Laparoscopic Roux-en-Y Gastric Bypass: Outcomes

  • Tomasz Rogula
  • Paul A. Thodiyil
  • Stacy A. Brethauer
  • Philip R. Schauer


Obesity is a rapidly growing health problem that contributes to numerous life-threatening or disabling problems including type 2 diabetes mellitus, hyperlipidemia, degenerative joint disease, and obstructive sleep apnea. Significant weight reduction in the morbidly obese patient improves or reverses associated illness and benefits the patient’s general well-being. The resolution of comorbidities following surgically induced weight loss is well established. Type 2 diabetes mellitus resolves in 82% to 98.8% of patients, hypertension in 52% to 91.5%, gastroesophageal reflux in 72%-97.8%, hypercholesterolemia in 63% to 97%, sleep apnea in 74% to 97.8%, stress urinary incontinence in 44% to 97%, arthritis in 41% to 90.3%, and migraine headache in 57% (1–5). Superior outcomes are expected with increasing experience, perfection of operative technique, and refinements in postoperative care.


Obstructive Sleep Apnea Bariatric Surgery Gastric Bypass Morbid Obesity Stress Urinary Incontinence 


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  1. 1.
    Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y—500 patients: technique and results, with 3–60 month follow-up. Obes Surg 2000;10(3):233–239.PubMedCrossRefGoogle Scholar
  2. 2.
    Higa KD, Boone KB, Ho T. Complications of the laparo-scopic Roux-en-Y gastric bypass: 1,040 patients—what have we learned? Obes Surg 2000;10(6):509–513.PubMedCrossRefGoogle Scholar
  3. 3.
    Higa KD, Ho T, Boone KB. Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendosc Adv Surg Tech A 2001;11(6):377–382.PubMedCrossRefGoogle Scholar
  4. 4.
    Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 2000;232(4):515–529.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    DeMaria EJ, Sugerman HJ, Kellum JM, et al. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg 2002;235(5): 640–645; discussion 645–647.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Shepherd MF, Rosborough TK, Schwartz ML. Heparin thromboprophylaxis in gastric bypass surgery. Obes Surg 2003;13(2):249–253.PubMedCrossRefGoogle Scholar
  7. 7.
    Nguyen NT, Rivers R, Wolfe BM. Factors associated with operative outcomes in laparoscopic gastric bypass. J Am Coll Surg 2003;197(4):548–555; discussion 555–557.PubMedCrossRefGoogle Scholar
  8. 8.
    Podnos YD, Jimenez JC, Wilson SE, et al. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg 2003;138(9):957–961.PubMedCrossRefGoogle Scholar
  9. 9.
    Courcoulas A, Perry Y, Buenaventura P, Luketich J. Compar-ing the outcomes after laparoscopic versus open gastric bypass: a matched paired analysis. Obes Surg 2003;13(3):341–346.PubMedCrossRefGoogle Scholar
  10. 10.
    Jones DB, Provost DA, DeMaria EJ, et al. Optimal man-agement of the morbidly obese patient SAGES appropri-ateness conference statement. Surg Endosc 2004.Google Scholar
  11. 11.
    Grundy SM, Brewer HB Jr, Cleeman JI, et al. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circu-lation 2004;109(3):433–438.CrossRefGoogle Scholar
  12. 12.
    Mattar SG, Velcu LM, Rabinovitz M, et al. Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome. Ann Surg 2005;242(4):610–617; discussion 618–620.PubMedCentralPubMedGoogle Scholar
  13. 13.
    Lew WJ, Yu PJ, Wang W et al. Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obsity: a prospective randomized controlled clinical trial. Ann Surg 2005;242:20–28.CrossRefGoogle Scholar
  14. 14.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292(14):1724–1737.PubMedCrossRefGoogle Scholar
  15. 15.
    Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparo-scopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg 2003;238(4):467–484; discussion 484–485.PubMedCentralPubMedGoogle Scholar
  16. 16.
