Full Record & Graph Of A Top 20 Paper in Bariatric Surgery

#1 Paper of the Top 20 Papers in Bariatric Surgery

Title:

WHO WOULD HAVE THOUGHT IT - AN OPERATION PROVES TO BE THE MOST EFFECTIVE THERAPY FOR ADULT-ONSET DIABETES-MELLITUS

Authors:

PORIES WJ, SWANSON MS, MACDONALD KG, LONG SB, MORRIS PG, BROWN BM, BARAKAT HA, DERAMON RA, ISRAEL G, DOLEZAL JM, DOHM L

Source:

ANNALS OF SURGERY 222 (3): 339-352 SEP 1995

Document Type:

Article

Language:

English

Cited References:

Times Cited:

268

Abstract:

Objective:
This report documents that the gastric bypass operation provides long-term control for obesity and diabetes.

Summary Background Data:
Obesity and diabetes, both notoriously resistant to medical therapy, continue to be two of our most common and serious diseases.

Methods:
Over the last 14 years, 608 morbidly obese patients underwent gastric bypass, an operation that restricts caloric intake by (1) reducing the functional stomach to approximately 30 mt, (2) delaying gastric emptying with a c. 0.8 to 1.0 cm gastric outlet, and (3) excluding foregut with a 40 to 60 cm Roux-en-Y gastrojejunostomy. Even though many of the patients were seriously ill, the operation was performed with a perioperative mortality and complication rate of 1.5% and 8.5%, respectively. Seventeen of the 608 patients (<3%) were lost to follow-up.

Results:
Gastric bypass provides durable weight control. Weights fell from a preoperative mean of 304.4 lb (range, 198 to 615 lb) to 192.2 lb (range, 104 to 466) by 1 year and were maintained at 205.4 lb (range, 107 to 512 lb) at 5 years, 206.5 lb (130 to 388 lb) at 10 years, and 204.7 lb (158 to 270 lb) at 14 years.

The operation provides long-term control of non-insulin-dependent diabetes mellitus (NIDDM). In those patients with adequate follow-up, 121 of 146 patients (82.9%) with NIDDM and 150 of 152 patients (98.7%) with glucose impairment maintained normal levels of plasma glucose, glycosylated hemoglobin, and insulin. These antidiabetic effects appear to be due primarily to a reduction in caloric intake, suggesting that insulin resistance is a secondary protective effect rather than the initial lesion. In addition to the control of weight and NIDDM, gastric bypass also corrected or alleviated a number of other comorbidities of obesity, including hypertension, sleep apnea, cardiopulmonary failure, arthritis, and infertility.

Conclusions:
Gastric bypass is now established as an effective and safe therapy for morbid obesity and its associated morbidities. No other therapy has produced such durable and complete control of diabetes mellitus.

Keywords Plus:

HUMAN SKELETAL-MUSCLE; GLUCOSE-TRANSPORT; GASTRIC BYPASS; MORBIDLY OBESE; TOLERANCE; NIDDM

Addresses:

PORIES WJ (reprint author), E CAROLINA UNIV, SCH MED, DEPT SURG, GREENVILLE, NC 27858 USA
E CAROLINA UNIV, SCH MED, DEPT BIOCHEM, GREENVILLE, NC 27858 USA
E CAROLINA UNIV, HUMAN PERFORMANCE LAB, GREENVILLE, NC 27858 USA

Publisher:

LIPPINCOTT-RAVEN PUBL, 227 EAST WASHINGTON SQUARE, PHILADELPHIA, PA 19106

Subject Category:

SURGERY

IDS Number:

RU875

ISSN:

0003-4932

Graph - Number of Citations (by year):

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