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: Background : Laparoscopic adjustable gastric b and ing ( LAGB ) and open vertical b and ed gastroplasty ( VBG ) are treatment modalities for morbid obesity . However , few prospect i ve r and omized clinical trials ( RCT ) have been performed to compare both operations . Methods : 100 patients ( 50 per group ) were included in the study . Postoperative outcomes included hospital length of stay ( LOS ) , complications , percent excess weight loss ( % EWL ) , BMI and reduction in total comorbidities . Follow-up in all patients was 2 years . Results : LOS was significantly shorter in the LAGB group . 3 LAGB were converted to open ( 1 to gastric bypass ) . Directly after VBG , 3 patients needed relaparotomies due to leakage , of which one ( 2 % ) died . After 2 years , 100 % follow-up was achieved . BMI and % EWL were significantly decreased in both groups but significantly more in the VBG group compared to the LAGB group ( 31.0 kg/m2 and 70.1 % vs 34.6 and 54.9 % respectively ) . Co-morbidities significantly decreased in both groups in time . 2 years after LAGB , 20 patients needed reoperation for pouch dilation/slippage ( n=12 ) , b and leakage ( n=2 ) , b and erosion ( n=2 ) and access-port problems ( n=4 ) . In the VBG group , 18 patients needed revisional surgery due to staple-line disruption ( n=15 ) , narrow outlet ( n=2 ) or insufficient weight loss ( n=1 ) . Furthermore , 8 VBG patients developed an incisional hernia . Conclusion : This RCT demonstrates that , despite the initial better weight loss in the  VBG group , based on complication rates and clinical outcome , LAGB is preferred . It had a shorter LOS and less postoperative morbidity Background The objective of this study is to evaluate the long-term outcomes following  laparoscopic Roux-en-Y gastric bypass ( LREYGB ) in veteran patients . The VA bariatric population differs from its counterpart in the private sector by the predominance of a male population , a higher percentage of patients from a lower socioeconomic background , a higher mean age , and a higher rate of obesity-related comorbidities . Methods A retrospective review with prospect ively collected data was used to analyze postoperative changes of comorbidities and percent of excess weight loss ( % EWL ) in consecutive patients who underwent LREYGB between August 2003 and September 2006 . Results Among 70 patients , 73 % were men with a mean age of 52 years ( 29–66 years ) . Average preoperative weight and body mass index were 310 lbs ( 224–397 lbs ) and 46 kg/m2 ( 36–60 kg/m2 ) , respectively . The incidence of major and minor complications was 1.4 % and 15.7 % , respectively . There were no mortalities . Follow-up ( f/u ) was possible in all patients . At a mean f/u rate of 39 months , % EWL was 56 % . At 1 , 3 , and 5 years , % EWL was 61 % , 53 % , and 59 % , respectively . Thirty-five patients ( 50 % ) had type 2 diabetes mellitus ( T2DM ) . Glycosylated hemoglobin concentrations returned to normal levels in 91 % of patients and improved in an additional 6 % of T2DM cases . Only 7 % of patients are still maintained on antidiabetic medications . In patients with more than 1 year f/u , most other comorbidities were improved or resolved . Conclusions Long-term f/u of LREYGB in veteran patients demonstrated significant and durable weight loss ( 56 % EWL ) with marked improvements in comorbidities especially T2DM to test early  nutritional interventions  and prospect i ve observational cohorts . RCTs are generally accepted as method ologically the best approach for informing health policy . They can equalise unknown as well as known confounding factors and so can demonstrate causation ; they permit estimation of effect size and so can be used to assess likely 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 The efficacy of three gastric restriction operations were compared in a prospect i ve r and omized study of 310 morbidly obese subjects . The median patient age was 34 years ( range , 18 to 62 years ) . They were predominantly female ( 13:1 ) and had a median pre-operative weight that was 198 % of their ideal weight ( range , 160 % to 318 % ) . There was an equitable dispersion of perceived risk factors between the groups under study and there were no deaths during the perioperative period . Compliance with follow-up at 3 years was 91 % . When success was defined as a loss of more than 50 % of excess weight or a current pregnancy , the success rates at 3 years were 17 % for gastrogastrostomy , 48 % for vertical gastroplasty , and 67 % for Roux-en-Y gastric bypass ( p less than 0.001 ) . Although the gastric bypass operation took longer to perform , there were similar outcome patterns for the three groups during the postoperative period . We conclude that the Roux-en-Y gastric bypass is the preferred procedure for the surgical treatment of morbid obesity Background : In the non-superobese population , consensus is currently unavailable in bariatric surgery . We report the results of a prospect i ve comparison of vertical b and ed gastroplasty ( VBG ) and Roux-en-Y gastric bypass ( RYGBP ) in a non-superobese population . Methods : From 1994 to 2000 , 179 patients with clinical ly severe obesity underwent various surgical procedures in our department . During this time a prospect i ve study was undertaken in order to compare VBG with RYGBP in morbidly obese patients with a BMI < 50 kg/m2 . Based on specific criteria including eating behavior , 68 patients were selected to undergo RYGBP and 35 VBG . All patients have undergone complete follow-up evaluation at 1 , 3 , 6 , and 12 months postoperatively and every year thereafter . Results : All patients have now completed their 5th postoperative year . Mean follow-up period to date is 96.5±12.2 months for VBG and 67.6±11.3 months for RYGBP . 3 patients ( 8.6 % ) in the VBG group and 9 patients ( 13.2 % ) in the RYGBP group are lost to follow-up . Mean excess weight loss ( EWL ) was always better in the RYGBP group ( P=0.0013 ) . The percentage of failure , defined as EWL < 25 % , was not significantly different between the two procedures . No statistically significant differences were observed between the 2 groups in the total number of non-metabolic complications , and the only statistically significant difference observed in metabolic complications was vitamin B12 deficiency after RYGBP . Frequency of vomiting was significantly less and quality of eating significantly better in RYGBP than in VBG patients . Conclusion : This prospect i ve long-term study , with nearly complete follow-up , suggests that in the non-superobese population , preoperative eating habits may play a role in choosing the most appropriate bariatric operation for each patient . Although RYGBP is associated with better mean weight loss outcomes , the percentage of patients who achieved and maintained ≥50 % EWL after VBG in this pre-selected patient population was not significantly different . Each type of operation has advantages and disadvantages , and , if properly chosen , a purely restrictive procedure can be successful for some patients . Therefore , it can be said that the decision regarding which bariatric procedure to perform in non-superobese patients must be based on in-depth preoperative evaluation as well as the patients ' own preferences and outcome expectations 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 mL , ( 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 Background Laparoscopic Roux-en-Y gastric bypass surgery ( RYGB ) was introduced at the authors ’ institution 5 years ago . The authors analyzed the short- and long-term results of this procedure compared with those for the same procedure using the laparotomy approach over the same period . Methods Retrospective analysis of a prospect ively collected bariatric data base used the outcome end points used by the American Society of Bariatric Surgery ( ASBS ) and the American College of Surgeons ( ACS ) in their center of excellence programs . Results From January 2001 to July 2005 , 568 laparoscopic and 399 open gastric bypasses were performed at V and erbilt University . The patients were from the same bariatric surgery program and therefore received the same pre- and postoperative care . The hospital length of stay in the laparoscopic group was significantly shorter ( 2.5 ± 2.4 days ) than in the open group ( 3.7 ± 3.7 days ; p = 0.001 ) . The procedure time was significantly shorter in the laparoscopic group ( 164 ± 50 min ) than in the open group ( 195 ± 50 min ; p = 0.0001 ) . The follow-up assessment response at 2 years was 76.6 % . At 2 years , the excess weight loss ( EWL ) was significantly greater in the laparoscopic group ( 71.3 % ± 18.4 % ) than in the open group ( 67.3 % ± 15.3 % ; p = 0.03 ) . The wound infection rate was 
    Output:
    
agent
Gastric bypass has better outcomes than gastric b and procedures for long-term weight loss , type 2 diabetes control and remission , hypertension , and hyperlipidemia .