    Friedman JE, Dohm GL, Leggett-Frazier N, et al. Restora-tion of insulin responsiveness in skeletal muscle of mor-bidly obese patients after weight loss. Effect on muscle glucose transport and glucose transporter GLUT4. J Clin Invest 1992;89(2):701–705.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effec-tive therapy for adult-onset diabetes mellitus. Ann Surg 1995;222(3):339–350; discussion 350–352.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Perugini RA, Mason R, Czerniach DR, et al. Predictors of complication and suboptimal weight loss after laparo-scopic Roux-en-Y gastric bypass: a series of 188 patients. Arch Surg 2003;138(5):541–545; discussion 545–546.PubMedCrossRefGoogle Scholar
  19. 19.
    Sugerman HJ, Sugerman EL, DeMaria EJ, et al. Bariatric surgery for severely obese adolescents. J Gastrointest Surg 2003;7(1):102–107; discussion 107–108.PubMedCrossRefGoogle Scholar
  20. 20.
    Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. 2000;232(4):515–529.Google Scholar
  21. 21.
    Scheuller M, Weider D. Bariatric surgery for treatment of sleep apnea syndrome in 15 morbidly obese patients: long-term results. Otolaryngol Head Neck Surg 2001;125(4):299–302.PubMedCrossRefGoogle Scholar
  22. 22.
    Charuzi I, Lavie P, Peiser J, Peled R. Bariatric surgery in morbidly obese sleep-apnea patients: short-and long-term follow-up. Am J Clin Nutr 1992;55(2 suppl):594S–596S.PubMedGoogle Scholar
  23. 23.
    Charuzi I, Ovnat A, Peiser J, et al. The effect of surgical weight reduction on sleep quality in obesity-related sleep apnea syndrome. Surgery 1985;97(5):535–538.PubMedGoogle Scholar
  24. 24.
    Peiser J, Ovnat A, Uwyyed K, et al. Cardiac arrhythmias during sleep in morbidly obese sleep-apneic patients before and after gastric bypass surgery. Clin Cardiol 1985; 8(10):519–521.PubMedCrossRefGoogle Scholar
  25. 25.
    Pillar G, Peled R, Lavie P. Recurrence of sleep apnea without concomitant weight increase 7.5 years after weight reduction surgery. Chest 1994;106(6):1702–1704.PubMedCrossRefGoogle Scholar
  26. 26.
    Kessler R, Chaouat A, Schinkewitch P, et al. The obesity-hypoventilation syndrome revisited: a prospective study of 34 consecutive cases. Chest 2001;120(2):369–376.PubMedCrossRefGoogle Scholar
  27. 27.
    Sugerman HJ, Fairman RP, Sood RK, et al. Long-term effects of gastric surgery for treating respiratory insufficiency of obesity. Am J Clin Nutr 1992;55(2 suppl):597S–601S.PubMedGoogle Scholar
  28. 28.
    Nguyen NT, Anderson JT, Budd M, et al. Effects of pneu-moperitoneum on intraoperative pulmonary mechanics and gas exchange during laparoscopic gastric bypass. Surg Endosc 2004;18(1):64–71.PubMedCrossRefGoogle Scholar
  29. 29.
    Nguyen NT, Lee SL, Goldman C, et al. Comparison of pulmonary function and postoperative pain after laparo-scopic versus open gastric bypass: a randomized trial. J Am Coll Surg 2001;192(4):469–476; discussion 476–477.PubMedCrossRefGoogle Scholar
  30. 30.
    Frezza EE, Ikramuddin S, Gourash W, et al. Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass. Surg Endosc 2002;16(7):1027–1031.PubMedCrossRefGoogle Scholar
  31. 31.
    Schauer P, Hamad G, Ikramuddin S. Surgical manage-ment of gastroesophageal reflux disease in obese patients. Semin Laparosc Surg 2001;8(4):256–264.PubMedCrossRefGoogle Scholar
  32. 32.
    Scapinelli R. [Obesity and articular tropho-mechanic dis-orders]. Clin Ortop 1975;26:97–108.PubMedGoogle Scholar
  33. 33.
    Parvizi J, Trousdale RT, Sarr MG. Total joint arthroplasty in patients surgically treated for morbid obesity. J Arthro-plasty 2000;15(8):1003–1008.CrossRefGoogle Scholar
  34. 34.
    Cummings JM, Rodning CB. Urinary stress incontinence among obese women: review of pathophysiology therapy. Int Urogynecol J Pelvic Floor Dysfunct 2000;11(1):41–44.PubMedCrossRefGoogle Scholar
  35. 35.
