intervention groups : usual care ( UC ) or lifestyle intervention ( LS ) group . Patients were followed for 3 years postoperatively . Outcome measures included weight loss , dietary habits , physical activity level ( PAL ) , and eating behavior changes . Weight was significantly lower in the LS group after 12 months ( 84.4 + /- 3.9 kg vs. 98.4 + /- 4.4 kg , P < 0.05 ) , 24 months ( 83.0 + /- 3.3 vs. 101.9 + /- 5.3 kg , P < 0.05 ) , and 36 months following surgery ( 84.2 + /- 3.3 vs. 102.5 + /- 3.5 kg , P < 0.05 ) . Repeated measures ANOVA revealed significant differences between the two groups overall and at specific time points for the PAL and TV viewing . With regard to eating behavior , the LS group scored significantly better in total Dutch Eating Behavior Question naire ( DEBQ ) , Restraint Eating and External Eating scales at all postoperative time points . Similarly , significant differences were found between the two groups in dietary intake . These findings outline the importance of lifestyle intervention on weight loss and maintenance following bariatric surgery . The favorable effects of lifestyle intervention may be through adoption of healthier eating behaviors and increased physical activity BACKGROUND The increase in obesity coupled with greater acceptance of the field of bariatric surgery has result ed in a substantial rise in the number of weight-loss operations . Because obese individuals are at high risk for surgical complications , concern about the safety of bariatric procedures exists . Earlier investigations of the clinical features associated with surgical complications have produced conflicting results . We sought to identify risk factors for surgical complications in a large , nationally representative population of US veterans . STUDY DESIGN We analyzed data  on bariatric procedures performed at 12 Veterans ' Affairs medical centers approved to perform weight-loss operations between 1998 and 2004 . Detailed pre- , intra- , and postoperative information and longterm mortality data were prospect ively collected using the National Surgical Quality Improvement Program methodology . We used multivariable logistic regression to identify clinical features associated with postoperative complications . RESULTS Among 575 bariatric patients assessed between 1998 and 2004 , 74 % were men with a mean age of 51 years . Thirty-day mortality was 1.4 % . Overall complication rate was 19.7 % . Of those with complications , one-half were of considerable clinical importance , as they were associated with prolonged length of stay . Clinical features that were predictive of adverse events in our multivariable analyses were superobesity , weight>350 pounds , and smoking . A more than 20 pack-year history of smoking was also associated with difficulty in weaning from a ventilator postoperatively . CONCLUSIONS We identified smoking and superobesity as preoperative risk factors associated with postoperative complications . Future studies should examine the effect of preoperative weight loss and smoking cessation on bariatric procedure outcomes Background : A prospect i ve , r and omized trial comparing vertical b and ed gastroplasty ( VBG ) and gastric bypass ( GB ) was performed on 106 patients between 1987 and 1990 . Methods and Results : Failures of these two operations ( manifested by failure to lose weight , late weight gain or intolerance of adequate oral intake ) were treated by means of a third operation , isolated gastric bypass ( IGB ) , in which the small gastric pouch was isolated from the gastric fundus . The latter operation was significantly better than VBG or GB and achieved a 63 % success rate , i.e. body mass index ( BMI ) < 35 kg m−2 and less than 50 % excess weight . During the year following this trial an additional 54 patients underwent IGB .  When this operation was performed for morbid obesity and was the initial procedure , 96 % of the patients achieved a successful result . If IGB was performed as a revision procedure or for super obesity ( BMI > 50 kg m−2 ) , the success rate was 63 % with 100 % follow-up at 40 months . Major morbidity occurred in six of the 160 patients who underwent 195 operations ( the trial period and subsequent year ) . There were no deaths and follow-up was 98 % . Conclusions : The ideal gastric operation based on this study emphasizes the following requirements : a small pouch ( < 15ml ) totally separated from the stomach , a pouch not dependent on staples , placed in the dependent position to prevent stasis , constructed without foreign material and with an anastomosis which permits ingestion of solid food OBJECTIVE Obesity is an independent risk factor for the development of heart failure , and the two commonly co-exist . The European Society of Cardiology does not provide guidance regarding