Insufficient evidence exists regarding long-term outcomes for gastric sleeve resections
***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 : Laparoscopic adjustable gastric b and ing ( LAGB ) and open vertical b and ed gastroplasty ( VBG ) are treatment modalities for morbid obesity . However , few prospect i ve r and omized clinical trials ( RCT ) have been performed to compare both operations . Methods : 100 patients ( 50 per group ) were included in the study . Postoperative outcomes included hospital length of stay ( LOS ) , complications , percent excess weight loss ( % EWL ) , BMI and reduction in total comorbidities . Follow-up in all patients was 2 years . Results : LOS was significantly shorter in the LAGB group . 3 LAGB were converted to open ( 1 to gastric bypass ) . Directly after VBG , 3 patients needed relaparotomies due to leakage , of which one ( 2 % ) died . After 2 years , 100 % follow-up was achieved . BMI and % EWL were significantly decreased in both groups but significantly more in the VBG group compared to the LAGB group ( 31.0 kg/m2 and 70.1 % vs 34.6 and 54.9 % respectively ) . Co-morbidities significantly decreased in both groups in time . 2 years after LAGB , 20 patients needed reoperation for pouch dilation/slippage ( n=12 ) , b and leakage ( n=2 ) , b and erosion ( n=2 ) and access-port problems ( n=4 ) . In the VBG group , 18 patients needed revisional surgery due to staple-line disruption ( n=15 ) , narrow outlet ( n=2 ) or insufficient weight loss ( n=1 ) . Furthermore , 8 VBG patients developed an incisional hernia . Conclusion : This RCT demonstrates that , despite the initial better weight loss in the  VBG group , based on complication rates and clinical outcome , LAGB is preferred . It had a shorter LOS and less postoperative morbidity Background The objective of this study is to evaluate the long-term outcomes following  laparoscopic Roux-en-Y gastric bypass ( LREYGB ) in veteran patients . The VA bariatric population differs from its counterpart in the private sector by the predominance of a male population , a higher percentage of patients from a lower socioeconomic background , a higher mean age , and a higher rate of obesity-related comorbidities . Methods A retrospective review with prospect ively collected data was used to analyze postoperative changes of comorbidities and percent of excess weight loss ( % EWL ) in consecutive patients who underwent LREYGB between August 2003 and September 2006 . Results Among 70 patients , 73 % were men with a mean age of 52 years ( 29–66 years ) . Average preoperative weight and body mass index were 310 lbs ( 224–397 lbs ) and 46 kg/m2 ( 36–60 kg/m2 ) , respectively . The incidence of major and minor complications was 1.4 % and 15.7 % , respectively . There were no mortalities . Follow-up ( f/u ) was possible in all patients . At a mean f/u rate of 39 months , % EWL was 56 % . At 1 , 3 , and 5 years , % EWL was 61 % , 53 % , and 59 % , respectively . Thirty-five patients ( 50 % ) had type 2 diabetes mellitus ( T2DM ) . Glycosylated hemoglobin concentrations returned to normal levels in 91 % of patients and improved in an additional 6 % of T2DM cases . Only 7 % of patients are still maintained on antidiabetic medications . In patients with more than 1 year f/u , most other comorbidities were improved or resolved . Conclusions Long-term f/u of LREYGB in veteran patients demonstrated significant and durable weight loss ( 56 % EWL ) with marked improvements in comorbidities especially T2DM to test early  nutritional interventions  and prospect i ve observational cohorts . RCTs are generally accepted as method ologically the best approach for informing health policy . They can equalise unknown as well as known confounding factors and so can demonstrate causation ; they permit estimation of effect size and so can be used to assess likely 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 The efficacy of three gastric restriction operations were compared in a prospect i ve r and omized study of 310 morbidly obese subjects . The median patient age was 34 years ( range , 18 to 62 years ) . They were predominantly female ( 13:1 ) and had a median pre-operative weight that was 198 % of their ideal weight ( range , 160 % to 318 % ) . There was an equitable dispersion of perceived risk factors between the groups under study and there were no deaths during the perioperative period . Compliance with follow-up at 3 years was 91 % . When