    Noblett KL, Jensen JK, Ostergard DR. The relationship of body mass index to intra-abdominal pressure as measured by multichannel cystometry. Int Urogynecol J Pelvic Floor Dysfunct 1997;8(6):323–326.PubMedCrossRefGoogle Scholar
  36. 36.
    Bump RC, Sugerman HJ, Fantl JA, McClish DK. Obesity and lower urinary tract function in women: effect of sur-gically induced weight loss. Am J Obstet Gynecol 1992; 167(2):392–397; discussion 397–399.PubMedCrossRefGoogle Scholar
  37. 37.
    Raftopoulos Y, Gagne DJ, Papasavas P, et al. Improvement of hypothyroidism after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg 2004;14(4):509–513.PubMedCrossRefGoogle Scholar
  38. 38.
    Chousleb E, Szomstein S, Podkameni D, et al. Routine abdominal drains after laparoscopic Roux-en-Y gastric bypass: a retrospective review of 593 patients. Obes Surg 2004;14(9):1203–1207.PubMedCrossRefGoogle Scholar
  39. 39.
    Youssef WI, McCullough AJ. Steatohepatitis in obese indi-viduals. Best Pract Res Clin Gastroenterol 2002;16(5): 733–747.PubMedCrossRefGoogle Scholar
  40. 40.
    Marceau P, Kaufman D, Biron S, et al. Outcome of preg-nancies after biliopancreatic diversion. Obes Surg 2004; 14(3):318–324.PubMedCrossRefGoogle Scholar
  41. 41.
    Dixon JB, Bhathal PS, Hughes NR, O’Brien PE. Nonalco-holic fatty liver disease: improvement in liver histological analysis with weight loss. Hepatology 2004;39(6):1647–1654.PubMedCrossRefGoogle Scholar
  42. 42.
    Dallal RM, Mattar SG, Lord JL, et al. Results of laparo-scopic gastric bypass in patients with cirrhosis. Obes Surg 2004;14(1):47–53.PubMedCrossRefGoogle Scholar
  43. 43.
    Nguyen NT, Braley S, Fleming NW, et al. Comparison of postoperative hepatic function after laparoscopic versus open gastric bypass. Am J Surg 2003;186(1):40–44.PubMedCrossRefGoogle Scholar
  44. 44.
    Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg 1994;4(4):353–357.PubMedCrossRefGoogle Scholar
  45. 45.
    Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg 2004;14(9):1157–1164.PubMedCrossRefGoogle Scholar
  46. 46.
    Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparo-scopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 2001;234(3): 279–289; discussion 289–291.PubMedCentralPubMedCrossRefGoogle Scholar
  47. 47.
    Schauer P, Ikramuddin S, Hamad G, Gourash W. The learn-ing curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc 2003;17(2):212–215.PubMedCrossRefGoogle Scholar
  48. 48.
    Spanos C, Salzman E, Triglio CM, Shikora SA. A compar-ative study in percentage of weight loss between laparo-scopic and open Roux-en-Y gastric bypass. Obes Surg 2001;11:384.Google Scholar
  49. 49.
    Eagon CJ, Marin D. Laparoscopic gastric bypass has shorter length of stay and less complications but is more costly compared with open gastric bypass. Surg Endosc 2001;15:S120.Google Scholar
  50. 50.
    Fisher BL. Comparison of recovery time after open and laparoscopic gastric bypass and laparoscopic adjustable banding. Obes Surg 2004;14(1):67–72.PubMedCrossRefGoogle Scholar
  51. 51.
    Mathus-Vliegen EM, Tytgat GN Intragastric balloons for morbid obesity: results, patient tolerance and balloon life span. Br J Surg 1990;77(1):76–79.PubMedCrossRefGoogle Scholar
  52. 52.
    Felix EL, Swartz DE. Conversion of laparoscopic Roux-en-Y gastric bypass. Am J Surg 2003;186(6):648–651.PubMedCrossRefGoogle Scholar
  53. 53.
    Hamilton EC, Sims TL, Hamilton TT, et al. Clinical pre-dictors of leak after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc 2003;17(5):679–684.PubMedCrossRefGoogle Scholar
  54. 54.
