Surgical Complications

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Four postoperative deaths in 1870 operated patients have occurred in the SOS study (0.21%, February 2000). Three of these fatal cases were due to leakage that was detected too late. One death was caused by a technical mistake during a laparoscopic operation.

Peri- and postoperative complications have been calculated on 1164 patients followed for 4 years (13, and unpublished observations). During the primary stay at the hospital the following complications occurred: bleeding 0.5%, embolus and/or thrombosis 0.8%, wound complications 1.8%, deep infections (leakage, abscess) 2.1%, pulmonary 6.1%, other complications 4.8%. The number of complications was 193 and the number of patients with complications 151 (13%). In 26 patients (2.2%) the postoperative complications were serious enough to cause a reoperation.

Over 4 years 12% of the 1164 patients were re-operated, usually due to poor weight loss, but in some cases due to vomiting or other side ef-fects.Usually banding and VBG were converted to gastric bypass but in some cases the original operation was repaired.

Over the 4 years a number of other operations were undertaken in both groups. In the control group 10.1 operations per 100 person-years were undertaken while the corresponding figures in the

Figure 35.4 Weight loss (a) and energy intake (b) over 2 years in SOS patients who underwent gastropalsty or gastric bypass (□). The gastroplasty operations were banding and VBG pooled. Mean + SD. Values in parentheses indicate number of patients at each examination. Energy intake, estimated with validated technique (6,7), did not differ between groups at any time point. Body weights were significantly lower in gastric bypass patients at all time points after surgery P < 0.0001), whereas body weight before surgery did not differ significantly between groups. From Lindroos et al. (8) with permission

Figure 35.4 Weight loss (a) and energy intake (b) over 2 years in SOS patients who underwent gastropalsty or gastric bypass (□). The gastroplasty operations were banding and VBG pooled. Mean + SD. Values in parentheses indicate number of patients at each examination. Energy intake, estimated with validated technique (6,7), did not differ between groups at any time point. Body weights were significantly lower in gastric bypass patients at all time points after surgery P < 0.0001), whereas body weight before surgery did not differ significantly between groups. From Lindroos et al. (8) with permission

Figure 35.5 Weight change (95% CI) in 232 obese controls and 251 surgically treated patients from matching until end of year 8 in the SOS intervention study. Analysis based on completer population. R, registry study with collection of matching variables. Banding, n = 63. Vertical banded gastroplasty, VBG, n = 164, gastric bypass, GBP, n = 24. Each one of the surgical groups had a significantly (P < 0.01) larger weight reduction than the controls. From C.D. Sjostrom et al. (12), with permission

Figure 35.5 Weight change (95% CI) in 232 obese controls and 251 surgically treated patients from matching until end of year 8 in the SOS intervention study. Analysis based on completer population. R, registry study with collection of matching variables. Banding, n = 63. Vertical banded gastroplasty, VBG, n = 164, gastric bypass, GBP, n = 24. Each one of the surgical groups had a significantly (P < 0.01) larger weight reduction than the controls. From C.D. Sjostrom et al. (12), with permission

Table 35.1 BMI and risk factors in 50-year-old men and women from SOS and in 50-year-old randomly selected reference subjects. Risk factor levels for other age groups, see Sjostrom et al. (2)

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