weight loss strategies in heart failure . The aim of this study was to systematic ally review the evidence for outcomes following intentional weight loss in patients with heart failure and obesity . METHOD A systematic review of English articles was undertaken using data bases PubMed , Embase and CENTRAL . R and omized controlled trials and observational studies reporting outcomes following intentional weight loss by lifestyle , surgical or pharmacotherapy intervention in patients with obesity and heart failure were included . RESULTS Four r and omized controlled trials and seven observational studies were identified . Two r and omized controlled trials used  diet and exercise  as an intervention , one used diet alone and one used a pharmacological intervention ( orlistat ) . All but one reported significant weight loss . Two reported improvement in exercise capacity and quality of life . One reported improvement in New York Heart Association functional class in heart failure with preserved ejection fraction . The observational studies , five of which reported on outcomes following bariatric surgery , despite being small , heterogeneous and high risk of bias , suggested a trend in improvement of left ventricular function , quality of life and exercise capacity following weight loss . CONCLUSION Weight loss is achievable with lifestyle intervention in those with heart failure and obesity and may result in improvements in New York Heart Association classification , quality of life and exercise capacity A prospect i ve , r and omized trial comparing vertical b and ed gastroplasty ( VBG ) and vertical gastric bypass ( GB ) for obesity was completed in 106 patients who did not differ in baseline body mass index ( BMI = kg/m2 ) or length of follow-up . The goal of this surgery was to return patients to within 50 % of their ideal weight , i.e. , a body mass index less than 35 kg/m2 , and to accomplish this while maintaining a low risk for malnutrition as well as other morbidity and mortality . Success was defined as a BMI less than 35 kg/m2 because the mortality risk increases rapidly above this degree of obesity . Surgical failures were encountered in 43 % of the 54 patients in the VBG group , all of whom had division between the vertical staple lines . The main causes of failure were stenosis and enlargement of the gastroplasty orifice . Surgery failed in 23 % of the GB-treated patients , due to perforation of the vertical staple line . An  isolated gastric bypass ( IGB )  not dependent on staples was performed as the remedial operation for the failures of both VBG and GB . IGB was significantly better than VBG or GB , with a success rate of 83 % compared with 39 % for VBG and 58 % for GB . Subsequent experience since completion of this r and omized trial in 54 consecutive patients supports IGB for primary , as well as remedial , operations for the morbidly obese ( BMI = 40 to 50 kg/m2 ) , as well as for patients who are super obese ( BMI greater than 50 kg/m2 ) AIM : To determine whether visceral fat reduction in connection with bariatric surgery could improve weight loss and metabolic profile of obese subjects . PATIENTS AND METHODS : In a one-center , r and omized and controlled pilot trial we assigned 50 subjects with severe obesity ( body mass index > 35 kg/m2 ) to either adjustable gastric b and ing ( AGB ) alone ( 11 men and 14 women ) , or AGB plus surgical removal of the total greater omentum ( 11 men and 14 women ) . The patients were followed at regular intervals for 2 y and examined at 0 and 24 months with respect to body composition and metabolic profile . RESULTS : No significant differences between control and omentectomized patients were observed at baseline . The removed greater omentum constituted 0.8±0.4 % ( mean±s.d . ) of total body fat . At 2 y follow-up there was an expected decrease in body weight and an improvement in metabolic profile in both groups . Although omentectomized subjects tended to lose more weight than control subjects the difference was not statistically significant and changes in waist-to-hip ratio and saggital diameter did not differ between groups . However , the improvements in oral glucose tolerance , insulin sensitivity and fasting plasma glucose and insulin were 2–3 times greater in omentectomized as compared to control subjects ( P from 0.009 to 0.04 ) , which was statistically independent of the loss in body mass index . No differences in blood lipids between the groups were recorded . No adverse effects related to omentectomy were observed . CONCLUSIONS : Omentectomy , when performed together with AGB , has significant positive and long-term effects on the glucose and insulin metabolic profiles in obese subjects BACKGROUND We investigated the biochemical and inflammatory parameters as well as biomarkers of oxidative stress in morbidly obese patients before and after bariatric surgery and clinical treatment .  