Perioperative safety in the longitudinal assessment of bariatric surgery. Evaluation of Current Eligibility Criteria for Bariatric Surgery National Surgical Quality Improvement Program analysis of bariatric operations: modifiable risk factors contribute to bariatric surgical adverse outcomes. A bariatric surgery center of excellence: operative trends and long-term outcomes. Musculoskeletal function following bariatric surgery. Bariatric Surgery May Improve Employment Status in Unemployed, Underserved, Severely Obese Patients Surgical skill and complication rates after bariatric surgery. Development, feasibility, validity, and reliability of a scale for objective assessment of operative performance in laparoscopic gastric bypass surgery. Evaluation of Health Status and Quality of Life after Bariatric Surgery: Comparison of Standard Roux-en-Y Gastric Bypass, Vertical Banded Gastroplasty and Laparoscopic Adjustable Silicone Gastric Banding Three-Dimensional (3D) Versus Two-Dimensional (2D) Laparoscopic Bariatric Surgery: a Single-Surgeon Prospective Randomized Comparative Study Comprehensive behavioral-motivational nutrition education improves depressive symptoms following bariatric surgery: a randomized, controlled trial of obese Hispanic Americans. [Effectiveness of a recruitment manoeuvre and positive end-expiratory pressure on respiratory mechanics during laparoscopic bariatric surgery]. Feasibility of Smartphone-Based Education Modules and Ecological Momentary Assessment/Intervention in Pre-bariatric Surgery Patients Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. Long-term (>10-year) outcomes after laparoscopic Roux-en-Y gastric bypass. Validation of the Adapted Bariatric Quality of Life Index (BQL) in a Prospective Study in 446 Bariatric Patients as One-Factor Model Acceptance and commitment therapy for bariatric surgery patients, a pilot RCT.
BACKGROUND To improve decision making in the treatment of extreme obesity , the risks of bariatric surgical procedures require further characterization . METHODS We performed a prospect i ve , multicenter , observational study of 30-day outcomes in consecutive patients undergoing bariatric surgical procedures at 10 clinical sites in the United States from 2005 through 2007 . A composite end point of 30-day major adverse outcomes ( including death ; venous thromboembolism ; percutaneous , endoscopic , or operative reintervention ; and failure to be discharged from the hospital ) was evaluated among patients undergoing first-time bariatric surgery .  RESULTS There were 4776 patients who had a first-time bariatric procedure ( mean age , 44.5 years ; 21.1 % men ; 10.9 % nonwhite ; median body-mass index [ the weight in kilograms divided by the square of the height in meters ] , 46.5 ) . More than half had at least two coexisting conditions . A Roux-en-Y gastric bypass was performed in 3412 patients ( with 87.2 % of the procedures performed laparoscopically ) , and laparoscopic adjustable gastric b and ing was performed in 1198 patients ; 166 patients underwent other procedures and were not included in the analysis . The 30-day rate of death among patients who underwent a Roux-en-Y gastric bypass or laparoscopic adjustable gastric b and ing was 0.3 % ; a total of 4.3 % of patients had at least one major adverse outcome . A history of deep-vein thrombosis or pulmonary embolus , a diagnosis of obstructive sleep apnea , and impaired functional status were each independently associated with an increased risk of the composite end point . Extreme values of body-mass index were significantly associated with an increased risk of the composite end point , whereas age , sex , race , ethnic group , and other coexisting conditions were not . CONCLUSIONS The overall risk of death and other adverse outcomes after bariatric surgery was low and varied considerably according to patient characteristics . In helping patients make appropriate choices , short-term safety should be considered in conjunction with both the long-term effects of bariatric surgery and the risks associated with being extremely obese . ( Clinical Trials.gov number , NCT00433810 . OBJECTIVE Patients with a BMI < 35 kg/m2 and patients with a BMI between 35 and 40 kg/m2 without comorbidities are noneligible by current eligibility criteria for bariatric surgery .  