to study the relationship between diet and cancer. They observed five
deaths in 5,960 patient-years of follow-up in the surgical group, and
225 deaths in 25,280 patient-years of follow-up in the reference cohort.
Cox regression analysis indicated that the surgical patients were
73 per cent less likely to die than the control subjects (age, sex and BMI-
adjusted relative risk of death 0.27; 95 per cent CI: 0.09–0.81).50
American investigators determined long-term mortality (18 years; mean
8.4 years) among 8,172 morbidly obese patients treated by gastric by-pass
at a single surgical practice and in 8,172 population-based controls
matched for age, gender and BMI. Total mortality was found to have
reduced by 50 per cent in the surgical group (P < 0.0001). 51
An additional important finding of our study was the absence of a
clear dose-response relationship between the degree of weight loss and the
observed reduction of mortality. In our surgical series, the mortality rate
was significantly reduced in patients with a moderate weight reduction
(10–20 per cent of baseline body weight) as compared with patients with
no weight loss or weight gain (age, sex and BMI-adjusted relative risk of
death 0.11; 95 per cent CI: 0.01–0.91), but a more pronounced weight loss
(> 20 per cent of baseline body weight) seemed not to be associated with
an additional reduction of mortality (age, sex and BMI-adjusted relative
risk of death 0.27; 95 per cent CI: 0.06–1.29).48 This observation is based
on a very low number of events and should therefore be interpreted cau-
tiously. However, it seems to be confirmed by epidemiologic studies
investigating the relationship between intentional weight loss and total
mortality in the general population. In women with obesity-related health
problems, the reduction in the fully adjusted total mortality rate observed
after intentional weight loss was similar in subjects with 0.5–9.0 or >
9.0 kg of weight loss.52 In the overweight diabetic men enrolled in the
American Cancer Society’s Cancer Prevention Study I, the lowest mortal-
ity rate was found in patients experiencing a moderate 20–29 lb body
weight reduction.53 Finally, the observation that it may not be necessary to
achieve massive levels of weight loss to obtain a reduction in total mor-
tality of the morbidly obese patient fits very well with the previously
presented observations demonstrating that significant improvements in
metabolic and respiratory co-morbidities may be obtained with a moder-
ate weight loss in severe obesity, as well as in obesity in general.
382
L. Busetto et al.
Conclusion
In conclusion, we summarized in this review the large body of scientific
evidence definitively proving the sustained benefits of bariatric surgery on
obesity-related metabolic and respiratory co-morbidities and on the health
related quality of life. We finally presented more recent results suggesting
that these benefits may actually translate into a reduction of total mortality
in morbidly obese patients treated with bariatric surgery. In our opinion,
providing that operative mortality was kept at the very low level now
achievable by modern procedures, this evidence is sufficient to conclude
that bariatric surgery really improves long-term survival in morbid obesity.
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Index
389
abdominal
239, 247, 262, 273
pain
236, 250, 262, 268, 272
abscess
239, 247, 262, 273
acute concentric
233, 234, 242
adhesion
261, 262, 264, 272
adiponectin
332, 339
adjustable gastric banding (AGB)
91, 92, 125, 149, 327, 330,
333–336, 338, 340, 342, 344,
345, 347
aldosterone
328, 330
alimentary
behaviour
62, 72
limb
161–163, 170, 184
anastomosis
245, 246, 248–254,
256, 257, 259, 262, 263, 266, 267,
269–272, 274
anastomotic
leak
