10-year outcomes of the vertical transected gastric bypass for obesity: a systematic review.

With increasing worldwide obesity rates, the surgery of choice has become the vertical transected gastric bypass, showing short-term improvements in weight loss and comorbidities. However, corresponding 10-year data regarding such endpoints is limited. The objective of this review was to assess such evidence. A literature search yielded a total of five studies, of which three had extractable data. Results revealed a reduction in the weighted mean body mass index (BMI), from a pre- to post-operative mean BMI of 47.5 kg/m(2) ± 2.0 to 33.4 kg/m(2) ± 4.4 at 10 years. The weighted mean excess weight loss was 61.4 % ± 13.5. Although these results suggest that weight reduction may be sustainable in the long term, this systematic review demonstrates a lack of strong evidence to support favorable long-term outcomes following vertical transected gastric bypass for obesity.

The impact of an acute care emergency surgical service on timely surgical decision-making and emergency department overcrowding.

BACKGROUND: This study evaluated how implementation of an acute care emergency surgery service (ACCESS) affected key determinants of emergency department (ED) length of stay, and particularly, surgical decision time. Also, we analyzed how ACCESS affected ED overcrowding. STUDY DESIGN: We conducted a before and after study of all ED patients referred to ACCESS from January 1, 2007 to June 30, 2009. ACCESS was implemented on July 1, 2008. The primary outcome was surgical decision time; the secondary outcome was a measure of overall ED overcrowding: "time-to-stretcher" for all ED patients. The control groups were patients referred to internal medicine or urology. Patients with appendicitis were studied in order to analyze the impact on patient outcomes and to determine barriers to efficient ED patient flow. RESULTS: Of 2,510 patients, 1,448 patients were pre-ACCESS, and 1,062 were after ACCESS implementation. Implementation of ACCESS was associated with a 15% reduction in surgical decision time (12.6 hours vs 10.8 hours, p < 0.01). During the same period, there were no significant changes in decision time for our control groups. Also, the mean time-to-stretcher for all ED patients decreased by 20%. In patients with appendicitis, we found that patient flow could be further improved by a timely request for surgical consultation and expedited imaging. Finally, we found that patients with nonperforated appendicitis with a fecalith on CT imaging were more likely to suffer perforation while waiting for surgery. CONCLUSIONS: ACCESS reduced surgical decision time for surgical patients. Also, ACCESS improved overall ED crowding, as measured by time-to-stretcher for ED patients. Further improvements could be made by improving time to imaging. Patients referred for nonperforated appendicitis with a fecalith on CT should have expedited surgery.