***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND There is limited outcome data for super-super-obese ( SSO ) patients , those with Body Mass Index ( BMI ) ≥ 60 kg/m(2 ) , who seek surgical treatment with Laparoscopic Roux-en-Y Gastric Bypass ( LRYGB ) .  A large single center LRYGB experience was review ed to compare the safety and efficacy of LRYGB in SSO patients to the st and ard obese population undergoing this procedure . METHODS The American College of Surgeons National Surgical Quality Improvement Program ( ACS NSQIP ) data base and an Institutional Review Board approved prospect i ve data base was used to identify all patients undergoing LRYGB by multiple surgeons at a single institution between 1/1/1994 and 11/15/2013 . Preoperative co-morbidities , postoperative complications , 30-day outcomes , and weight loss at yearly intervals were analyzed to determine difference between SSO patients and NonSSO patients ( BMI < 60 kg/m(2 ) ) . RESULTS Of the 2009 patients undergoing LRYGB over the past 20 years ; 328 had BMI ≥ 60 kg/m(2 ) . Preoperative co-morbidities , conversion to open , and length of stay were significantly increased among SSO patients ; however there was no significant difference in postoperative outcomes or complications . Percent reduction of excess BMI beyond 12 months was significantly improved among NonSSO patients with less than 30 % follow-up beyond 2 years . CONCLUSIONS LRYGB appears well tolerated for super-super-obese patients with BMI ≥ 60 kg/m(2 ) in experienced centers . These patients still have significant reduction in excess BMI despite being less than NonSSO patients undergoing RYGB . The ACS NSQIP data base provides excellent tracking of institutional progress with bariatric surgical outcomes to facilitate the improvement of best practice techniques BACKGROUND Studies have demonstrated that laparoscopic Roux-en-Y gastric bypass ( RYGB ) is associated with the greatest readmission rate among bariatric surgeries . Some readmissions might be avoidable . We sought to evaluate the risk factors for readmission in a high-volume bariatric surgery program at a university hospital in the United States . METHODS We performed a retrospective review of prospect ively maintained data . Patients readmitted within 30 days of laparoscopic RYGB  were r and omly matched to  control patients who had undergone RYGB  in the same year but were not readmitted . The readmissions were categorized as technical complications ( leak ) , wound infections , or malaise ( nausea , dehydration , or benign abdominal pain ) . Patients with a wound infection treated in an outpatient setting were also evaluated and compared with the patients admitted with a wound infection . RESULTS From July 2002 to July 2008 , 450 patients underwent RYGB .  Readmission occurred in 42 patients ( 9 % ) . Of these 42 patients , 6 were admitted with wound infections ( 14 % ) , 18 ( 43 % ) with malaise , and 18 ( 43 % ) with technical complications . The patients admitted with wound infections were similar to their controls , except that they were more likely to have publicly funded insurance ( Medicare or Medicaid ) and more likely to present for medical attention to the emergency department after clinic hours . The patients admitted with malaise reported a greater pain score at discharge and were also more likely to have public health insurance than controls . The patients with technical complications did not differ from the control patients in any examined variable . CONCLUSIONS Patients with publicly funded insurance are at increased risk of readmission after RYGB . Outpatient mechanisms for managing wound infections and malaise might result in decreased readmissions Objective : To compare laparoscopic versus open gastric bypass procedures with respect to 30-day morbidity and mortality rates , using multi-institutional , prospect i ve , risk-adjusted data . Summary Background Data : Laparoscopic Roux-en-Y gastric bypass for weight loss is being performed with increasing frequency , partly driven by consumer dem and . However , there are no multi-institutional , risk-adjusted , prospect i ve studies comparing laparoscopic and open gastric bypass outcomes . Methods : A multi-institutional , prospect i ve , risk-adjusted cohort study of patients undergoing laparoscopic and open gastric bypass procedures was performed from hospitals ( n = 15 ) involved in the Private Sector Study of the National Surgical Quality Improvement Program ( NSQIP ) . Data points have been extensively vali date d , are based on st and ardized definitions , and were collected by nurse review ers who are audited for accuracy . Results : From 2000 to 2003 , data from 1356 gastric bypass procedures was collected . The 30-day mortality rate was zero in the laparoscopic group ( n = 401 ) , and 0.6 % in the open group ( n = 955 ) ( P = not significant ) . The 30-day complication rate was significantly lower in the laparoscopic group as compared with the open group : 7 % versus 14.5 % ( P < 0.0001 ) . Multivariate logistic regression analysis was performed to control for potential confounding variables and showed that patients undergoing an open procedure were more likely to develop a complication , as compared with patients undergoing an laparoscopic procedure ( odds ratio = 2.08 ; 95 % confidence interval , 1.33–3.25 ) . Propensity score modeling revealed similar results . A prediction model was derived , and variables that significantly predict higher complication rates after gastric bypass included an open procedure , a high ASA class ( III , IV , V ) , functionally dependent patient , and hypertension as a comorbid illness . Conclusions : Multicenter , prospect i ve , risk-adjusted data show that laparoscopic gastric bypass is safer than open gastric bypass , with respect to 30-day complication rate Objective To compare outcomes , quality of life ( QOL ) , and costs of laparoscopic and open gastric bypass ( GBP ) .  