247, 249, 251
obstruction
247, 252
structure
245, 246, 248–254,
256, 257, 259, 262, 263, 266,
267, 269–272, 274
anatomy
224, 226, 245, 246, 248,
273
angiography
256
angiotensin
328
anterior slippage
235, 240
apnoea-hypopnea index (AHI)
331
associated disease
76
Ballobes Intragastric Balloon
63
balloon
224, 228, 230, 233, 234,
237, 241, 242, 244
deflation
241, 242
band
223–242, 244, 262
adjustment
224, 226, 230–232,
235, 241
erosion
238, 239, 244
removal
232, 238
slippage
228, 235, 237, 240
band slip–hernia–pouch dilatation
complex
234, 236, 240
Bariatric Analysis and Reporting
Outcome System (BAROS)
347,
348
BAROS MA II
317
bariatric surgery
223, 245, 247,
253, 261, 273, 285, 286, 291
barium
226–228, 230, 231,
233–237, 239, 248, 251, 253, 257,
258, 264–266
390
Index
Barrett’s oesophagus
343, 344
best practice care recovery model
306
beta cell
338
Bezoar
237, 261, 265
bilevel positive airway pressure
(BIPAP)
51
biliopancreatic diversion (BPD)
327, 330, 334, 336–339, 343, 347,
348
biliopancreatic limb
245, 246, 253,
256, 258, 266, 267
BioEnterics Intragastric Balloon
(BIB)
61, 64–86
intolerance
83
removal of
70, 74, 82, 84
bleeding
171, 175, 177, 247, 250
blood pressure (BP)
328–330
body mass index (BMI)
16, 17, 27,
46, 47, 51
bowel obstruction
244, 247, 249,
253, 256, 261, 262, 264, 265, 267,
269, 271, 272
Buchwald meta-analysis
337
cardiac output (CO)
26, 29–31
cholelithiasis
177
cholesterol
327, 330, 334–337
chronic concentric pouch dilatation
233
closed-loop obstruction
253
closing capacity (CC)
24, 25
clot
253, 255, 256
co-morbidity
2, 4, 5, 7, 9, 207, 213,
214, 327–329, 343, 346, 348
metabolic
361
complications
125–130, 133, 136,
138, 140–142, 144, 146, 151, 152,
155, 160, 171, 179, 186, 202–205,
208–210, 215, 217, 223, 224, 226,
228, 230, 232, 238, 239, 241, 242,
244–247, 255–257, 262, 272, 273
balloon
241
band
238
major
82, 84
minor
82
computed tomography (CT)
223,
224, 226, 228, 229, 238, 240, 245,
247, 248, 251, 252, 255, 256, 259,
261–263, 265–274
congestive heart failure (CHF)
18,
20, 28
connecting tube
225, 227, 229,
242–244
continuous positive airway pressure
(CPAP)
26, 51, 331–334
death
247, 252, 273
deficiencies
180
delayed gastric emptying
66, 69
depression
345
diabetes
157, 158, 173, 185, 187,
188
type 2
336–343, 361–366, 378
‘diet of thoughts’
300, 301, 308,
315, 321
discomfort
66
distribution volume (Vd)
31–36
duodenum
245, 253, 256, 270
dyslipidemia
334–336, 368–370
dysmotility
232
dysphagia
226, 233, 237, 264
eccentric pouch dilatation
233–236,
240
end tidal CO2 (ETCO2)
49
endobarrier
286
endoscopy
237, 239, 252, 255–257,
259, 264
Epworth sleepiness scale (ESS)
332, 333
evidenced based practice
320
exertional dyspnoea
371, 372
expiratory volume reserve (EVR)
24
extravasation
238, 250, 259
fibreoptic bronchoscope (FOB)
42,
45
fistula
247, 249, 250, 257–259, 261
fluid collection
228, 229, 240, 247,
252, 267, 273
fluoroscopic guidance
228, 230
food
224, 232, 234, 235, 237, 240,
245, 246, 258, 265
intolerance
232, 234, 235,
240
forced expiratory volume in one
second (FEV1)
24
forced vital capacity (FVC)
24
foregut
339
fractional inspired oxygen
concentration (FiO2)
33, 46, 48
free fatty acids (FFA)
31
fully stapled laparoscopic Roux-en-Y
gastric bypass (FS-LRYGB)
164,
165
functional residual capacity (FRC)
24, 25
Garren-Edwards Gastric Bubble
(GEGB)
62, 63
gastric
dilation
69
obstruction
82–84, 236, 237,
240
perforation
83, 84, 238
pouch
156, 157, 161–163,
165–168, 173, 174, 177, 181,
184, 224, 234, 245, 248–251,
254, 255, 258, 261, 262, 265,
269
remnant
249, 252, 253,
259–261
gastrogastric fistula
247, 249,
257–259, 261
gastrografin
249, 251, 254, 255,
259, 260
gastrointestinal bleed
250
gastrojejunostomy
246–249, 251,
253–260, 262–265, 270
gastro-oesophageal reflux
230,
232–234
gastro-oesophageal reflux disease
