Relationship among Adiponectin, Adiponectin Gene Expression and Fatty Acids Composition in Morbidly Obese Patients

Background he aim of this study was to examine the relationship between adiponectin plasma circulating levels and its gene expression in two abdominal fat depots (subcutaneous and visceral) with the fatty acid composition of plasma and adipose tissue in morbidly obese subjects. Methods 20 patients (10 women and 10 men) were selected. All were morbidly obese (BMI ≥40 kg/m²) and admitted for gastric surgery. Plasma samples and adipose tissue from both subcutaneous and visceral regions were obtained. Plasma adiponectin and adipose adiponectin expression were analyzed. Results Adiponectin mRNA expression in the subcutaneous tissue was significantly higher (P = 0.048) than in visceral tissue. Circulating adiponectin values, were positively associated with the proportion of n-3 polyunsaturated fatty acids in plasma (r = 0.62, P = 0.002). The visceral depot showed greater statistical associations between adiponectin gene expression and fatty acids profile, being saturated fatty acids associated with a decrease (r = −0.68, P = 0.015), whereas monounsaturated were related to an increase in this adipose region (r = 0.67, P = 0.017). Conclusions e demonstrated significant associations between adipose tissue adiponectin gene expression and fatty acid composition. These associations were more evident in relation to the visceral depot, an adipose tissue region highly implicated in the metabolic syndrome.     

GLP-1 and Adiponectin: Effect of Weight Loss After Dietary Restriction and Gastric Bypass in Morbidly Obese Patients with Normal and Abnormal Glucose Metabolism

Background  It has been proposed that there is improvement in glucose and insulin metabolism after weight loss in patients who underwent diet restriction and bariatric surgery. Methods  Eleven normal glucose tolerant (NGT) morbidly obese patients [body mass index (BMI), 46.1 ± 2.27 g/m²] and eight abnormal glucose metabolism (AGM) obese patients (BMI, 51.20 kg/m²) were submitted to diet-restriction and bariatric surgery. Prospective study on weight loss changes, over the glucose, insulin metabolism, glucagon-like peptide-1 (GLP-1), and adiponectin levels were evaluated by oral glucose tolerance test during three periods: T1 (first evaluation), T2 (pre-surgery), and T3 (9 months after surgery). Results  Insulin levels improved after surgery. T1 was 131.1 ± 17.60 pmol/l in the NGT group and 197.57 ± 57.94 pmol/l in the AGM group, and T3 was 72.48 ± 3.67 pmol/l in the NGT group and 61.2 ± 9.33 pmol/l in the AGM group. The major reduction was at the first hour of the glucose load as well as fasting levels. At 9 months after surgery (T3), GLP-1 levels at 30 and 60 min had significantly increased in both groups. It was observed that the AGM group had higher levels of GLP-1 at 30 min (34.06 ± 6.18 pmol/l) when compared to the NGT group (22.69 ± 4.04 pmol/l). Homeostasis model assessment of insulin resistance from the NGT and AGM groups had a significant reduction at periods T3 in relation to T1 and T2. Adiponectin levels had increased concentration in both groups before and after surgical weight loss. However, it did not have any statistical difference between periods T1 vs. T2. Conclusions  Weight loss by surgery leads to improvement in the metabolism of carbohydrates in relation to sensitivity to the insulin, contributing to the reduction of type 2 diabetes incidence. This improvement also was expressed by the improvement of the levels of adiponectin and GLP-1.     

Robotic-Assisted Laparoscopic Hysterectomy: Outcomes in Obese and Morbidly Obese Patients

Objective:

To describe patient characteristics and perioperative outcomes among women undergoing robotic-assisted laparoscopic hysterectomy and to evaluate the characteristics of nonobese, obese, and morbidly obese patients.

