human
***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: Importance Sleeve gastrectomy is increasingly used in the treatment of morbid obesity , but its long-term outcome vs the st and ard Roux-en-Y gastric bypass procedure is unknown . Objective To determine whether there are differences between sleeve gastrectomy and Roux-en-Y gastric bypass in terms of weight loss , changes in comorbidities , increase in quality of life , and adverse events . Design , Setting , and Participants The Swiss Multicenter Bypass or Sleeve Study ( SM-BOSS ) , a 2-group r and omized trial , was conducted from January 2007 until November 2011 ( last follow-up in March 2017 ) . Of 3971 morbidly obese patients evaluated for bariatric surgery at 4 Swiss bariatric centers , 217 patients were enrolled and r and omly assigned to sleeve gastrectomy or Roux-en-Y gastric bypass with a 5-year follow-up period . Interventions Patients were r and omly assigned to undergo laparoscopic sleeve gastrectomy ( n = 107 ) or laparoscopic Roux-en-Y gastric bypass ( n = 110 ) . Main Outcomes and Measures The primary end point was weight loss , expressed as percentage excess body mass index ( BMI ) loss . Exploratory end points were changes in comorbidities and adverse events . Results Among the 217 patients ( mean age , 45.5 years ; 72 % women ; mean BMI , 43.9 ) 205 ( 94.5 % ) completed the trial . Excess BMI loss was not significantly different at 5 years : for sleeve gastrectomy , 61.1 % , vs Roux-en-Y gastric bypass , 68.3 % ( absolute difference , −7.18 % ; 95 % CI , −14.30 % to −0.06 % ; P = .22 after adjustment for multiple comparisons ) . Gastric reflux remission was observed more frequently after Roux-en-Y gastric bypass ( 60.4 % ) than after sleeve gastrectomy ( 25.0 % ) . Gastric reflux worsened ( more symptoms or increase in therapy ) more often after sleeve gastrectomy ( 31.8 % ) than after Roux-en-Y gastric bypass ( 6.3 % ) . The number of patients with reoperations or interventions was 16/101 ( 15.8 % ) after sleeve gastrectomy and 23/104 ( 22.1 % ) after Roux-en-Y gastric bypass . Conclusions and Relevance Among patients with morbid obesity , there was no significant difference in excess BMI loss between laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass at 5 years of follow-up after surgery . Trial Registration clinical trials.gov Identifier : BACKGROUND There are few studies of long-term outcomes for either laparoscopic adjustable gastric b and ing ( LAGB ) or laparoscopic Roux-en-Y gastric bypass ( LRYGB ) . The objective of this study was to compare outcomes of patients r and omly assigned to undergo LAGB or LRYGB  at 10 years . METHODS LAGB , using the pars flaccida technique , and st and ard LRYGB were performed . From January 2000 to November 2000 , 51 patients ( mean age 34.0 ± 8.9 years ; range 20 - 49 ) were r and omly allocated to undergo either LAGB  ( n = 27 , 5 men and 22 women ; mean age 33.3 years ; mean weight 120 kg ; mean body mass index [ BMI ] 43.4 kg/m(2 ) ) or LRYGB ( n = 24 , 4 men and 20 women ; mean age 34.7 ; mean weight 120 kg ; mean BMI 43.8 kg/m(2 ) ) . Data on complications , reoperations , weight , BMI , percentage of excess weight loss , and co-morbidities were collected yearly . The data were analyzed using Student 's t test and Fisher 's exact test , with P<.05 considered significant . RESULTS Five patients in the LAGB group and 3 patients in the LRYGB group were lost to follow-up . No patient died . Conversion to laparotomy was performed in 1 ( 4.2 % ) of 24 LRYGB patients . Reoperations were required in 9 ( 40.9 % ) of 22 LAGB patients and in 6 ( 28.6 % ) of the 21 LRYGB patients . At 10-year follow-up , the LRYGB patients had a greater percentage of mean excess weight loss than did the LAGB patients ( 69±29 % versus 46±27 % ; P = .03 ) . CONCLUSION LRYGB was superior to LAGB in term of excess weight loss results ( 76.2 % versus 46.2 % ) at 10 years . However , LRYGB exposes patients to higher early complication rates than LAGB ( 8.3 % versus 0 % ) and potentially lethal long-term surgical complications ( internal hernia and bowel obstruction rate : 4.7 % ) BACKGROUND For over a decade , the laparoscopic adjustable gastric b and ( LAGB ) was 1 of the most performed bariatric procedures in Europe . This study is a retrospective analysis with prospect ively collected data of the experience in 1 specialized Dutch center with the adjustable gastric b and over 14 years . METHODS Between 1995 and 2003 , 201 patients underwent an LAGB for morbid obesity in our hospital . Data on preoperative clinical characteristic , postoperative outcome and weight loss patterns , and co-morbidities for up to 18 years are presented and evaluated using the Bariatric Analysis and Reporting Outcome System ( BAROS ) . RESULTS Average follow-up was 13.6 ( ± 2.0 ) years ( 163 mo ) and 99 % of patients with complete follow-up . Two thirds of patients reached an excess weight loss (EWL)>50 % at some point after LAGB placement . However , due to insufficient weight loss or complications in 53 % of patients , the LAGB had to be removed or converted to a Roux-en-Y gastric bypass . Additionally , half of the remaining patients had disappointing results according to the BAROS score . In total , less than one quarter ( 22 % ) of patients had a functioning b and with a good result after the follow-up period . Although initially the number of patients experiencing co-morbidities was reduced , most of them returned and a large number of patients developed new co-morbidities . Complications , other than weight regain , were numerous as 47 % of patients experienced at least 1 . In total , 204 reoperations were performed in 137 ( 68 % ) patients . Furthermore , patients who were lost to follow-up did almost twice as bad in terms of EWL compared to patients who had regular follow-up . CONCLUSION Morbid obesity is a chronic disease that can be resolved with bariatric surgery . One of the treatment options is the LAGB , which in the short term shows good results in terms of EWL and co-morbidity reduction . In the long term , however , EWL and co-morbidity reduction are disappointing , and the LAGB does not seem to live up to expectations . Besides the decrease in EWL over time , the number of reoperations required is alarming . In total , less than a quarter of patients still had a functioning b and after a mean 14 years of follow-up Background . Gastric b and ing ( GB ) is a common bariatric procedure that is performed worldwide . Weight loss can be substantial after this procedure , but it is not sufficient in a significant portion of patients . Long-term rates for associated complications increase with every year of follow up , and only a few long-term studies have been published that examine these rates . We present our results after 14 years of postoperative follow up . Methods . Two hundred patients were operated upon form 01.02.1995 to 31.01.2009 . Data collection was performed prospect ively . In retrospective analysis , we analyzed weight loss , short- and long-term complications , amelioration of comorbidities and long-term outcome . Results . The mean postoperative follow up time was 94.4 months ( range 2–144 ) . The follow up rate was 83.5 % . The incidence of postoperative complications for slippage was 2.5 % , for pouch dilatation was 9.5 % , for b and migration was 5.5 % and 12.0 % for overall b and removal . After 14 years , the reoperation rate was 30.5 % with a reoperation rate of 2.2 % for every year of follow up . Excess weight loss was 40.2 % after 1 year , 46.3 % after 2 years , 45.9 % after 3 years , 41.9 % after five years , 33.3 % after 8 years , 30.8 % after 10 years , 33.3 % after 12 years and 15.6 % after 14 years of follow up . Conclusion . The complication and reoperation rate after GB is high . Nevertheless , GB is still a therapeutic option in morbid obese patients , but the criteria for patient selection should be carefully evaluated BACKGROUND Obesity is associated with increased mortality . Weight loss improves cardiovascular risk factors , but no prospect i ve interventional studies have reported whether weight loss decreases overall mortality . In fact , many observational studies suggest that weight reduction is associated with increased mortality . METHODS The prospect i ve , controlled Swedish Obese Subjects study involved 4047 obese subjects . Of these subjects , 2010 underwent bariatric surgery ( surgery group ) and 2037 received conventional treatment ( matched control group ) .  We report on overall mortality during an average of 10.9 years of follow-up . At the time of the analysis ( November 1 , 2005 ) , vital status was known for all but three subjects ( follow-up rate , 99.9 % ) . RESULTS The average weight change in control subjects was less than + /-2 % during the period of up to 15 years during which weights were recorded . Maximum weight losses in the surgical subgroups were observed after 1 to 2 years : gastric bypass , 32 % ; vertical-b and ed gastroplasty , 25 % ; and b and ing , 20 % . After 10 years , the weight losses from baseline were stabilized at 25 % , 16 % , and 14 % , respectively . There were 129 deaths in the control group and 101 deaths in the surgery group . The unadjusted overall hazard ratio was 0.76 in the surgery group ( P=0.04 ) , as compared with the control group , and the hazard ratio adjusted for sex , age , and risk factors was 0.71 ( P=0.01 ) . The most common causes of death were myocardial infa rct ion ( control group , 25 subjects ; surgery group , 13 subjects ) and cancer ( control group , 47 ; surgery group , 29 ) . CONCLUSIONS Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality Objective : To evaluate the long-term results of laparoscopic vertical b and ed gastroplasty ( VBG )  for morbid obesity . Background : Laparoscopic VBG , a safe and straightforward bariatric procedure characterized by good short-term results , has been progressively replaced by other more complex procedures on the basis of a presumed high rate of long-term failure . Nevertheless , some authors have recently reported long-term efficacy in selected patients . Methods : All patients who underwent laparoscopic VBG  were included in a prospect i ve data base . Patients reaching 10-year follow-up received a complete evaluation including clinical , endoscopic , and biochemical examinations . Results : Between January 1996 and March 1999 , 266 morbidly obese patients underwent bariatric procedures . Among them , 213 were selected for laparoscopic VBG ; exclusion criteria were as follows : contraindications to pneumoperitoneum , gastroesophageal reflux disease , and psychological contraindications to restrictive procedures . Mean age , preoperative weight , and body mass index were 36.9 years , 123.6 kg , and 45.4 kg/m2 , respectively .  Intraoperative complication rate and conversion rate were 0.9 % and 0.9 % , respectively . Early postoperative complication rate was 4.2 % and early reoperation rate was 0.5 % . Mean hospital length of stay was 6.3 days . Mortality was nil . The 10-year follow-up rate was 70.4 % ( 150 patients ) . Late postoperative complication rate was 14.7 % , and 10-year revisional surgery rate was 10.0 % . The excess weight loss percentages at 3 , 5 , and 10 years were 65.0 % , 59.9 % , and 59.8 % , respectively . The resolution and /or improvement rate for comorbidity were 47.5 % for hypertension , 55.6 % for diabetes , 75 % for sleep apnea , and 47.4 % for arthritis . Mean Moorehead-Ardelt Quality of Life Question naire and BAROS values were 1.4 and 3.8 , respectively . Conclusions : The present study demonstrates that laparoscopic VBG in carefully selected patients leads to long-term results comparable with more complex and invasive procedures . Given the low postoperative morbidity for laparoscopic VBG , its present clinical 
    Output:
    
agent
Reoperations were common in all groups .
Reoperation rate was initially high but reduced markedly with improved b and and surgical and aftercare techniques .
Conclusion All current procedures are associated with substantial and durable weight loss .
More long-term data are needed for one-anastomosis gastric bypass and sleeve gastrectomy  .
Reoperation is likely to remain common across all procedures
***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: Importance Sleeve gastrectomy is increasingly used in the treatment of morbid obesity , but its long-term outcome vs the st and ard Roux-en-Y gastric bypass procedure is unknown . Objective To determine whether there are differences between sleeve gastrectomy and Roux-en-Y gastric bypass in terms of weight loss , changes in comorbidities , increase in quality of life , and adverse events . Design , Setting , and Participants The Swiss Multicenter Bypass or Sleeve Study ( SM-BOSS ) , a 2-group r and omized trial , was conducted from January 2007 until November 2011 ( last follow-up in March 2017 ) . Of 3971 morbidly obese patients evaluated for bariatric surgery at 4 Swiss bariatric centers , 217 patients were enrolled and r and omly assigned to sleeve gastrectomy or Roux-en-Y gastric bypass with a 5-year follow-up period . Interventions Patients were r and omly assigned to undergo laparoscopic sleeve gastrectomy ( n = 107 ) or laparoscopic Roux-en-Y gastric bypass ( n = 110 ) . Main Outcomes and Measures The primary end point was weight loss , expressed as percentage excess body mass index ( BMI ) loss . Exploratory end points were changes in comorbidities and adverse events . Results Among the 217 patients ( mean age , 45.5 years ; 72 % women ; mean BMI , 43.9 ) 205 ( 94.5 % ) completed the trial . Excess BMI loss was not significantly different at 5 years : for sleeve gastrectomy , 61.1 % , vs Roux-en-Y gastric bypass , 68.3 % ( absolute difference , −7.18 % ; 95 % CI , −14.30 % to −0.06 % ; P = .22 after adjustment for multiple comparisons ) . Gastric reflux remission was observed more frequently after Roux-en-Y gastric bypass ( 60.4 % ) than after sleeve gastrectomy ( 25.0 % ) . Gastric reflux worsened ( more symptoms or increase in therapy ) more often after sleeve gastrectomy ( 31.8 % ) than after Roux-en-Y gastric bypass ( 6.3 % ) . The number of patients with reoperations or interventions was 16/101 ( 15.8 % ) after sleeve gastrectomy and 23/104 ( 22.1 % ) after Roux-en-Y gastric bypass . Conclusions and Relevance Among patients with morbid obesity , there was no significant difference in excess BMI loss between laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass at 5 years of follow-up after surgery . Trial Registration clinical trials.gov Identifier : BACKGROUND There are few studies of long-term outcomes for either laparoscopic adjustable gastric b and ing ( LAGB ) or laparoscopic Roux-en-Y gastric bypass ( LRYGB ) . The objective of this study was to compare outcomes of patients r and omly assigned to undergo LAGB or LRYGB  at 10 years . METHODS LAGB , using the pars flaccida technique , and st and ard LRYGB were performed . From January 2000 to November 2000 , 51 patients ( mean age 34.0 ± 8.9 years ; range 20 - 49 ) were r and omly allocated to undergo either LAGB  ( n = 27 , 5 men and 22 women ; mean age 33.3 years ; mean weight 120 kg ; mean body mass index [ BMI ] 43.4 kg/m(2 ) ) or LRYGB ( n = 24 , 4 men and 20 women ; mean age 34.7 ; mean weight 120 kg ; mean BMI 43.8 kg/m(2 ) ) . Data on complications , reoperations , weight , BMI , percentage of excess weight loss , and co-morbidities were collected yearly . The data were analyzed using Student 's t test and Fisher 's exact test , with P<.05 considered significant . RESULTS Five patients in the LAGB group and 3 patients in the LRYGB group were lost to follow-up . No patient died . Conversion to laparotomy was performed in 1 ( 4.2 % ) of 24 LRYGB patients . Reoperations were required in 9 ( 40.9 % ) of 22 LAGB patients and in 6 ( 28.6 % ) of the 21 LRYGB patients . At 10-year follow-up , the LRYGB patients had a greater percentage of mean excess weight loss than did the LAGB patients ( 69±29 % versus 46±27 % ; P = .03 ) . CONCLUSION LRYGB was superior to LAGB in term of excess weight loss results ( 76.2 % versus 46.2 % ) at 10 years . However , LRYGB exposes patients to higher early complication rates than LAGB ( 8.3 % versus 0 % ) and potentially lethal long-term surgical complications ( internal hernia and bowel obstruction rate : 4.7 % ) BACKGROUND For over a decade , the laparoscopic adjustable gastric b and ( LAGB ) was 1 of the most performed bariatric procedures in Europe . This study is a retrospective analysis with prospect ively collected data of the experience in 1 specialized Dutch center with the adjustable gastric b and over 14 years . METHODS Between 1995 and 2003 , 201 patients underwent an LAGB for morbid obesity in our hospital . Data on preoperative clinical characteristic , postoperative outcome and weight loss patterns , and co-morbidities for up to 18 years are presented and evaluated using the Bariatric Analysis and Reporting Outcome System ( BAROS ) . RESULTS Average follow-up was 13.6 ( ± 2.0 ) years ( 163 mo ) and 99 % of patients with complete follow-up . Two thirds of patients reached an excess weight loss (EWL)>50 % at some point after LAGB placement . However , due to insufficient weight loss or complications in 53 % of patients , the LAGB had to be removed or converted to a Roux-en-Y gastric bypass . Additionally , half of the remaining patients had disappointing results according to the BAROS score . In total , less than one quarter ( 22 % ) of patients had a functioning b and with a good result after the follow-up period . Although initially the number of patients experiencing co-morbidities was reduced , most of them returned and a large number of patients developed new co-morbidities . Complications , other than weight regain , were numerous as 47 % of patients experienced at least 1 . In total , 204 reoperations were performed in 137 ( 68 % ) patients . Furthermore , patients who were lost to follow-up did almost twice as bad in terms of EWL compared to patients who had regular follow-up . CONCLUSION Morbid obesity is a chronic disease that can be resolved with bariatric surgery . One of the treatment options is the LAGB , which in the short term shows good results in terms of EWL and co-morbidity reduction . In the long term , however , EWL and co-morbidity reduction are disappointing , and the LAGB does not seem to live up to expectations . Besides the decrease in EWL over time , the number of reoperations required is alarming . In total , less than a quarter of patients still had a functioning b and after a mean 14 years of follow-up Background . Gastric b and ing ( GB ) is a common bariatric procedure that is performed worldwide . Weight loss can be substantial after this procedure , but it is not sufficient in a significant portion of patients . Long-term rates for associated complications increase with every year of follow up , and only a few long-term studies have been published that examine these rates . We present our results after 14 years of postoperative follow up . Methods . Two hundred patients were operated upon form 01.02.1995 to 31.01.2009 . Data collection was performed prospect ively . In retrospective analysis , we analyzed weight loss , short- and