(GORD)
327, 329, 343, 344
ghrelin
157, 159, 332
glucagon-like peptide 1 (GLP-1)
157–159, 338, 339
glucose
330, 338–340, 342, 343
guidelines
4, 6
haematemesis
238, 239, 256,
272
haemorrhage
228, 238, 255–257
HbA1c
337, 342
HDL cholesterol
369–371
Index
391
health related quality of life
(HRQoL)
347, 360, 377, 383
heart rate (HR)
28, 41
Helicobacter pylori
257
hernia
hiatal
232, 250, 265, 266
internal
163, 164, 178, 179,
267, 271, 272
Petersen
267, 271
port-site
273
herniation
223, 228, 230, 235–237,
240, 242, 261, 267–272
eccentric balloon
242
gastric
228, 235–237, 240
internal
261, 267–269, 271,
272
high-density lipoprotein (HDL)
18,
21, 334–337
hindgut
339
hypercholesterolemia
327, 335,
368, 369
hypertension (IPT)
18, 21, 22,
27–30, 49, 51, 327–330, 345, 360,
367, 368
hypertriglyceridaemia
334, 335,
369, 370
ideal body weight (IBW)
16, 33,
35, 36, 47, 48, 50
imaging
223, 224, 226, 228, 242,
251, 256, 261, 262, 264, 265, 268,
272, 273, 275
indications
1, 5, 6, 8
infarction
223, 273
infection
223, 230, 239, 242, 244,
250, 257
insulin
328, 337–340, 342, 346
resistance
328, 338, 339, 346
sensitivity
338, 339
intensive care unit (ICU)
49
interventional radiology
224
intragastric balloon
61–66, 68, 73,
74, 76, 78, 79, 82, 85, 86
intraperitoneal leak
239
intravenous contrast
240, 248, 251,
265, 268–270, 274
intussusception
261, 262, 272–274
investigation
244, 247, 255–257,
259, 262, 264, 273
iron
181, 182
Jackson-Pratt drain
251, 255
jejunojejunal
anastomosis
249, 252, 253,
259, 262, 266, 267, 271, 272
obstruction
253
laparoscopic
223–225, 229, 245,
253, 262, 267, 273
gastric banding
229
laparoscopic adjustable gastric
banding (LAGB)
223, 224, 226,
230, 232, 244
laparoscopy
91, 93, 126, 127, 129,
134, 138, 144, 147
laparotomy
238, 252, 272, 273
LAP-BAND®
105, 108–110, 112,
117, 120–122
L-cell
338
leak
171, 173–175, 226, 229, 238,
239, 241, 242, 244, 247, 249–252,
255, 259, 260, 273
392
Index
lean body weight (LBW)
32, 33, 35
left ventricular end diastolic pressure
(LVEDP)
27
left ventricular stroke work (LVSW)
49
leptin
332, 339, 340
life expectancy
359–361, 378
lipoprotein
334, 335, 337
long-term result
105, 110
low back pain
345
low-density lipoprotein (LDL)
334,
336, 337
lower oesophageal sphincter (LES)
343
marginal ulcer
176, 177, 256–258
mechanism of action
210
Medical Outcome Study Short
Form-36 (MOS SF-36)
347
mental health evaluation/interview
311
metabolic syndrome
328, 330,
344
methylene blue
65, 68, 69
morbidity
164, 171
mortality
164, 171–174, 187, 188,
245, 247
multidisciplinary/interdisciplinary
team
296, 300, 303
multiple treatment
71, 81, 82, 86
musculoskeletal
327, 344, 345
mushroom sign
263, 271
natural orifice transluminal
endoscopic surgery (NOTES)
199, 214–217
negative self fulfilling prophecy
300
nitrous oxide (N2O)
24, 36
non-alcoholic steatohepatitis (NASH)
345
non-invasive blood pressure (NIBP)
38
nuclear scintigraphy
224
obesity
1–7
morbid
105, 110, 120, 285,
359–361, 364, 371, 374, 378,
383
obstruction
223, 226, 228, 230,
236–240, 244, 246, 247, 249,
251–256, 261–267, 269–272, 274
obstructive sleep apnoea (OSA)
18,
20, 22–24, 30, 41, 52, 327,
331–334
obstructive sleep apnoea syndrome
(OSAS)
41
obstructive sleep hypopnoea (OSH)
18, 22, 23
oedema
228, 237, 252–254
oesophageal dilatation
232–234
oesophago–gastro–duodenoscopy
68–70
oesophagus
229, 232, 233, 235,
245, 249, 254, 262–265, 269, 271
oral contrast
248, 250, 252, 259,
261, 263, 266
orotracheal intubation (OTI)
40–44,
47
pain
232, 233, 236, 249, 250, 252,
257, 262, 264, 268, 272
Index
393
partial pressure of carbon dioxide
in arterial blood (PaCO2)
23, 49
partial pressure of oxygen in
arterial blood (PaO2)
23, 25, 26,
43, 53
peptide YY (PYY)
157–159, 339
perforation
223, 228, 229, 238, 249,
257, 262, 271–273