Methods:

A retrospective review was conducted of 442 cases of women who underwent robotic-assisted laparoscopic hysterectomy for benign and malignant conditions over a 4-y period at an academic and community teaching hospital. Patient demographics, surgical indications, operative outcomes, and complications were evaluated for patients with a body mass index (BMI) <30 kg/m², 30 kg/m² to 39.9 kg/m², and ≥40 kg/m².

Results:

Of the 442 patients, 257 (58%) were obese or morbidly obese, with a BMI of ≥30 kg/m². Overall, the median estimated blood loss was 100 mL (range, 10 to 800), the operative time was 135 min (range, 40 to 436), and the length of stay was 1 d (range, 0 to 22). These did not differ significantly by BMI group. Overall, 11.9% of patients experienced complications (7.9% minor, 4.1% major), and this did not differ significantly across BMI groups.

Conclusion:

Robotic hysterectomy can be performed safely in obese and morbidly obese patients, with surgical outcomes and complications similar to those in nonobese patients.     

Stanford Type A Aortic Dissection which Ruptured into the Left Atrium: Report of a Case

A Stanford type A aortic dissection ruptures usually into the pericardial space or the mediastinal space. We herein report the rare surgical case of a Stanford type A aortic dissection which ruptured into the left atrium. The patient had a previous history of mitral valve replacement. The time and the cause of the aortic dissection was unclear. At operation, adhesions around the proximal aorta and between the aortic root and the left atrial roof were confirmed to be one of the causes for this rare form. A fistula to the cardiac cavity following an aortic dissection may occur in any patient, especially in those with a history of previous cardiac surgery. Received: November 19, 2001 / Accepted: July 2, 2002 Reprint requests to: K. Matsumoto     

Relationship Between Knee Anthropometry and Surgical Time in Total Knee Arthroplasty in Severely and Morbidly Obese Patients: A New Prognostic Index of Surgical Difficulty

BACKGROUND: Total knee arthroplasty (TKA) in patients with severe and morbid obesity is one of the current challenges in prosthetic knee surgery. The body mass index (BMI) is used to identify patients who may present difficulties during surgery and postoperative complications. We carried out a prospective study with an initial hypothesis that BMI is not associated with tourniquet time in obese patients undergoing TKA and that some anthropometric parameters may be useful in predicting tourniquet time in severely and morbidly obese patients. METHODS: One hundred consecutive patients diagnosed with knee osteoarthritis with BMI > or =35 kg/m(2) scheduled for TKA were prospectively studied. Suprapatellar, infrapatellar, and supra/infrapatellar anthropometric indexes were calculated before surgery. The tourniquet time was determined. RESULTS: The mean BMI was 39.81 kg/m(2) (SD +/- 3.75). A total of 58% of patients were classified as class III obesity (BMI 35-39.99) and 42% as class IV (BMI > or = 40) Mean tourniquet time was 41.67 min (SD +/- 9.26). There was no association between the BMI and tourniquet time. The suprapatellar index was negatively associated with tourniquet time (p < 0.038). DISCUSSION: The BMI is not the only parameter that should be considered in order to identify severely and morbidly obese patients who may have more surgical difficulties during TKA. Preoperative determination of the suprapatellar index helped us to classify these patients according to the morphology of the knee and predicted a longer tourniquet time and, therefore, greater surgical difficulty, in patients with a suprapatellar ratio below 1.6 in this study.     

Bariatric Surgery Can Correct Iron Depletion in Morbidly Obese Women: A Link with Chronic Inflammation