    Oliak D, Ballantyne GH, Davies RJ, et al. Short-term results of laparoscopic gastric bypass in patients with BMI > or = 60. Obes Surg 2002;12(5):643–647.PubMedCrossRefGoogle Scholar
  55. 55.
    Fernandez AZ Jr, DeMaria EJ, Tichansky DS, et al. Expe-rience with over 3,000 open and laparoscopic bariatric pro-cedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc 2004;18(2):193–197.PubMedCrossRefGoogle Scholar
  56. 56.
    Oliak D, Owens M, Schmidt HJ. Impact of fellowship training on the learning curve for laparoscopic gastric bypass. Obes Surg 2004;14(2):197–200.PubMedCrossRefGoogle Scholar
  57. 57.
    Shikora SA, Kim JJ, Tarnoff ME. Reinforcing gastric staple-lines with bovine pericardial strips may decrease the likelihood of gastric leak after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2003;13(1):37–44.PubMedCrossRefGoogle Scholar
  58. 58.
    Sapala JA, Wood MH, Schuhknecht MP. Anastomotic leak prophylaxis using a vapor-heated fibrin sealant: report on 738 gastric bypass patients. Obes Surg 2004;14(1):35–42.PubMedCrossRefGoogle Scholar
  59. 59.
    Gonzalez R, Lin E, Venkatesh KR, et al. Gastrojejunos-tomy during laparoscopic gastric bypass: analysis of 3 tech-niques. Arch Surg 2003;138(2):181–184.PubMedCrossRefGoogle Scholar
  60. 60.
    Nguyen NT, Stevens CM, Wolfe BM. Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass. J Gastrointest Surg 2003;7(8):997–1003; dis-cussion 1003.PubMedCrossRefGoogle Scholar
  61. 61.
    Ahmad J, Martin J, Ikramuddin S, et al. Endoscopic balloon dilation of gastroenteric anastomotic stricture after laparoscopic gastric bypass. Endoscopy 2003;35(9): 725–728.PubMedCrossRefGoogle Scholar
  62. 62.
    Griffen WO Jr, Bivins BA, Bell RM, Jackson KA. Gastric bypass for morbid obesity. World J Surg 1981;5(6):817–822.PubMedCrossRefGoogle Scholar
  63. 63.
    Fobi MA, Lee H, Holness R, Cabinda D. Gastric bypass operation for obesity. World J Surg 1998;22(9):925–935.PubMedCrossRefGoogle Scholar
  64. 64.
    Hall JC, Watts JM, O’Brien PE, et al. Gastric surgery for morbid obesity. The Adelaide Study. Ann Surg 1990; 211(4):419–427.PubMedCentralPubMedCrossRefGoogle Scholar
  65. 65.
    Nguyen NT, Cronan M, Braley S, et al. Duplex ultrasound assessment of femoral venous flow during laparoscopic and open gastric bypass. Surg Endosc 2003;17(2):285–290.PubMedCrossRefGoogle Scholar
  66. 66.
    Szomstein S, Avital S, Brasesco O, et al. Laparoscopic gastric bypass in patients on thyroid replacement therapy for subnormal thyroid function—prevalence and short-term outcome. Obes Surg 2004;14(1):95–97.PubMedCrossRefGoogle Scholar
  67. 67.
    Sapala JA, Wood MH, Sapala MA, Flake TM Jr. Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients. Obes Surg 1998;8(5):505–516.PubMedCrossRefGoogle Scholar
  68. 68.
    Westling A, Gustavsson S. Laparoscopic vs open Roux-en-Y gastric bypass: a prospective, randomized trial. Obes Surg 2001;11(3):284–292.PubMedCrossRefGoogle Scholar
  69. 69.
    Sanyal AJ, Sugerman HJ, Kellum JM, et al. Stomal com-plications of gastric bypass: incidence and outcome of therapy. Am J Gastroenterol 1992;87(9):1165–1169.PubMedGoogle Scholar
  70. 70.
    Champion JK, Williams M. Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2003;13(4):596–600.PubMedCrossRefGoogle Scholar
  71. 71.
    Westling A, Ohrvall M, Gustavsson S. Roux-en-Y gastric bypass after previous unsuccessful gastric restrictive surgery. J Gastrointest Surg 2002;6(2):206–211.PubMedCrossRefGoogle Scholar
  72. 72.