long-term complications , amelioration of comorbidities and long-term outcome . Results . The mean postoperative follow up time was 94.4 months ( range 2–144 ) . The follow up rate was 83.5 % . The incidence of postoperative complications for slippage was 2.5 % , for pouch dilatation was 9.5 % , for b and migration was 5.5 % and 12.0 % for overall b and removal . After 14 years , the reoperation rate was 30.5 % with a reoperation rate of 2.2 % for every year of follow up . Excess weight loss was 40.2 % after 1 year , 46.3 % after 2 years , 45.9 % after 3 years , 41.9 % after five years , 33.3 % after 8 years , 30.8 % after 10 years , 33.3 % after 12 years and 15.6 % after 14 years of follow up . Conclusion . The complication and reoperation rate after GB is high . Nevertheless , GB is still a therapeutic option in morbid obese patients , but the criteria for patient selection should be carefully evaluated BACKGROUND Obesity is associated with increased mortality . Weight loss improves cardiovascular risk factors , but no prospect i ve interventional studies have reported whether weight loss decreases overall mortality . In fact , many observational studies suggest that weight reduction is associated with increased mortality . METHODS The prospect i ve , controlled Swedish Obese Subjects study involved 4047 obese subjects . Of these subjects , 2010 underwent bariatric surgery ( surgery group ) and 2037 received conventional treatment ( matched control group ) .  We report on overall mortality during an average of 10.9 years of follow-up . At the time of the analysis ( November 1 , 2005 ) , vital status was known for all but three subjects ( follow-up rate , 99.9 % ) . RESULTS The average weight change in control subjects was less than + /-2 % during the period of up to 15 years during which weights were recorded . Maximum weight losses in the surgical subgroups were observed after 1 to 2 years : gastric bypass , 32 % ; vertical-b and ed gastroplasty , 25 % ; and b and ing , 20 % . After 10 years , the weight losses from baseline were stabilized at 25 % , 16 % , and 14 % , respectively . There were 129 deaths in the control group and 101 deaths in the surgery group . The unadjusted overall hazard ratio was 0.76 in the surgery group ( P=0.04 ) , as compared with the control group , and the hazard ratio adjusted for sex , age , and risk factors was 0.71 ( P=0.01 ) . The most common causes of death were myocardial infa rct ion ( control group , 25 subjects ; surgery group , 13 subjects ) and cancer ( control group , 47 ; surgery group , 29 ) . CONCLUSIONS Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality Objective : To evaluate the long-term results of laparoscopic vertical b and ed gastroplasty ( VBG )  for morbid obesity . Background : Laparoscopic VBG , a safe and straightforward bariatric procedure characterized by good short-term results , has been progressively replaced by other more complex procedures on the basis of a presumed high rate of long-term failure . Nevertheless , some authors have recently reported long-term efficacy in selected patients . Methods : All patients who underwent laparoscopic VBG  were included in a prospect i ve data base . Patients reaching 10-year follow-up received a complete evaluation including clinical , endoscopic , and biochemical examinations . Results : Between January 1996 and March 1999 , 266 morbidly obese patients underwent bariatric procedures . Among them , 213 were selected for laparoscopic VBG ; exclusion criteria were as follows : contraindications to pneumoperitoneum , gastroesophageal reflux disease , and psychological contraindications to restrictive procedures . Mean age , preoperative weight , and body mass index were 36.9 years , 123.6 kg , and 45.4 kg/m2 , respectively .  Intraoperative complication rate and conversion rate were 0.9 % and 0.9 % , respectively . Early postoperative complication rate was 4.2 % and early reoperation rate was 0.5 % . Mean hospital length of stay was 6.3 days . Mortality was nil . The 10-year follow-up rate was 70.4 % ( 150 patients ) . Late postoperative complication rate was 14.7 % , and 10-year revisional surgery rate was 10.0 % . The excess weight loss percentages at 3 , 5 , and 10 years were 65.0 % , 59.9 % , and 59.8 % , respectively . The resolution and /or improvement rate for comorbidity were 47.5 % for hypertension , 55.6 % for diabetes , 75 % for sleep apnea , and 47.4 % for arthritis . Mean Moorehead-Ardelt Quality of Life Question naire and BAROS values were 1.4 and 3.8 , respectively . Conclusions : The present study demonstrates that laparoscopic VBG in carefully selected patients leads to long-term results comparable with more complex and invasive procedures . Given the low postoperative morbidity for laparoscopic VBG , its present clinical 
    Output:
    