Background Obesity is associated with a chronic and low-grade inflammation which may cause hypoferremia as seen in patients with chronic inflammatory diseases. The aim of the present study was to investigate the relationship between iron status and markers of inflammation in morbidly obese women and the effect of bariatric surgery. Methods Our cohort of patients consisted of 178 morbidly obese females selected for bariatric surgery. Clinical and biochemical data were recorded before surgery, and histopathological studies were carried out on preoperative liver biopsy samples. Fifty-five patients have been followed up after bariatric surgery. Results A high prevalence of iron depletion was present in this cohort, with 53% having a transferrin saturation ratio below 0.20. Iron depletion was significantly correlated with raised levels of indices of inflammation, C-reactive protein (CRP), orosomucoid and haptoglobin), and with the white blood cell count. In multivariate analysis, orosomucoid and CRP were independently associated with iron depletion. Moreover, 6 months after bariatric surgery, inflammation level decreased, which was inversely correlated with the increase in transferrin saturation. Conclusions Iron depletion is common in morbidly obese women. Low-grade chronic inflammation associated with obesity could be a modulator of iron uptake and utilization. Bariatric surgery may reduce chronic inflammation and improve iron status.     

Expression of Cytokine Signaling Genes in Morbidly Obese Patients with Non-Alcoholic Steatohepatitis and Hepatic Fibrosis

Background  White adipose tissue (WAT) from visceral adiposity plays an important role in the pathogenesis of non-alcoholic steatohepatitis (NASH). Development of NASH and its progression to fibrosis is partially due to cytokines and adipokines produced by WAT. The aim of this study was to assess the association of hepatic fibrosis and NASH by evaluating the intrinsic differences in the inflammatory cytokine signaling in the visceral adipose tissue obtained from morbidly obese patients. Methods  We used targeted microarrays representing human genes involved in the inflammatory and fibrogenic reactions to profile visceral adipose samples of 15 well-matched NASH patients with and without fibrosis. Additionally, visceral adipose samples were subjected to real-time polymerase chain reaction profiling of 84 inflammations related genes. Results  Eight genes (CCL2, CCL4, CCL18, CCR1, IL10RB, IL15RA, and LTB) were differentially expressed in NASH with fibrosis. Additionally, an overlapping but distinct list of the differentially expressed genes were found in NASH with type II diabetes (DM; IL8, BLR1, IL2RA, CD40LG, IL1RN, IL15RA, and CCL4) as compared to NASH without DM. Conclusions  Inflammatory cytokines are differentially expressed in the adipose tissue of NASH with fibrosis, as well in NASH with DM. These findings point at the interaction of adipose inflammatory cytokines, DM, hepatic fibrosis in NASH, and its progression to cirrhosis and end-stage liver disease. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Laparoscopic Roux-en-Y Gastric Bypass for Morbidly Obese Chinese Patients: Learning Curve,Advocacy and Complications

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) involves a combination of both restrictive and mal-absorptive mechanisms and has become the procedure of choice for patients with morbid obesity in Western countries. However, its efficacy remains uncertain in Asian populations. We report our pilot experience with LRYGB in a Chinese population. METHODS: Between August 2005 and February 2007, 100 morbidly obese patients received LRYGB. We evaluated the learning curve for the operation, its efficacy in weight reduction, and its postoperative complications. RESULTS: Surgical time reached a plateau after about 50 cases, decreasing from 216 min for the initial 50 patients to 105 min for the final 50. The conversion rate from laparoscopic to open surgery was 2%. The mean percent body mass index loss was 33.9% after 12 months. Twenty-four complications occurred in 18 patients, but most resolved with conservative treatment without mortality. Patients with advanced age (P = 0.04) or hypertension (P = 0.03) were at increased risk for complications leading to prolonged surgical times and hospital stays. The complication rate declined as technical expertise increased. CONCLUSION: In Chinese patients with morbid obesity, LRYGB is promising procedure because of its acceptable learning curve, good efficacy, and low complication rate.     