We used Swedish obese subjects ( SOS ) to explore long-term outcomes in noneligible versus eligible patients . RESEARCH DESIGN AND METHODS The SOS study involved 2,010 obese patients who underwent bariatric surgery ( 68 % vertical-b and ed gastroplasty , 19 % b and ing , and 13 % gastric bypass ) and 2,037 contemporaneously matched obese controls receiving usual care .  At inclusion , the participant age was 37–60 years and BMI was ≥34 kg/m2 in men and ≥38 kg/m2 in women . The effect of surgery was assessed in patients that do ( n = 3,814 ) and do not ( n = 233 ) meet current eligibility criteria . The date of analysis was 1 January 2012 . The follow-up time was up to 20 years , with a median of 10 years . RESULTS Cardiovascular risk factors were significantly improved both in noneligible and eligible individuals after 10 years of follow-up . Surgery reduced the diabetes incidence in both the noneligible ( adjusted hazard ratio 0.33 [ 95 % CI 0.13–0.82 ] , P = 0.017 ) and eligible ( 0.27 [ 0.22–0.33 ] , P < 0.001 ) groups . We could not detect a difference in the effect of surgery between the groups ( adjusted interaction P value = 0.713 ) . CONCLUSIONS Bariatric surgery drastically reduced the incidence of type 2 diabetes both in noneligible and eligible patients and improved cardiovascular risk factors in both groups . Our results show that strict BMI cutoffs are of limited use for bariatric surgery prioritization if the aim is to prevent diabetes and improve cardiovascular risk factors 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 Surgery remains the most effective intervention for obesity and its comorbidities . However , the long-term efficacy of bariatric procedures is rarely reported . This study addresses operative trends , efficiency , and long-term outcomes from a large bariatric program . STUDY DESIGN Data were prospect ively collected on 3,460 patients undergoing 3,503 operations from January 2004 to March 2013 . Primary procedures included  Roux-en-Y gastric bypass  ( RY ; n = 2,966 ) , adjustable b and ( AB ; n = 352 ) , and sleeve gastrectomy ( SG ; n = 118 ) . There were 67 revisional procedures ( RP ) . Mean operative time , hospital length of stay , major 30-day morbidity/mortality , follow-up compliance , and weight loss per procedure at follow-up were recorded . RESULTS Mean operative times decreased to the following : RY , 53 minutes ; AB , 35 minutes ; SG , 46 minutes ; and RP , 71 minutes . Mean length of stay was reduced to the following : RY , 1.53 days ; AB , 0.97 days ; SG , 2.12 days ; and RP , 2.68 days . Major complications were mortality , 0.09 % ; leak , 0.51 % ; bleed , 2.37 % ; pneumonia , 0.63 % ; venous thromboembolism , 0.40 % ; and reoperation , 2.34 % . The complication rate was lowest for AB and highest for SG ( p < 0.05 ) . Adjustable b and was the initial procedure in 73 % of cases requiring RP . Follow-up compliance was 93 % at 1 year , 79 % at 3 years , 71 % at 5 years , and 33 % at 9 years . Adjustable b and offered significant weight loss at 1 and 3 years ( p < 0.0001 ) , but less than RY or SG ( p < 0.0001 ) . Excess weight loss was not significantly different between RY and SG at 1 year . Significant weight loss with RY persisted at 7 to 9 years ( p < 0.0001 ) . CONCLUSIONS Our bariatric program experienced an increase in SG and RP and a decrease in AB . Optimization of care reduced operative time and length of stay . All procedures achieved significant weight loss in the first year . Adjusted b and had the lowest morbidity , but inferior weight loss and greater need for revision . Long-term weight-loss data are only available for RY OBJECTIVE Bariatric surgery is an effective method for acute weight loss . While the impact of bariatric surgery on general medical conditions ( e.g. , type 2 diabetes ) is well documented , few studies focus on physical functional outcomes following weight-loss induced by bariatric surgery . DESIGN AND METHODS We report on 50 women aged 20 - 74 scheduled for Roux-en-Y gastric bypass ( RYGB ) procedure who were enrolled for a prospect i ve 1-year study . Height , weight , and waist circumference were recorded preoperatively and at 6 and 12 months , postoperatively . To track musculoskeletal/physical function changes , the  timed-get-up- and -go ( TGUG ) and short-form health survey-36 ( SF-36 ) and short musculoskeletal function assessment ( SFMA ) question naires were administered . RESULTS Patients had significant weight loss and functional improvement . At 1 year mean weight loss was 48.5 kg and mean TGUG improvement was 3.1 s. SMFA and SF-36 also showed improvement in functional components with weight loss at 6 months and 1-year post surgery . Significant associations were observed between TGUG and SMFA measures at all time points . Final weight at 1 year post bariatric surgery was also significantly correlated with most functional outcomes and changes in these outcomes . Partial correlations controlling for age revealed additional associations between body weight and functional outcomes , especially at the 6-month visit . CONCLUSION Our results suggest that significant rapid weight loss , such as that attained by bariatric surgery , acutely improves musculoskeletal function in morbidly obese patients . Additionally , for patients with musculoskeletal disease or injury , weight loss result ing from bariatric surgery may serve as an adjunct for improving global functional outcome , and enhancing the rehabilitation potential 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 Clinical outcomes after many complex surgical procedures vary widely across hospitals and surgeons . Although it has been assumed that the proficiency of the operating surgeon is an important factor underlying such variation , empirical data are lacking on the relationships between technical skill and postoperative outcomes . METHODS We conducted a study involving 20 bariatric surgeons in Michigan who participated in a statewide collaborative improvement program . Each surgeon su bmi tted a single representative videotape of himself or herself performing a laparoscopic gastric bypass . Each videotape was rated in various domains of technical skill on a scale of 1 to 5 ( with higher scores indicating more advanced skill ) by at least 10 peer surgeons who were unaware of the identity of the operating surgeon . We then assessed relationships between these skill ratings and risk-adjusted complication rates , using data from a prospect i ve , externally audited , clinical - outcomes registry involving 10,343 patients . RESULTS Mean summary ratings of technical skill ranged from 2.6 to 4.8 across the 20 surgeons . The bottom quartile of surgical skill , as compared with the top quartile , was associated with higher complication rates ( 14.5 % vs. 5.2 % , P<0.001 ) and higher mortality ( 0.26 % vs. 0.05 % , P=0.01 ) . The lowest quartile of skill was also associated with longer operations ( 137 minutes vs. 98 minutes , P<0.001 ) and higher rates of reoperation ( 3.4 % vs. 1.6 % , P=0.01 ) and readmission ( 6.3 % vs. 2.7 % ) ( P<0.001 ) . CONCLUSIONS The technical skill of practicing bariatric surgeons varied widely , and greater skill was associated with fewer postoperative complications and lower rates of reoperation , readmission , and visits to the emergency department . Although these findings are preliminary , they suggest that peer rating of operative skill may be an effective strategy for assessing a surgeon 's proficiency BACKGROUND There is no objective scale for assessment of operative skill in laparoscopic gastric bypass ( LGBP ) . The objective of this study was to develop and demonstrate feasibility of use , validity , and reliability of a Bariatric Objective Structured Assessment of Technical Skill ( BOSATS ) scale . STUDY DESIGN The BOSATS scale was developed using a hierarchical task analysis ( HTA ) , a Delphi question naire , and a panel of international experts in bariatric surgery . The feasibility of use , reliability , and validity of the developed scale were demonstrated by review ing 52 prospect ively collected video recordings of LGBP performed by novice and experienced surgeons . RESULTS A total of 214 discrete steps were identified in HTA . A total of 12 and 17 panel members completed the first and second round of the Delphi question naire , respectively . Consensus among the panel was achieved after the second round ( Cronbach 's alpha = 0.85 ) . The BOSATS scale demonstrated high inter-rater ( intraclass correlation coefficient [ ICC ] = 0.954 ; p < 0.001 ) and test-retest reliability ( ICC = 0.99 ; p < 0.001 ) . Significant differences between BOSATS scores of experienced and novice surgeon groups were noted for the creation of jejunojejunostomy ( JJ ) , gastric pouch , linear stapled gastrojejunostomy ( GJ ) , circular stapled GJ , and h and -sewn GJ . Moderate to high correlations between BOSATS scale and Objective Structured Assessment of Technical Skills Global Rating Scale ( OSATS GRS ) were seen for JJ ( rho = 0.59 ; p = 0.001 ) , gastric pouch ( rho = 0.48 ; p = 0.0004 ) , linear stapled GJ ( rho = 0.70 ; p = 0.0001 ) , and h and -sewn GJ ( rho = 0.96 ; p < 0.0001 ) . CONCLUSIONS The BOSATS scale is a feasible to use , reliable , and valid instrument for objective assessment of operative performance in LGBP . Implementation of this scale is expected to facilitate deliberate practice and provide a means for future certification in bariatric surgery Background : This study is a trial to compare the effects and outcomes of three different  bariatric procedures performed in two centers .  St and ard Roux-en-Y gastric bypass was performed by Dr. Norman Samuels in Fort Lauderdale ( Florida ) ; vertical b and ed gastroplasty and laparoscopic adjustable silicone gastric b and ing were done in Hallein ( Salzburg ) by Dr. Emanuel Hell and Dr. Karl Miller . Methods : In a prospect i ve comparative study 30 matched patients from each group were followed to assess post-operative improvement in health status and quality of life , to compare the three different techniques . The  Bariatric Analysis and Reporting Outcome System ( BAROS  ) as described by Oria and Moorehead has been used for evaluation . Results : The observation time was at least 3 years ( 3 to 8 years ) in each individual case . A significant increase in quality of life and health status in 75 % of the surgically-treated patients was observed when compared with a non-operated control group of morbidly obese patients . Conclusions : By utilizing BAROS it has been found possible to compare the results of different procedures done by different surgeons with different techniques , utilizing patients from different cultures and with different language s. The results of this comparative study favor the st and ard gastric bypass for the treatment of morbid obesity . This operation is superior to purely gastric restrictive procedures in weight loss and improvement of quality of life Background To address the issue whether three-dimensional ( 3D ) offers real operative time advantages to the laparoscopic surgical procedure , we have design ed a single-surgeon prospect i ve r and omized comparison of 3D versus two-dimensional ( 2D ) imaging during two different bariatric procedures . Methods Forty morbidly obese patients were r and omized on the day of surgery by a r and om computer-generated allocation list to receive either a 3D high-definition ( HD ) display or 2D HD imaging system laparoscopic bariatric procedure by a single experienced surgeon . Forty operations were performed with either a 3D HD display or 2D HD imaging system . After the insertion of the access ports , both surgical procedures were divided in component tasks , and the execution times were compared . Results The execution times for the entire procedure and the single tasks were not significantly different between the 2D and 3D groups during sleeve gastrectomy . The execution times for the entire procedure and the single tasks , except for the first one , were significantly different between the 2D and 3D groups during mini-gastric bypass ( p < 0.05 ) . The surgeon experienced better depth perception with the 3D system and subjectively reported less strain using 3D vision system rather than the 2D system particularly during longer procedure . Conclusions 3D imaging seems to decrease the performance time of more difficult bariatric procedures , which involve surgical tasks as suturing and intestinal measurement . Further comparative studies are necessary to address the issue if novice surgeons could benefit from reduced learning curve requested with 3D vision and to verify with greater numbers if 3D imaging can reduce complications OBJECTIVE To evaluate the effect of 2 post-bariatric support interventions on depressive symptoms of Hispanic Americans