METHODS This study was conducted using 60 individuals ( 10 men and 50 women ) distributed into 3 groups :  the control group , 20 non-diabetic obese patients given clinical treatment , the bariatric group , 20 non-diabetic obese patients given a Roux-en-Y bypass gastroplasty , and the bariatric diabetic group , 20 diabetic obese patients given a Roux-en-Y bypass gastroplasty .  Measurements were made before and 1 , 3 , 6 , and 12months after surgery and clinical treatment . RESULTS We showed a significant decrease in body weight , body mass index ( BMI ) and waist circumference , accompanied by a decrease in the lipid profile and glucose and glycated hemoglobin concentrations in the groups that received bariatric surgery . The concentrations of lipid peroxidation , carbonyl protein and NPSH , as well as superoxide dismutase ( SOD ) and catalase ( CAT ) activity , significantly decreased in both groups after surgery . The concentrations of inteleukin-6 , inteleukin-1 , TNF-α and resistin were also significantly lower , while adiponectin concentrations significantly increased 12months after bariatric surgery . No significant alterations were observed in the biochemical , inflammatory or oxidative parameters of the control group . CONCLUSIONS Our findings demonstrate a decrease in body mass and a subsequent improvement in biochemical , metabolic and anthropometric parameters in patients given bariatric surgery .  This may contribute to the reduction of oxidative damage in these patients and consequently a reduction in the risk of the development and progression of multiple co-morbidities associated with obesity Background Few studies have looked at non-surgical alternatives for morbid obese patients . This study aims to compare 1-year weight loss and changes in risk factors and comorbidities after bariatric surgery and three conservative treatments . Methods Patients with morbid obesity ( BMI > 40 or BMI > 35 kg/m2 plus comorbidities ) on waiting list for bariatric surgery  , were non-r and omly allocated to ( A ) bariatric surgery or to one of three conservative treatments ; ( B ) residential intermittent program ; ( C ) commercial weight loss camp and ( D ) hospital outpatient program . Body weight , risk factors and comorbidities were assessed at baseline and 1 year . Results Of 206 participants , 179 completed the study . All treatments result ed in significant weight loss , but bariatric surgery ( 40 ± 14 kg , 31 ± 9 % ) led to the largest weight loss ( P < 0.0001 ) . There were no differences in weight loss between B and C ( 22 ± 13 kg , 15 ± 8 % vs. 18 ± 12 kg , 13 ± 8 % ) , but these result ed in larger weight loss compared with D ( 7 ± 10 kg , 5 ± 8 % ) . There were no differences in changes in total or LDL cholesterol , triacylglycerols or glucose between groups ; however , the increase in HDL cholesterol was significantly larger in groups A and C. There were no differences in comorbidities resolution between groups A and B , C and D combined ( except hypertension , which was better in group A ) . Conclusion In conclusion , although bariatric surgery leads to a greater weight loss at 1 year compared with conservative treatment , in patients with morbid obesity , clinical significant weight loss and similar improvements in risk factors and comorbidities resolution can also be achieved with lifestyle interventions Background The purpose of this study was to determine the impact of bariatric surgery on employment status in underserved , unemployed patients with severe obesity . Methods A retrospective review of all unemployed severely obese patients seen in our urban safety-net bariatric surgery program was performed . Preoperative patient question naires and medical records were review ed to evaluate patient employment status at the time of initial evaluation by the multidisciplinary bariatric surgery team . Follow-up data was obtained on all available patients ( including those who did not undergo surgery ) , including weight and employment status . A st and ardized telephone question naire was administered to supplement details regarding employment . Changes in employment status and body weight were determined in both groups . Results Here , 193 unemployed severely obese patients were evaluated by the multidisciplinary obesity team . The vast majority of patients ( > 80 % ) were minorities ( primarily Hispanic ) and publicly insured . Seventy-two underwent bariatric surgery and 121 did not . Twenty-four percent of the surgical patients and 9 % of the non-surgical patients had acquired full-time employment at least one year postoperatively ( p = 0.043 ) . There was a 10-point body mass index reduction in the surgical group , compared to 1-point reduction in the non-surgical group after one year . Conclusions Bariatric surgery may improve employment status in an unemployed severely obese patient cohort . Future research in this area should collect detailed prospect i ve data on employment prior to surgery and assess changes longitudinally to provide a more complete picture of the impact of bariatric surgery on employment Background Obesity is an increasingly common serious chronic health condition . We sought to determine the impact of body mass index ( BMI ) on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery .  Methods A prospect i ve , multi-institutional , risk-adjusted cohort study of patients undergoing major intra-abdominal cancer surgery was performed from the 14 university hospitals participating in the Patient Safety in Surgery Study of the National Surgical Quality Improvement Program ( NSQIP ) . Demographic , clinical , and intraoperative variables and 30-day morbidity and mortality were prospect ively collected in st and ardized fashion . Analysis of variance , Bonferroni multiple comparisons of means tests , and multivariable logistic regression analysis were performed . Results We identified 2258 patients who underwent esophagectomy ( n = 29 ) , gastrectomy ( n = 223 ) , hepatectomy ( n = 554 ) , pancreatectomy ( n = 699 ) , or low anterior resection/proctectomy ( n = 753 ) . Patients were stratified by National Institutes of Health (NIH)-defined BMI obesity class , with 573 ( 25.4 % ) patients classified as obese ( BMI > 30 kg/m2 ) . There were no differences in mean work relative value units , total time of operation , or length of stay amongst the BMI classes . After adjusting for other risk factors , obesity was not a risk factor for death or major complications but was a risk factor for wound complications . The risk of postoperative death was greatest in underweight patients ( odds ratio [ OR ] 5.24 ; 95 % confidence interval [ CI ] 1.7–16.2 ) . Conclusion In patients undergoing major intra-abdominal cancer surgery , obesity is not a risk factor for postoperative mortality or major complications . Importantly , underweight patients have a fivefold increased risk of postoperative mortality , perhaps a consequence of their underlying nutritional status Introduction The influence of obesity [ body mass index ( BMI ) ≥ 30 kg/m2 ] on the outcome of  laparoscopic colorectal surgery  remains controversial . The complexity of rectal laparoscopic resections requires a specific assessment of the impact of obesity on the feasibility and short-term results of the surgery . Methods Between February 2002 and May 2007 , 210 laparoscopic mesorectal excisions were performed . Demographic , oncologic and perioperative data were entered in a prospect i ve data base . Twenty-four patients ( 11.4 % ) with BMI over 30 kg/m2 formed the obese group ( OG ) . The outcomes in the OG and the nonobese group ( NOG ) were compared . Results There were significantly more American Society of Anesthesiologists ( ASA ) score 3 patients ( 26 % in OG versus 9 % in NOG ; p = 0.03 ) in the obese group . Obese patients experienced longer operative times ( 513 min in OG vs. 421 min in NOG ; p < 0.01 ) and more frequent conversion to laparotomy ( 46 % in OG vs. 12 % in NOG ; p < 0.001 ) . Morbidity grade 1 was higher in the obese group ( 29.2 % vs. 9.7 % in NOG ; p = 0.01 ) , but there was no difference in regards to morbidity grade 2 or more ( 33.3 % in OG vs. 32.3 % in NOG ) . In addition , conversion to laparotomy among the obese did not increase significantly morbidity grade 2 or higher ( 5 of 11 for OG converted vs. 3 of 13 for OG nonconverted ; p = 0.39 ) . Regarding the oncological parameters ( e.g. number of lymph nodes removed , distal and lateral margins ) there was no difference between groups . Conclusion Obesity increases operative duration and conversion rate of rectal laparoscopic resection for cancer . Although obesity is associated with a worse preoperative evaluation , there is no increase in relevant morbidity and no impairment of oncological safety OBJECTIVE To prospect ively examine the effect of weight loss 1 year after  laparoscopic adjustable gastric b and surgery on a broad range of health outcomes in 50 diabetic subjects . RESEARCH DESIGN AND METHODS A total of 50 ( 17 men , 33 women ) of 51 patients with type 2 diabetes , from a total of 500 consecutive patients , were studied preoperatively and again 1 year after surgery . RESULTS Preoperative weight and BMI ( means + /- SD ) were 137 + /- 30 kg and 48.2 + /- 8 kg/m(2 ) , respectively ; at 1 year , weight and BMI were 110 + /- 24 kg and 38.7 + /- 6 kg/m(2 ) , respectively . There was significant improvement in all measures of glucose metabolism . Remission of diabetes occurred in 32 patients ( 64 % ) , and major improvement of glucose control occurred in 13 patients ( 26 % ) ; glucose metabolism was unchanged in 5 patients ( 10 % ) . HbA(1c ) was 7.8 + /- 3.2 % preoperatively and 6.2 + /- 2.7 % at 1 year ( P < 0.001 ) . Remission of diabetes was predicted by greater weight loss and a shorter history of diabetes ( pseudo r(2 ) = 0.44 , P < 0.001 ) . Improvement in diabetes was related to increased insulin sensitivity and beta-cell function . Weight loss was associated with significant improvements in fasting triglyceride level , HDL cholesterol level , hypertension , sleep , depression , appearance evaluation , and health-related quality of life . Early complications occurred in 6 % of patients ( wound infections in 4 % , respiratory support in 2 % ) , and late complications occurred in 30 % of patients ( gastric prolapse in 20 % , b and erosion in 6 % , and tubing leaks in 4 % ) . All late complications were successfully revised surgically . CONCLUSIONS Modern laparoscopic weight-loss surgery is effective in managing the broad range of health problems experienced by severely obese individuals with type 2 diabetes . Surgery should be considered as an early intervention BACKGROUND As severe obesity becomes an increasing problem , it is important that the role of surgery in the management of the condition becomes better understood and recognised . This study reports the outcome of a large series of gastric bypass operations performed for severe obesity by a single surgeon . METHODS AND RESULTS Between 1990 - 2002 , 310 patients underwent gastric bypass surgery with all data being collected prospect ively and recorded on a computerised data base .  Mean preoperative weight and percentage excess weight were 132 kg and 119 % , respectively . There was no 30-day mortality and only one life threatening complication . Re-operations were required in 43 patients , most of which were related to ring removal or staple line disruption seen in the earlier form of gastric bypass . These problems are largely overcome with the currently performed technique . Percentage excess weight loss at 1 , 2 , 3 , 4 and 5 years was 73 % , 73 % , 66 % , 64 % , and 59 % respectively . Forty-nine of the 52 patients with type 2 diabetes were cured following surgery and 87 % of those with hypertension resolved or improved their condition . Dyslipidaemia resolved or improved in 87 % and asthma was cured or improved in 89 % of those affected . 61 patients had symptoms of obstructive sleep apnoea prior to surgery and in 51 of these symptoms resolved following surgery . CONCLUSION This study confirms that gastric bypass is a very effective treatment for severe obesity  and can be performed with a high level of safety . Gastric transection is an important component of the operation . The majority of important comorbidities seen before surgery either resolve or improve following surgery . Bariatric surgery is establishing itself as a very important and satisfying branch of upper gastrointestinal ( GI ) surgery BACKGROUND ( Extreme ) obesity is a chronic harmful condition with high risk of medical comorbidities and negative social and emotional consequences . Bariatric surgery is an effective intervention for obesity , but approximately 20 to 30 % of the patients experience adverse outcomes after surgery and there is a need for augmentation of current treatment strategies . This study examines the added value of pre-operative cognitive behavioral therapy ( CBT ) focused on modification of thoughts and behaviors in terms of eating behavior and physical exercise as well as preparation for surgery and postoperative life style . We hypothesize that pre-operative CBT will result in better weight loss maintenance , reduction of maladaptive eating behavior and better adherence to postoperative lifestyle on the long term as compared to bariatric surgery alone . METHODS One hundred and twenty eight patients that are on a waiting list for bariatric surgery are r and omly assigned to the control or treatment condition . Patients in the treatment condition receive 10 sessions of CBT before surgery aim ed at modifying dysfunctional eating habits and behaviors and developing more rational weight and body-related beliefs in order to enable long term maintenance of a healthier lifestyle after surgery . Weight loss , eating behavior , eating disorders , depression , quality of life and psychological distress are assessed before and after treatment , as well as 1 , 3 , and 5 year following surgery BACKGROUND : The impact of obesity per se on the surgical strategy , ie , sphincter sacrifice ( abdominoperineal resection ) vs sphincter-preserving resection , outcomes , and long-term maintenance of intestinal continuity has been poorly studied in patients with mid and low rectal cancer . OBJECTIVE : The aim of this study is to compare the outcomes and long-term maintenance of intestinal continuity for obese and nonobese patients treated surgically for mid and low rectal cancers . DESIGN : This is a retrospective cohort study from a prospect ively collected data base . SETTING : The investigation took place in a high-volume specialized colorectal surgery department . PATIENTS : All patients who underwent curative surgery for mid or low rectal adenocarcinoma at a single institution from 1976 to 2011 were identified . MAIN OUTCOME MEASURES : Obese ( BMI ≥30 kg/m2 ) and nonobese patients were matched 1:2 for age , sex , ASA class , location , and stage of tumor . Demographics , use of neoadjuvant chemoradiotherapy , operative and perioperative outcomes , pathology , long-term outcomes including oncologic outcomes , and whether restoration of intestinal continuity was obtained were compared . RESULTS : One hundred fifty-seven obese patients and 314 nonobese patients were included in the study . The groups were similar for matched characteristics . The use of neoadjuvant chemoradiotherapy  ( p = 0.048 ) and anastomotic leak ( p = 0.0003 ) rates were higher in obese patients . A similar proportion of nonobese and obese patients  underwent sphincter-preserving resection  ( p > 0.99 ) , and postoperative hospital stay ( p = 0.23 ) , 30-day postoperative reoperation ( p = 0.83 ) , mortality ( p > 0.99 ) , and readmissions ( p = 0 . 13 ) were similar . The obese and nonobese groups had similar overall ( p = 0.61 ) and disease-free survival ( p = 0.74 ) at a mean follow-up of 5 years for both groups . LIMITATIONS : This study was limited by its retrospective and nonr and omized nature . CONCLUSION : At a high-volume specialized colorectal unit , proctectomy can be performed in obese patients with similar long-term oncologic outcomes and ability to restore intestinal continuity in comparison with nonobese patients . Proctectomy in obese patients , however , is associated with an increased risk of anastomotic leak in comparison with nonobese patients BACKGROUND Obese patients are generally believed to be at a higher risk for surgery than those who are not obese , although convincing data are lacking . METHODS We prospect ively investigated a cohort of 6336 patients undergoing general elective surgery at our institution to assess whether obesity affects the outcome of surgery . Exclusion criteria were emergency , vascular , thoracic , and bariatric operations ; transplantation procedures ; patients under immunosuppression ; and operations done under local anaesthesia .  Postoperative morbidity was analysed for non-obese and obese patients ( body-mass index < 30 kg/m(2 ) vs > or=30 kg/m(2 ) ) . Obesity was further stratified into mild obesity ( 30.0 - 34.9 kg/m(2 ) ) and severe obesity ( > or=35 kg/m(2 ) ) . Risk factors were analysed with univariate and multivariate models . FINDINGS The cohort consisted of 6336 patients , of whom 808 ( 13 % ) were obese , 569 ( 9 % ) were mildly obese , and 239 ( 4 % ) had severe obesity . The morbidity rates in patients who were obese compared with those who were not were much the same ( 122 [ 15.1 % ] of 808 vs 901 [ 16.3 % ] of 5528 ; p=0.26 ) , with the exception of an increased incidence of wound infections after open surgery in patients who were obese ( 17 [ 4 % ] of 431 vs 92 [ 3 % ] of 3555 , p=0.03 ) . Incidence of complications did not differ between patients who were mildly obese ( 91 [ 16.0 % ] of 569 ) , severely obese ( 36 [ 15.1 % ] of 239 ) , and non-obese ( 901 [ 16.3 % ] of 5528 ; p=0.19 ) . In multivariate regression analyses , obesity was not a risk factor for development of postoperative complications . Of note , the additional medical re source use as estimated by a new classification of complications showed no differences between patients who were and were not obese . INTERPRETATION Obesity alone is not a risk factor for postoperative complications . The regressive attitude towards general surgery in obese patients is no longer justified
Results Insulin resistance indicators were significantly improved after bariatric surgery .
Leptin was also significantly decreased while adiponectin was significantly increased .
Although the level of metabolic hormones changed after bariatric surgery , they were not statistically significant .
Inflammation indicators were significantly decreased .
Significant reduction was also detected in PAI-1 and sICAM-1 .
Conclusions Bariatric surgery is beneficial in morbidly obese patients .
Although treating obesity in a surgical way may cause some complications , the weight loss is generally safe and effective
Background Considering conflicting results on the consequences of all types of obesity surgery , we were to summarize them via a systematic review .