Serum C-Reactive Protein and White Blood Cell Count in Morbidly Obese Surgical Patients

Background  Obesity has been widely recognized as a chronic inflammatory condition and associated with elevated inflammatory indicators including C-reactive protein (CRP) and white blood cell count (WBC). Recent studies have shown elevated CRP or WBC is a significant risk factor for cardiac events and stroke but the clinical significance of CRP and WBC has not been clearly studied in morbidly obese patients. This study is aimed at the clinical significance of WBC and CRP in morbidly obese patients and the change after bariatric surgery. Methods  The study was a prospectively controlled clinical study. From December 1, 2001 to January 31, 2006, of 640 (442 females and 198 males) consecutive morbid obese patients enrolled in a surgically supervised weight loss program with at least 1 year’s follow-up were examined. Results  Of the patients, 476 (74.4%) had elevated CRP and 100 (15.6%) had elevated WBC at preoperative study. CRP and WBC were significantly related and both increased with increasing body mass index (BMI). CRP is also increased with increasing waist, glucose level, hemoglobin, albumin, Ca, insulin, C-peptide, and metabolic syndrome while WBC is increased with metabolic syndrome but decreased with increasing age. Multivariate analysis confirmed fasting glucose level and hemoglobin are independent predictors of the elevation of CRP while age is the only independent predictor for elevated WBC. Both WBC and CRP levels decreased rapidly after obesity surgery. These improvements resulted in a 69.8% reduction of CRP and 26.4% reduction of WBC 1 year after surgery. Although individuals who underwent laparoscopic gastric bypass lost significantly more weight (36.8 ± 11.7 kg vs. 17.3 ± 10.8 kg; p = 0.000) and achieved a lower BMI (27.8 ± 4.6 vs. 35.0 ± 5.5; p = 0.000) than individuals who underwent laparoscopic gastric banding, there was no difference in the resolution of elevated CRP 1 year after surgery (95.9% vs. 84.5%; p = 0.169) and WBC (99.4% vs. 98.3%; p = 0.323). Conclusions  Both baseline WBC and CRP are elevated in morbid obese patients but CRP has a better clinical significance. Significant weight reduction 1 year after surgery markedly reduced CRP and WBC with a resolution rate of 93.9% and 98.2% separately. Obesity surgery performed by laparoscopic surgery is recommended for obese patients with elevated CRP or WBC.     

部分左心房切除的扩大切除术在局部晚期肺癌16例手术中的应用临床观察

目前 探讨左心房部分切除的肺扩大切除术治疗局部晚期肺癌的手术方法及临床疗效。方法 2001年12月至2006年12月,16例肿瘤累及左心房的局部晚期肺癌患者施行肺叶或全肺切除时,同时切除部分左心房。其中左肺下叶切除6例,左全肺切除4例,右肺中下叶切除3例,右肺下叶切除3例。结果 16例患者均顺利完成手术,无手术死亡及术中并发症。术后有2例发生心律失常,2例并发肺炎。平均存活时间36个月,术后1、3、5年生存率分别为75%（12/16）、43.75%（7/16）、25％（4/16）。结论 肺切除加部分左心房切除的扩大切除术治疗局部晚期肺癌,术后配以放化疗,具有较好的临床疗效,能明显提高其生存质量并延长生存时间。     

Incarcerated Spigelian Hernia in Morbidly Obese Patients: the Role of Intraoperative Ultrasonography for Hernia Localization

Background: Spigelian hernias are uncommon and their diagnosis can be difficult. Ultrasonography is, as a rule helpful in making the diagnosis, but extensive exploration is sometimes needed to locate the defect. Methods: Two patients are described in whom the diagnosis was made preoperatively by ultrasonography, but intraoperative location of the hernias proved extremely difficult because of the patients' obesity. Results: In the first patient, the hernia was located by means of intraoperatively performed ultrasonography. In the second patient, ultrasonography was combined with intraoperatively insufflated pneumoperitoneum and this proved successful in identifying the position of the sac. Conclusion: Intraoperative ultrasonography is a valid option for accurate localization of Spigelian hernias, especially in obese patients; extensive intraoperative dissection, distortion of tissue planes, and associated morbidity risks may be avoided.     