treated with gastric bypass for morbid or severe obesity . DESIGN / SETTING Prospect i ve r and omized , controlled trial conducted in a laparoscopic institution . PARTICIPANTS / INTERVENTIONS During the Phase 1 clinical trial ( from preoperative evaluation to 6 months after surgery ) , all participants received st and ard care . During Phase 2 ( 6 - 12 months after surgery ) , participants were r and omly assigned to receive either st and ard care ( n = 72 ) or comprehensive support ( n = 72 ) . Comprehensive group participants received 6 educational sessions focused on behavior change strategies and motivation with nutrition counseling . MAIN OUTCOME MEASURES Depression scores and weight change over time . ANALYSIS Independent sample s t tests and regression analysis assessed relationships among depression scores and excess weight loss . RESULTS Participants receiving behavioral-motivational intervention scored significantly lower on Beck 's Depression Inventory question naire scores than those receiving st and ard care . For those with depressive symptoms at r and omization , 24 % of participants who received the comprehensive intervention reported no depressive symptoms at 12 months after surgery , compared with 6 % of those who received st and ard care ( P < .001 ) . Patients ' depressive mood improvement was significantly and positively associated with excess weight loss and attendance at educational sessions ( P < .001 ) . CONCLUSIONS AND IMPLICATION S Findings support the importance of post-bariatric comprehensive behavioral-motivational nutrition education for decreasing risk for depression and improving weight loss OBJECTIVE To evaluate recruitment manoeuvre ( RM ) efficiency associated with a 10 cmH(2)O positive end expiratory pressure ( PEEP ) on respiratory mechanic estimated by lung compliance ( Ctp ) and PEEP to ZEEP expiratory volume delta ( Delta VTE ) during laparoscopic bariatric surgery in patients with morbid obesity . STUDY DESIGN Prospect i ve r and omized study . METHODS Twenty-six obese patients ( BMI > 40 kg/m(2 ) ) undergoing laparoscopic bariatric surgery .  The recruitment group received an RM followed by a 10 cmH(2)O PEP versus only 10 cmH(2)O PEP in the control group . Ctp was measured during the intervention and functional residual capacity ( FRC ) was estimated measuring Delta VTE during a PEP to ZEP manoeuvre . Mann and Whitney tests as well as a t-test were used ( significance p<0.05 ) . RESULTS In the RM group , a significant improvement of 52+/-14 ml/cmH(2)O was noted versus a 36+/-10 ml/cmH(2)O in the PEP group ( p=0,004 ) . This improvement was transitory and no statistically significant Delta VTE difference was noted between the groups at the end of the intervention ( 360 [90 - 770]ml [ MRA ] and 310 [190 - 450]ml [ PEP ] ) . CONCLUSION In patients with morbid obesity undergoing laparoscopic bariatric surgery , an RM conducted prior the pneumoperitoneum temporarily improves lung mechanics but without any change of the end expiratory lung volume at the end of the surgery in comparison with PEP alone . The RM was well tolerated Background Bariatric surgery is the most effective means of long-term weight loss . Knowledge gaps and lack of engagement in pre-operative patients can result in suboptimal outcome after surgery . Mobile technology , utilizing ecological momentary assessment (EMA)/intervention ( EMI ) , has shown tremendous promise in changing behaviors . The primary objective of the study is to assess feasibility of using smartphone app with EMA/EMI functionality to prepare patients for bariatric surgery . Methods Subjects seeking primary bariatric surgery were provided a smartphone app containing video-based education modules with linked assessment s to evaluate mastery of topic . Subjects received algorithmic EMA text messages soliciting a response regarding lifestyle behavior . Upon answering , subjects received tailored EMI text messaging supporting healthy lifestyle . Results Thirty subjects ( 27 female and 3 male ) , with age of 41.3 ± 11.4 years and BMI of 46.3 ± 7.4 kg/m2 were enrolled . Twenty subjects completed the study . Ten subjects withdrew . On average , seven out of nine education modules were completed ( 70.9 ± 27.3 % ) , and 37.8/123 EMA were answered ( 30.7 ± 21.7 % ) , with response time of 17.4 ± 4.4 min . Subjects reported high satisfaction with the app . Many felt that the app fit into their routine “ somewhat easily ” or “ very easily ” ( n = 12 ) , had “ perfect ” amount of EMA messages ( n = 8) , and was very helpful in preparing for surgery ( n = 7 ) . Conclusions This study is the first to reveal the feasibility of using a smartphone app in the education and engagement of patients prior to bariatric surgery . The app was well-received based on subject satisfaction scores and revealed trends toward positive behavior change and increased weight loss . R and omized trials are necessary to delineate true efficacy BACKGROUND Weight loss protects against type 2 diabetes but is hard to maintain with behavioral modification alone . In an analysis of data from a nonr and omized , prospect i ve , controlled study , we examined the effects of bariatric surgery on the prevention of type 2 diabetes . METHODS In this analysis , we included 1658 patients who underwent bariatric surgery and 1771 obese matched controls ( with matching performed on a group , rather than individual , level ) . None of the participants had diabetes at baseline . Patients in the bariatric-surgery cohort underwent b and ing  ( 19 % ) , vertical b and ed gastroplasty ( 69 % ) , or gastric bypass ( 12 % ) ; nonr and omized , matched , prospect i ve controls received usual care . Participants were 37 to 60 years of age , and the body-mass index ( BMI ; the weight in kilograms divided by the square of the height in meters ) was 34 or more in men and 38 or more in women . This analysis focused on the rate of incident type 2 diabetes , which was a prespecified secondary end point in the main study . At the time of this analysis ( January 1 , 2012 ) , participants had been followed for up to 15 years . Despite matching , some baseline characteristics differed significantly between the groups ; the baseline body weight was higher and risk factors were more pronounced in the bariatric-surgery group than in the control group . At 15 years , 36.2 % of the original participants had dropped out of the study , and 30.9 % had not yet reached the time for their 15-year follow-up examination . RESULTS During the follow-up period , type 2 diabetes developed in 392 participants in the control group and in 110 in the bariatric-surgery group , corresponding to incidence rates of 28.4 cases per 1000 person-years and 6.8 cases per 1000 person-years , respectively ( adjusted hazard ratio with bariatric surgery , 0.17 ; 95 % confidence interval , 0.13 to 0.21 ; P<0.001 ) . The effect of bariatric surgery was influenced by the presence or absence of impaired fasting glucose ( P=0.002 for the interaction ) but not by BMI ( P=0.54 ) . Sensitivity analyses , including end-point imputations , did not change the overall conclusions . The postoperative mortality was 0.2 % , and 2.8 % of patients who underwent bariatric surgery required reoperation within 90 days owing to complications . CONCLUSIONS Bariatric surgery appears to be markedly more efficient than usual care in the prevention of  type 2 diabetes in obese persons . ( Funded by the Swedish Research Council and others ; Clinical Trials.gov number , NCT01479452 . ) BACKGROUND  Laparoscopic Roux-en-Y gastric bypass ( LRYGB )  has been the " gold st and ard " for weight loss surgery . Long-term data are limited , and reporting methods for LRYGB outcomes vary in the literature . In addition , follow-up compliance within bariatric centers is poor due to insurance and access to care issues , making long-term follow-up evaluation difficult . OBJECTIVE Evaluate long-term LRYGB outcomes using st and ard outcome reporting definitions . SETTING Integrated multispecialty health system . METHODS A retrospective review of our institution 's prospect i ve bariatric surgery registry and integrated multispecialty electronic medical record system was completed for patients who underwent LRYGB from 2001 to 2015 . Data were defined according to the 2015 St and ards for Outcome Reporting . RESULTS During the study period , 1402 patients underwent primary LRYGB ; mean age and preoperative body mass index were 44.5±10.3 years and 47.5±6.2 kg/m2 , respectively . Early complications included anastomotic leak ( 0.2 % ) , venous thromboembolism ( 0.6 % ) , surgical site infections ( 1.4 % ) , and urinary tract infections ( 1.6 % ) . The 30-day readmission rate was 3.5 % . There were no 30-day mortalities . Follow-up weight data were available for>70 % of eligible patients through 12 years postoperative . The highest mean percent excess weight loss and lowest body mass index were reached at 18 months postoperative at 79 % and 30.1 kg/m2 , respectively . Remission of diabetes , dyslipidemia , and hypertension were observed through 8 years postoperatively . CONCLUSION This is the first report of long-term ( > 10-year ) outcomes from a single integrated health system using the 2015 St and ards for Outcome Reporting . LRYGB results in significant , sustained weight loss and durable improvement and remission of obesity-related co-morbidities . Integrated healthcare systems provide an optimal environment for data collection and long-term follow-up Background : The Bariatric Quality of Life Index ( BQL ) was created and vali date d as a nine-factor model in 2005 for the measurement of quality of life (QoL)in  patients before and after bariatric surgery .  Even though the results were acceptable , the statistical structure of the test was very unclear . Methods : A total·f466 patients were enrolled in an ongoing prospect i ve longitudinal German study . The assessment took place preoperatively and at 1 , 3 , 6 , 9 , and 12 months postoperatively . After that period , reevaluations were done on a yearly basis . In addition to demographic and clinical data , QoL data were collected using the  BQL  , the Short Form12 ( SF-12v2 ) , the Gastrointestinal Quality of Life Index ( GIQLI ) , and the  Bariatric Analysis and Reporting Outcome System  ( BAROS ; old version since the study started in 2001 ) . Statistical parameters for contingency ( Cronbach ’s Α),construct and criterion validity ( Pearson ’s r ) , and responsiveness ( st and ardized effect sizes ) were calculated . The data of the assessment s conducted preoperatively and after 6 and 12 months were used for the validation . Results : The factor analysis and the screeplot showed that a one-factor solution explained 45.37%of variance . The selectivity of the items ranged between 0.61 and 0.85 , and Cronbach ’s Α was 0.898 . The measurements showed similar excellent results with the analysis of all measurement points . Pearson ’s test showed a good retest reliability ( r = 0.9 ) . The correlations with the SF-12 and the Moorehead-Ardelt I question naire ( MA-I ) were significant , while the correlation with the GIQLI was low . The results of the correlation with the excess weight loss (EWL)(0.45 and 0.49 ) and the BMI ( –0.38 and –0.47 ) were good . Conclusion : The BQL is a valid instrument and should be preferred over generic question naires as it provides betterresponsiveness SUMMARY Bariatric surgery ( BS ) is rated as the best evidence based treatment for obesity with regard to weight loss and maintenance of weight loss evaluated to date . Although BS interventions are effective , 20 - 30 % of BS patients start to regain weight within 24 months . Emotional eating is a behavior pattern which has been found to predict poor outcome . The aim of this study is to evaluate the effects of acceptance and commitment therapy  ( ACT ) for patients who underwent BS  , with regard to emotional eating , body dissatisfaction and quality of life . This study is a r and omized controlled trial ( n = 39 ) with two conditions ( 1 ) ACT including two face-to-face sessions and support via an Internet application and ( 2 ) treatment as usual ( TAU ) comprising the st and ard follow-up used by the BS team . Results show that participants in the ACT condition significantly improve on eating disordered behaviors , body dissatisfaction , quality of life and acceptance for weight related thoughts and feelings , as compared to those in the TAU group . This study shows that it is possible to improve effects of  BS  by specifically targeting emotional eating behavior .
Reoperations were common in all groups .
Reoperation rate was initially high but reduced markedly with improved b and 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
Introduction Durability is a key requirement for the broad acceptance of bariatric surgery .