Rationale:

• Complications of obesity need intensive inpatient care.

Evidence:

• In a large controlled study (277), a large review (339), and a meta-analysis (340), several procedures are available to bariatric surgeons.
• Gastric-bypass surgery produces more weight loss that appears to be maintained more successfully than gastroplasty or laparoscopic gastric bands (277; 341; 342).
• In a systematic review and meta-analysis, 78.1% of patients with diabetes had a remission after bariatric surgery (343); bilio-pancreatic diversion was more effective than gastric bypass, which was in turn better than banding (343).
• Bariatric surgery may be a cost-effective treatment in patients recently diagnosed with type 2 diabetes (344; 345).
• Bariatric surgical procedures including gastric bypass can be done by laparoscopic surgery (346).
• A gastric sleeve produced more weight loss after 1 and 3 years than did adjustable gastric banding (347).
• Venous thrombolism is a risk of bariatric surgery (348).
• Complications including anatomic leaks, inadequate reduction in gastric size, or inadequate weight loss may require repeated hospitalization and surgery with similar risk (339; 349).
• Gastric operations for obesity reduce mortality (350; 351), increase longevity (352), and improve quality of life (352; 353).
• Malabsorptive bariatric surgery corrects both insulin hypersecretion and insulin resistance at a time when BMI is still high (354).
• Omentectomy added no benefit to gastric bypass in one study (355).

Comments:

• Complications of deep venous thromboembolism can be reduced by treatment with low-dose dalteparin (356).