Orally Administered Ranitidine Plasma Concentrations before and after Biliopancreatic Diversion in Morbidly Obese Patients

Background: Patients undergoing biliopancreatic diversion (BPD) may develop gastric ulcers, particularly within the first postoperative year. The prophylactic use of antisecretory compounds at the usual therapeutic doses, mainly conventional H₂-receptor antagonists such as ranitidine, may reduce the incidence of this complication, which occurs in ∼5% of patients after BPD. Methods: The authors measured the plasma concentrations of ranitidine (300 mg orally) in obese patients, before and 8 months after BPD, and in control subjects of normal weight. The study included 11 obese patients undergoing BPD (age 45 ± 14 years; preoperative and postoperative weights 124 ± 21 and 92 ± 11 kg) and 10 normal-weight subjects (age 37 ± 13 years, weight 67 ± 9 kg). Results: Postoperative ranitidine plasma concentrations showed only minor differences from preoperative levels, with slightly higher maximum concentrations occurring sooner. The mean area under the curve was on the average 30% higher than preoperatively. All parameters, however, were similar to those in control subjects. Conclusions: BPD per se does not greatly affect the pharmacokinetic behavior of ranitidine, and therefore a conventional dosage regimen appears adequate for the prophylaxis and therapy of gastric ulcers associated with this operation.     

Outcome Following Bariatric Surgery in Super versus Morbidly Obese Patients: Does Weight Matter?

Background: Numerous investigators have attempted to identify prognostic indicators for successful outcome following bariatric surgery. The purpose of this study was to determine whether degree of obesity affects outcome in super obese [>225% ideal body weight (IBW)] versus morbidly obese patients (160-225% IBW) undergoing gastric restrictive/bypass procedures. Methods: Since 1984, 157 patients underwent either gastric bypass or vertical banded gastroplasty. Super obese (78) and morbidly obese (79) patients were followed prospectively, documenting outcome and complications. Results: Super obese patients reached maximum weight loss 3 years following bariatric surgery, exhibiting a decrease in body mass index (BMI) from 61 to 39 kg/m² and an average loss of 42% excess body weight (EBW). Morbidly obese patients had a decrease in BMI from 44 to 31 kg/m² and carried 39% EBW at 1 year. After their respective nadirs, each group began to regain the lost weight with the super obese exhibiting a current BMI of 45 kg/m² (61% EBW) versus 34 kg/m² (52% EBW) in the morbidly obese at 72 months cumulative follow-up. Currently, loss of 50% or more of EBW occurred in 53% of super obese patients versus 72% of morbidly obese (P < 0.01). Twenty-six percent of super obese patients returned to within 50% of ideal body weight (IBW) while 71% of morbidly obese were able to reach this goal (P < 0.01). Co-morbidities and complications related to surgery were similar in each group. Conclusions: Super obese patients have a greater absolute weight loss after bariatric surgery than do morbidly obese patients. Using commonly utilized measures of success based on weight, morbidly obese patients tend to have better outcomes following bariatric surgery.     

Changes in Bone Mineral Density, Body Composition and Adiponectin Levels in Morbidly Obese Patients after Bariatric Surgery

Background  Gastric bypass surgery (GBP) is increasingly used as a treatment option in morbid obesity. Little is known about the effects of this surgery on bone mineral density (BMD) and the underlying mechanisms. To evaluate changes on BMD after GBP and its relation with changes in body composition and serum adiponectin, a longitudinal study in morbid obese subjects was conducted. Methods  Forty-two women (BMI 45.0 ± 4.3 kg/m²; 37.7 ± 9.6 years) were studied before surgery and 6 and 12 months after GBP. Percentage of body fat (%BF), fat-free mass (FFM), and BMD were measured by dual-energy X-ray absorptiometry and serum adiponectin levels by RIA. Results  Twelve months after, GBP weight was decreased by 34.4 ± 6.5% and excess weight loss was 68.2 ± 12.8%. Significant reduction (p < 0.001) in total BMD (−3.0 ± 2.1%), spine BMD (−7.4 ± 6.8%) and hip BMD (−10.5 ± 5.6%) were observed. Adiponectin concentration increased from 11.4 ± 0.7 mg/L before surgery to 15.7 ± 0.7 and 19.8 ± 1.0 at the sixth and twelfth month after GBP, respectively (p < 0.001). Thirty-seven percent of the variation in total BMD could be explained by baseline weight, initial BMD, BF reduction, and adiponectin at the twelfth month (r ² = 0.373; p < 0.001). Adiponectin at the twelfth month had a significant and positive correlation with the reduction of BMD, unrelated to baseline and variation in body composition parameters (adjusted correlation coefficient: r = 0.36). Conclusion  GBP induces a significant BMD loss related with changes in body composition, although some metabolic mediators, such as adiponectin increase, may have an independent action on BMD which deserves further study.     

