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Obesity Surgery December 2013 issue: the highlights

The December issue of Obesity Surgery (Volume 23, Issue 12,), the official journal of the International Federation for the Surgery of Obesity and Metabolic Disorders, is now available online. Here are some of the highlights from this issue:

Gastric Bypass and Sleeve Gastrectomy for Type 2 Diabetes: A Systematic Review and Meta-analysis of Outcomes.
Researchers wanted to ascertain whether Roux-en-Y gastric bypass (GBP) or sleeve gastrectomy (SG) is the most effective procedure and their review compared T2D remission and weight loss in patients with T2D after each procedure.  A total of 21 prospective (three randomised control trials) and 12 retrospective studies, involving 1,375 patients were included. They reported that there were no significant differences in either T2D remission or weight loss, and weight loss with both procedures increase substantially between three and 12 months post-operatively.  They added that additional randomised controlled trials comparing both procedures are needed to evaluate relative benefits.

Early Post-operative Complications: Incidence, Management, and Impact on Length of Hospital Stay. A Retrospective Comparison Between Laparoscopic Gastric Bypass and Sleeve Gastrectomy.
The investigators examined the incidence of early complications following LRYGB and LSG and their impact on hospital stay (HS). A total of 1,345 LRYGB operations and 686 LSG operations were evaluated. The results reported the differences between the procedures in terms of: gender, mean BMI, median length of HS, leakage and bleeding, and prolonged elevation of inflammatory markers. They concluded that although LSG was associated with more early complications, it could be attributed to higher BMI and predominance of males in LSG group.

Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy.
During the Fourth International Consensus Summit on LSG in New York Dec. 2012, an online questionnaire was filled out by 130 surgeons experienced in LSG to assess the procedural data and outcomes. The 130 surgeons performed 46,133 LSGs. The paper reports the following: number of procedures converted to an open operation, sole operation or second stage procedure, bougie size, staple-line reinforcement, mean %EWL at years 1-6, complications, mortality and nutritional deficiency rates.

Remission of Type 2 Diabetes Mellitus Should Not Be the Foremost Goal after Bariatric Surgery.
The aim of this study was to evaluate the metabolic control status in patients considered as diabetes “non-remitters.” A retrospective study of 125 patients with preoperative diagnosis of T2D who underwent surgery was conducted. The researchers evaluated the metabolic status of non-remitters, according to the American Diabetes Association's (ADA) target recommendations. They reported that although almost 50 % of the patients may not be classified as diabetes remitters, significant improvement in metabolic control should be regarded as a success, according to most scientific societies' target recommendations.

Bariatric Surgery for the Treatment of Severely Obese Patients in South Korea—Is it Cost Effective?
The researchers undertook the cost effectiveness study of bariatric surgery in South Korea, the first such study in Asia. They compared cost effectiveness of bariatric surgery to nonsurgical interventions for severe obese Korean people. They used the Markov model to compare the lifetime expected costs and quality-adjusted life years (QALYs) between bariatric surgery and nonsurgical interventions from Korean Healthcare system perspectives, and an incremental cost-effectiveness ratio (ICER) of bariatric surgery compared to non-surgery interventions was calculated. They found that bariatric surgery was a cost-effective alternative to nonsurgical interventions over a lifetime, providing substantial lifetime benefits for severely obese Korean people.