    Sugerman HJ, Brewer WH, Shiffman ML, et al. A multi-center, placebo-controlled, randomized, double-blind, prospective trial of prophylactic ursodiol for the preven-tion of gallstone formation following gastric-bypass-induced rapid weight loss. Am J Surg 1995;169(1):91–96; discussion 96–97.PubMedCrossRefGoogle Scholar
  73. 73.
    dela Torre RA, Scott JS. Laparoscopic Roux-en-Y gastric bypass: a totally intra-abdominal approach—technique and preliminary report. Obes Surg 1999;9(5):492–498.PubMedCrossRefGoogle Scholar
  74. 74.
    Fobi M, Lee H, Igwe D, et al. Prophylactic cholecystec-tomy with gastric bypass operation: incidence of gallblad-der disease. Obes Surg 2002;12(3):350–353.PubMedCrossRefGoogle Scholar
  75. 75.
    Amaral JF, Thompson WR. Gallbladder disease in the morbidly obese. Am J Surg 1985;149(4):551–557.PubMedCrossRefGoogle Scholar
  76. 76.
    Hamad GG, Ikramuddin S, Gourash WF, Schauer PR. Elective cholecystectomy during laparoscopic Roux-en-Y gastric bypass: is it worth the wait? Obes Surg 2003;13(1): 76–81.PubMedCrossRefGoogle Scholar
  77. 77.
    Schneider BE, Villegas L, Blackburn GL, et al. Laparo-scopic gastric bypass surgery: outcomes. J Laparoendosc Adv Surg Tech A 2003;13(4):247–255.PubMedCrossRefGoogle Scholar
  78. 78.
    Nguyen NT, Huerta S, Gelfand D, et al. Bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2004;14(2):190–196.PubMedCrossRefGoogle Scholar
  79. 79.
    Higa KD, Ho T, Boone KB. Internal hernias after laparo-scopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg 2003;13(3):350–354.PubMedCrossRefGoogle Scholar
  80. 80.
    Felsher J, Brodsky J, Brody F. Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Surgery 2003; 134(3):501–505.PubMedCrossRefGoogle Scholar
  81. 81.
    Mognol P, Vignes S, Chosidow D, Marmuse JP. Rhab-domyolysis after laparoscopic bariatric surgery. Obes Surg 2004;14(1):91–94.PubMedCrossRefGoogle Scholar
  82. 82.
    Khurana RN, Baudendistel TE, Morgan EF, et al. Postop-erative rhabdomyolysis following laparoscopic gastric bypass in the morbidly obese. Arch Surg 2004;139(1): 73–76.PubMedCrossRefGoogle Scholar
  83. 83.
    Nguyen NT, Goldman CD, Ho HS, et al. Systemic stress response after laparoscopic and open gastric bypass. J Am Coll Surg 2002;194(5):557–566; discussion 566–567.PubMedCrossRefGoogle Scholar
  84. 84.
    Moose D, Lourie D, Powell W, et al. Laparoscopic Roux-en-Y gastric bypass: minimally invasive bariatric surgery for the superobese in the community hospital setting. Am Surg 2003;69(11):930–932.PubMedGoogle Scholar
  85. 85.
    Kreitz K, Rovito PF. Laparoscopic Roux-en-Y gastric bypass in the “megaobese.” Arch Surg 2003;138(7):707–709; discussion 710.PubMedCrossRefGoogle Scholar
  86. 86.
    Feng JJ, Gagner M. Laparoscopic biliopancreatic diversion with duodenal switch. Semin Laparosc Surg 2002;9(2): 125–129.PubMedCrossRefGoogle Scholar
  87. 87.
    Kligman MD, Thomas C, Saxe J. Effect of the learning curve on the early outcomes of laparoscopic Roux-en-Y gastric bypass. Am Surg 2003;69(4):304–309; discussion 309–310.PubMedGoogle Scholar
  88. 88.
    Bloomberg RD, Fleishman A, Nalle JE, et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg 2005;15(2):145–154.PubMedCrossRefGoogle Scholar
  89. 89.
