title: Perioperative morbi-mortality associated with bariatric surgery: from systematic biliopancreatic diversion to a tailored laparoscopic gastric bypass or sleeve gastrectomy approach.
abstract: BACKGROUND
  The effectiveness and safety of the different bariatric surgical procedures currently available depend, partly, on the characteristics of the populations under study, the technical approach, the expertise of surgical teams, and on institutional factors. To evaluate the effectiveness and safety of these procedures, we compared the surgical results for biliopancreatic diversion surgery versus laparoscopic gastric bypass and sleeve gastrectomies performed in our institution.
  
  
  METHODS
  This was a retrospective observational study of 296 patients undergoing bariatric surgery from January 2005 through October 2010. We analyzed mortality rate, cardiocirculatory and pulmonary perioperative complications, duration of surgery, intensive care unit admissions, and length of stay. We describe the changes in the choice of the surgical procedures throughout the study period.
  
  
  RESULTS
  We observed a rate of pulmonary complications of 2.3 % and a mortality rate 3 months after discharge of 2.36 % with sepsis secondary to anastomotic leak as the main cause of death. Biliopancreatic diversion surgery was associated with higher mortality rates (p value = 0.014) and longer hospital stay (median of 9 versus 6 days for laparoscopic gastric bypass and sleeve gastrectomy, p value <0.001). Body mass index ≥ 50 was also related to higher mortality (p value = 0.023). We confirmed a progressive increase in laparoscopic restrictive and mixed techniques in our institution (from 0 % in 2005 to 87 % of all procedures in 2010).
  
  
  CONCLUSIONS
  Bariatric surgery in our institution has dramatically shifted from systematic biliopancreatic diversion to a tailored laparoscopic gastric bypass or sleeve gastrectomy approach, which has made it possible to reduce hospital stay and mortality rates.
authors.affiliation: Department of Anesthesia, Hospital General, Hospital Universitario Virgen del Rocío, Seville 41013, Spain. mdlmattam@hotmail.com
authors.forename: Manuel
authors.initials: M
authors.lastname: de la Matta-Martín
authors.forename: Jesús
authors.initials: J
authors.lastname: Acosta-Martínez
authors.forename: Salvador
authors.initials: S
authors.lastname: Morales-Conde
authors.forename: Augusto
authors.initials: A
authors.lastname: Herrera-González
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery; D015904:Biliopancreatic Diversion / Q000009:adverse effects / Q000379:methods*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology / Q000601:surgery