Serum Phenylalanine Concentration as a Marker of Liver Function in Obese Patients Before and After Bariatric Surgery

Background  Human obesity is associated with increased serum phenylalanine concentration, which is probably caused by liver dysfunction related to liver steatosis. This study examines whether improvements of liver function after bariatric surgery is associated with a decrease of serum phenylalanine concentration caused by an increase of phenylalanine metabolism. Method  Serum phenylalanine and alanine aminotransferase (an independent predictor of liver steatosis) concentrations as well as several parameters related to obesity were measured in 16 obese patients (seven men and nine women) before and 6 months after vertical banded gastroplasty. Ten (six men and four women) lean, healthy subjects served as controls. Results  Obese patients before surgery had approximately twofold higher serum phenylalanine concentration than control subjects. The serum phenylalanine concentration decreased 6 months after bariatric surgery. Serum alanine aminotransferase (ALT) concentration was higher in obese patients before surgery, and decreased 6 months after bariatric surgery. Changes in serum phenylalanine concentration correlated positively with changes of ALT concentration (r = 0.75; p < 0.001). The body weight, BMI, HOMA-IR, serum triacylglycerol, LDL-cholesterol/HLD-cholesterol ratio, leptin, insulin, and glucose concentrations were higher in obese patients, and decreased 6 months after bariatric surgery. Serum HDL-cholesterol concentration was lower in obese patients before surgery than in control subjects and increased 6 months after surgery. Conclusion  Results obtained indicate that bariatric surgery-induced weight loss had beneficial effects on several laboratory parameters including serum phenylalanine, ALT, lipid concentrations and insulin resistance. A strong positive correlation between serum phenylalanine and serum ALT concentrations suggests that deterioration of liver function in obese patients is contributing to a decrease in phenylalanine metabolism and consequently to the increase of serum phenylalanine concentration. One can suppose that serum phenylalanine concentration could be noninvasive marker of liver dysfunction associated with liver steatosis in obese patients.     

Adiponectin gene variant RS rs266729: Relation to lipid profile changes and circulating adiponectin after bariatric surgery

Background

ADIPOQ rs266729 have been associated with body mass index and metabolic parameters.

A Comparison of Open Surgery,Robotic-Assisted Surgery and Conventional Laparoscopic Surgery in the Treatment of Morbidly Obese Endometrial Cancer Patients

Methods:Morbidly obese (body mass index [BMI] > 40 kg/m²) patients with endometrial cancer who underwent OS, robotic-assisted laparoscopic surgery (RS), or conventional laparoscopic surgery (LS) were eligible. We sought to discern any outcome differences with regard to operative time, perioperative complications, and hospital stay.Results:Sixteen patients were treated with LS (BMI = 47.9 kg/m²), 13 were managed via RS (BMI = 51.2 kg/m²), and 24 underwent OS (BMI = 53.7 kg/m²). The OS (1.35 hours) patients had a significantly shorter operative duration than the LS (1.82 hours) and RS (2.78 hours) patients (P < .001); blood loss was greater in the OS (250 mL) group in comparison with the RS (100 mL) and LS (175 mL) patients (P = .002). Moreover, the OS (4 days) subjects had a significantly longer hospital stay than the LS (2 days) and RS (2 days) patients (P = .002).Conclusion:In the present study, we ascertained that minimally invasive surgery was associated with longer operative times but lower rates of blood loss and shorter hospital stay duration compared with treatment comprising an open procedure.     