Summary Background Data Laparoscopic GBP has been reported to be a safe and effective approach for the treatment of morbid obesity . The authors performed a prospect i ve r and omized trial to compare outcomes , QOL , and costs of laparoscopic GBP with those of open GBP . Methods From May 1999 to March 2001 , 155 patients with a body mass index ( BMI ) of 40 to 60 kg/m2 were r and omly assigned to undergo laparoscopic ( n = 79 ) or open ( n = 76 ) GBP .  The two groups were similar in age , sex ratio , mean BMI , and comorbidities . Main outcome measures included operative time , estimated blood loss , length of hospital stay , operative complications , percentage of excess body weight loss , and time to return to activities of daily living and work . Changes in QOL were assessed using the SF-36 Health Survey and the bariatric analysis of reporting outcome system ( BAROS ) . Operative and hospital costs of the two operations were also compared . Results There were no deaths in either group . Mean operative time was longer for laparoscopic GBP than for open GBP , but operative blood loss was less . Two ( 2.5 % ) of the 79 patients in the laparoscopic group required conversion to laparotomy . Median length of hospital stay was shorter for laparoscopic GBP patients ( 3 vs 4 days ) . The rate of postoperative anastomotic leak was similar between groups . Wound-related complications such as infection ( 10.5 vs 1.3 % ) and incisional hernia ( 7.9 vs 0 % ) were more common after open GBP ; late anastomotic stricture was less frequent after open GBP ( 2.6 vs 11.4 % ) . Time to return to activities of daily living and work were shorter after laparoscopic GBP than after open GBP .  Weight loss at 1 year was similar between groups . Preoperative SF-36 scores were similar between groups ; however , at 1 month after surgery , laparoscopic patients had better physical conditioning , social functioning , general health , and less body pain than open GBP patients . At 6 months , the BAROS outcome was classified as good or better in 97 % of laparoscopic GBP patients compared with 82 % of open GBP patients . Operative costs were higher for laparoscopic GBP patients , but hospital costs were lower . Conclusions Laparoscopic GBP is a safe and cost-effective alternative to open GBP . Despite a longer operative time , patients undergoing laparoscopic GBP benefited from less blood loss , a shorter hospital stay , and faster convalescence .  Laparoscopic GBP patients had comparable weight loss at 1 year but a more rapid improvement in QOL than open GBP patients . The higher initial operative costs for laparoscopic GBP were adequately offset by the lower hospital costs BACKGROUND Our objective was to ascertain procedure-related morbidity among  laparoscopic Roux-en-Y gastric bypass ( LRYGB ) , laparoscopic sleeve gastrectomy ( LSG ) , and laparoscopic adjustable gastric b and ing ( LAGB ) patients . These are the 3 most common bariatric procedures performed worldwide . We review ed our experience since the introduction of LSG and compared the procedure-related morbidity among all 3 procedures . STUDY DESIGN We conducted a retrospective review of a prospect ively collected data base of all morbidly obese patients who underwent bariatric surgery between the years 2005 and 2011 . We identified and compared complications , mortality , readmissions , and reoperations in patients who underwent LRYGB , LAGB , and LSG .  RESULTS A total of 2,199 bariatric procedures were performed during this period of time . Of those procedures , 1,327 were  LRYGB  , 619 were LSG , and 253 were LAGB .  Perioperative mortality was not applicable for all 3 procedures . The leak rate was 0.5 % for LRYGB and 0.3 % for LSG , and was not applicable for LAGB . The average number of readmissions postoperatively was less than 2 times for all 3 procedures : LRYGB 1.96 times , LSG 1.49 times , and LAGB 1.54 times . The percentages of procedures requiring reoperations due to complications or failures were 14.6 % in the LAGB group , 6.6 % in the LRYGB group , and 1.8 % in the LSG group . CONCLUSIONS In short- and mid-term follow-up , LSG appears to have the lowest procedure-related morbidity when compared with LRYGB and LAGB 
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They also allow us to evaluate infrequent situations for which r and omized control trials are not feasible and add specific information that can complement the quality of surgical knowledge