    Coates PS, Fernstrom JD, Fernstrom MH, et al. Gastric bypass surgery for morbid obesity leads to an increase in bone turnover and a decrease in bone mass. J Clin Endocrinol Metab 2004;89(3):1061–1065.PubMedCrossRefGoogle Scholar
  90. 90.
    Lujan JA, Frutos MD, Hernandez Q, et al. Laparoscopic versus open gastric bypass in the treatment of morbid obesity: a randomized prospective study. Ann Surg 2004; 239(4):433–437.PubMedCentralPubMedCrossRefGoogle Scholar
  91. 91.
    Papasavas PK, Hayetian FD, Caushaj PF, et al. Outcome analysis of laparoscopic Roux-en-Y gastric bypass for morbid obesity. The first 116 cases. Surg Endosc 2002; 16(12):1653–1657.PubMedCrossRefGoogle Scholar
  92. 92.
    Flum DR, Salem L, Elrod JA, et al. Early mortality among Medicare beneficiaries undergoing bariatric surgical pro-cedures. JAMA 2005;294(15):1903–1908.PubMedCrossRefGoogle Scholar
  93. 93.
    Nguyen NT, Paya M, Stevens CM, et al. The relationship between hospital volume and outcome in bariatric surgery at academic medical centers. Ann Surg 2004;240(4): 586–593; discussion 593–594.PubMedCentralPubMedGoogle Scholar
  94. 94.
    Zingmond DS, McGory ML, Ko CY. Hospitalization before and after gastric bypass surgery. JAMA 2005; 294(15):1918–1924.PubMedCrossRefGoogle Scholar
  95. 95.
    Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg 2004;240(3): 416–423; discussion 423–424.PubMedCentralPubMedCrossRefGoogle Scholar
  96. 96.
    Flum DR, Dellinger EP. Impact of gastric bypass opera-tion on survival: a population-based analysis. J Am Coll Surg 2004;199(4):543–551.PubMedCrossRefGoogle Scholar
  97. 97.
    Biertho L, Steffen R, Ricklin T, et al. Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding: a comparative study of 1,200 cases. J Am Coll Surg 2003;197(4):536–544; discussion 544–545.PubMedCrossRefGoogle Scholar
  98. 98.
    Farkas DT, Vemulapalli P, Haider A, et al. Laparoscopic Roux-en-Y gastric bypass is safe and effective in patients with a BMI > or = 60. Obes Surg 2005;15(4):486–493.PubMedCrossRefGoogle Scholar
  99. 99.
    Parikh MS, Shen R, Weiner M, et al. Laparoscopic bariatric surgery in super-obese patients (BMI > 50) is safe and effective: a review of 332 patients. Obes Surg 2005;15(6): 858–863.PubMedCrossRefGoogle Scholar
  100. 100.
    Dresel A, Kuhn JA, McCarty TM. Laparoscopic Roux-en-Y gastric bypass in morbidly obese and super morbidly obese patients. Am J Surg 2004;187(2):230–232; discussion 232.PubMedCrossRefGoogle Scholar
  101. 101.
    Fernandez AZ Jr, Demaria EJ, Tichansky DS, et al. Multi-variate analysis of risk factors for death following gastric bypass for treatment of morbid obesity. Ann Surg 2004; 239(5):698–702; discussion 702–703.PubMedCentralPubMedCrossRefGoogle Scholar
  102. 102.
    Liu C. Cost-analysis of laparoscopic versus open Roux-en-Y gastric bypass for morbid obesity. Obes Surg 2001;11:165.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Tomasz Rogula
    • 1
  • Paul A. Thodiyil
    • 2
  • Stacy A. Brethauer
    • 3
  • Philip R. Schauer
    • 4
    • 5
  1. 1.Bariatric and Metabolic Institute, Department of General SurgeryCleveland ClinicClevelandUSA
  2. 2.Department of SurgeryThe Cleveland Clinic FoundationClevelandUSA
  3. 3.Advanced Laparoscopic and Bariatric Surgery, Department of General SurgeryThe Cleveland Clinic FoundationClevelandUSA
  4. 4.Lerner College of MedicineUSA
  5. 5.Advanced Laparoscopic and Bariatric Surgery, Bariatric and Metabolic InstituteThe Cleveland Clinic FoundationClevelandUSA

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