Laparoscopic Adjustable Gastric Banding in 1,791 Consecutive Obese Patients: 12-Year Results

Background This study examines 1,791 consecutive laparoscopic adjustable gastric banding (LAGB) procedures with up to 12 years follow-up. Long-term results of LAGB with a high follow-up rate are not common. Methods Between September 1993 and December 2005, 1,791 consecutive patients (75.1% women, mean age 38.7 years, mean weight 127.7 ± 24 kg, mean BMI 46.2 ± 7.7) underwent LAGB by the same surgical team. Perigastric dissection was used in 77.8% of the patients, while subsequently pars flaccida was used in 21.5% and a mixed approach in 0.8%. Data were analyzed according to co-morbidities, conversion, shortand long-term complications and weight loss. Fluoroscopy-guided band adjustments were performed and patients received intensive follow-up. The effects of LAGB on life expectancy were measured in a case/control study involving 821 surgically-treated patients versus 821 treated by medical therapy. Results Most common baseline co-morbidities (%) were hypertension (35.6), osteoarthritis (57.8), diabetes (22), dyslipidemia (27.1), sleep apnea syndrome (31.4), depression (21.2), sweet eating (22.5) and binge eating (18.5). Conversion to open was 1.7%: due to technical difficulties (1.2) and due to intraoperative complications (0.5).Together with the re-positioning of the band, additional surgery was performed in 11.9% of the patients: hiatal hernia repair (2.4), cholecystectomy (7.8) and other procedures (1.7). There was no mortality. Reoperation was required in 106 patients (5.9%): band removal 55 (3.7%), band repositioning 50 (2.7%), and other 1 (0.05%). Port-related complications occurred in 200 patietns (11.2%). 41 patients (2.3%) underwent further surgery due to unsatisfactory results: removal of the band in 12 (0.7%), biliopancreatic diversion in 5 (0.27%) and a biliopancreatic diversion with gastric preservation (“bandinaro”) in 24 (1.3%). Weight in kg was 103.7 ± 21.6, 102.5 ± 22.5, 105.0 ± 23.6, 106.8 ± 24.3, 103.3 ± 26.2 and 101.4 ± 27.1 at 1, 3, 5, 7, 9, 11 years after LAGB. BMI at the same intervals was 37.7 ± 7.1, 37.2 ± 7.2, 38.1 ± 7.6, 38.5 ± 7.9, 37.5 ± 8.5 and 37.7 ± 9.1. The case/control study found a statistically significant difference in survival in favor of the surgically-treated group. Conclusions LAGB can achieve effective, safe and stable long-term weight loss. In experienced hands, the complication rate is low. Follow-up is paramount. Presented at the 11th World Congress of the International Federation for the Surgery of Obesity, Sydney, Australia, September 1, 2006.     

Effect of Wound Closure Technique on Wound Infection in the Morbidly Obese: results of a randomized trial

The effect of suture obliteration of the subcutaneous dead space in morbidly obese abdominal wounds was studied in a randomized trial, comparing a pre-fascial retention suture technique (utilized for approximation of the thick panniculus) to controls where the skin was simply closed with staples. The wound infection rates were similar (11.8% for the sutured group versus 12.3% for controls, p > 0.4), as were the total wound complication rates (26.5% for sutured group versus 21.9% for controls, p > 0.4). Ultrasound study of the wounds closed without suturing the panniculus demonstrated no dead spaces. We conclude that no advantage is to be gained by suturing the subcutaneous fat, however thick. The finding is of general application in wound closures involving thick layers of fat.