success was defined as a loss of more than 50 % of excess weight or a current pregnancy , the success rates at 3 years were 17 % for gastrogastrostomy , 48 % for vertical gastroplasty , and 67 % for Roux-en-Y gastric bypass ( p less than 0.001 ) . Although the gastric bypass operation took longer to perform , there were similar outcome patterns for the three groups during the postoperative period . We conclude that the Roux-en-Y gastric bypass is the preferred procedure for the surgical treatment of morbid obesity Background : In the non-superobese population , consensus is currently unavailable in bariatric surgery . We report the results of a prospect i ve comparison of vertical b and ed gastroplasty ( VBG ) and Roux-en-Y gastric bypass ( RYGBP ) in a non-superobese population . Methods : From 1994 to 2000 , 179 patients with clinical ly severe obesity underwent various surgical procedures in our department . During this time a prospect i ve study was undertaken in order to compare VBG with RYGBP in morbidly obese patients with a BMI < 50 kg/m2 . Based on specific criteria including eating behavior , 68 patients were selected to undergo RYGBP and 35 VBG . All patients have undergone complete follow-up evaluation at 1 , 3 , 6 , and 12 months postoperatively and every year thereafter . Results : All patients have now completed their 5th postoperative year . Mean follow-up period to date is 96.5±12.2 months for VBG and 67.6±11.3 months for RYGBP . 3 patients ( 8.6 % ) in the VBG group and 9 patients ( 13.2 % ) in the RYGBP group are lost to follow-up . Mean excess weight loss ( EWL ) was always better in the RYGBP group ( P=0.0013 ) . The percentage of failure , defined as EWL < 25 % , was not significantly different between the two procedures . No statistically significant differences were observed between the 2 groups in the total number of non-metabolic complications , and the only statistically significant difference observed in metabolic complications was vitamin B12 deficiency after RYGBP . Frequency of vomiting was significantly less and quality of eating significantly better in RYGBP than in VBG patients . Conclusion : This prospect i ve long-term study , with nearly complete follow-up , suggests that in the non-superobese population , preoperative eating habits may play a role in choosing the most appropriate bariatric operation for each patient . Although RYGBP is associated with better mean weight loss outcomes , the percentage of patients who achieved and maintained ≥50 % EWL after VBG in this pre-selected patient population was not significantly different . Each type of operation has advantages and disadvantages , and , if properly chosen , a purely restrictive procedure can be successful for some patients . Therefore , it can be said that the decision regarding which bariatric procedure to perform in non-superobese patients must be based on in-depth preoperative evaluation as well as the patients ' own preferences and outcome expectations 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 mL , ( 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 Background Laparoscopic Roux-en-Y gastric bypass surgery ( RYGB ) was introduced at the authors ’ institution 5 years ago . The authors analyzed the short- and long-term results of this procedure compared with those for the same procedure using the laparotomy approach over the same period . Methods Retrospective analysis of a prospect ively collected bariatric data base used the outcome end points used by the American Society of Bariatric Surgery ( ASBS ) and the American College of Surgeons ( ACS ) in their center of excellence programs . Results From January 2001 to July 2005 , 568 laparoscopic and 399 open gastric bypasses were performed at V and erbilt University . The patients were from the same bariatric surgery program and therefore received the same pre- and postoperative care . The hospital length of stay in the laparoscopic group was significantly shorter ( 2.5 ± 2.4 days ) than in the open group ( 3.7 ± 3.7 days ; p = 0.001 ) . The procedure time was significantly shorter in the laparoscopic group ( 164 ± 50 min ) than in the open group ( 195 ± 50 min ; p = 0.0001 ) . The follow-up assessment response at 2 years was 76.6 % . At 2 years , the excess weight loss ( EWL ) was significantly greater in the laparoscopic group ( 71.3 % ± 18.4 % ) than in the open group ( 67.3 % ± 15.3 % ; p = 0.03 ) . The wound infection rate was 
    Output:
    