peripheral nerve stimulator (PNS)
46
peritonitis
247, 250, 252, 268
physiology
156
pinch sign
268, 271
plasminogen activator inhibitor
(PAI-I)
21, 22
pleural effusion
249, 250
political change agent
321
polycystic ovary syndrome (PCOS)
327, 346
polysomnography
332, 333
port
224–228, 230, 231, 239,
241–245, 273
access
224, 228, 245
complications
242, 244
infection
239, 244
injection
241, 243
POSE (Primary Obesity Surgery
Endoluminal)
86, 286
positive end expiratory pressure
(PEEP)
26, 48, 49
post surgical support
314
posterior slippage
240,
postoperative
226–228, 230, 237,
238, 247, 249, 251–253, 256, 258,
262, 264, 267, 272, 273
pouch
224–226, 228, 230, 232–236,
238, 240, 242, 245, 246, 248–251,
253–255, 257–266, 269–271, 273
dilatation
230, 232–236, 240,
242, 262
predictive factor
75, 76
prejudice and discrimination
299
preoperative
232
strategy
76
pressure end tidal CO2
(PetCO2)
49
prosthesis
230, 245
proton pump inhibitor
69, 82
pseudoachalasia
232
pseudotumor cerebri (PTC)
345,
346
psychological informed consent
312
psychological intolerance
85
pulmonary embolism
223, 230,
247, 250
quality of life (QoL)
327, 329,
346–348
radiological investigation
247, 257,
264
reflux
230, 232–234, 250, 252, 257,
259, 266
rennin
328
residual volume (RV)
24
respiratory rate (RR)
28
restrictive respiratory impairment
372
role of psychology
293, 295
394
Index
Roux limb
245, 246, 248, 249,
253–255, 257, 258, 260, 262–264,
266, 267, 269, 270, 273, 274
Roux-en-Y anastomosis
246, 274
Roux-en-Y gastric bypass (RYGB)
155–165, 171, 173, 174, 176, 178,
179, 181–188, 223, 232, 245, 247,
253, 261, 262, 266, 267, 272, 273,
327–329, 332, 333, 335, 337–341,
344–347
satiety
224, 232
saturation of arterial haemoglobin
with oxygen (SaO2)
23, 43, 48,
51
scintigraphy
224, 230, 242
sepsis
247, 252, 273
sequential treatment
76, 78, 85,
285, 290, 292
silicone band
224, 226, 230, 236,
238
single incision laparoscopic surgery
(SILS)
199, 216, 217
sleep apnoea syndrome
374
sleeve gastrectomy
199–201, 204,
207, 213
slip
234, 236, 240
slippage
225, 228, 234–237, 240
small bowel
244, 245–247, 249,
251, 253, 261–272, 274
obstruction
244, 247, 249, 253,
261, 262, 265, 267, 269, 271,
272
sphincter
232
standard of care
2, 8, 9
staple line
245, 247–249, 253,
256–261
dehiscence
249, 253, 258–261
stapler
156, 162, 165, 166,
168–170, 176
stenosis
176, 233, 252
stoma
224–228, 232–235, 237, 242
stomach
224, 225, 227, 230,
233–236, 239, 240, 245, 253, 255,
256, 271
stomal
adjustment
226, 228
stenosis
233
ulceration
247, 256, 258, 265
stricture
247, 261, 262, 264–266
stump
246, 248, 249
succinylcholine (SCH)
32, 35, 44,
47
sulphonylurea
337
super-obese patient
61, 68, 78–80,
85, 86
suprabursal
225
surgery
1–10
Swedish Obese Subjects study (SOS)
328, 335, 346
swirl sign
269, 271
Tc99-colloid
242
technique
94–97, 102, 199, 201,
214, 217
operative
155, 164
total body weight (TBW)
35, 37
total lung capacity (TLC)
24, 25
‘transfer of addiction’ concept
312
transition point
262, 264
Index
395
transmesenteric
267, 268, 271
transmesocolic
267, 271
triglyceride
330, 335–337
UK prospective diabetes study
337
ulcer
246, 256–258
ultrasonography
224
upper gastrointestinal series (UGI)
223, 224, 226, 228, 233, 234,
236–241, 245, 247–250, 252–262,
264, 266–269, 273
ventilation/perfusion ratio (V/Q)
24, 25
vertical banded gastroplasty (VBG)
344, 345
very low density lipoprotein (VLDL)
20
vitamin B12
160, 181
volvulus
236, 238, 240
vomiting
233, 234, 236, 240, 257,
262, 264, 268, 272
weight
223, 224, 226, 228, 230,
231, 233, 234, 239–241, 245, 246,
259, 267
gain
239, 241
weight loss
2, 5–10, 202, 203,
206–208, 210, 212, 213, 223, 224,
226, 228, 231, 233, 234, 239, 240,
245–247
excess
183, 184
long-term
75
preoperative
62, 79
work of breathing (WOB)
25
wound
230, 250
infection
230, 250
396
Index