title: Management options for obesity after bariatric surgery.
abstract: BACKGROUND
  Many patients do not maintain weight loss after gastric bypass. We compared outcomes for patients undergoing diet/exercise intervention with patients undergoing surgical intervention through restorative obesity surgery-endolumenal, band over bypass, and endoscopic gastro gastric fistula closure.
  
  
  METHODS
  We hypothesized surgery would result in greater weight loss. A retrospective analysis was performed on a bariatric database. Patients who underwent gastric bypass and failed to lose weight were selected and evaluated after intervention. Records were reevaluated at 3, 6, and 12 months after intervention for primary outcomes, that is, weight loss and comorbidity resolution.
  
  
  RESULTS
  A total of 60 patients met the criteria. Forty-three underwent nonsurgical management; 17 underwent operative intervention. Mean body mass index decreased significantly in surgical patients compared with patients with supervised weight loss (P=0.001). Interventional patients trended toward better comorbidity resolution.
  
  
  CONCLUSIONS
  Restorative obesity surgery-endolumenal, band over bypass, and endoscopic fistula closure results in greater weight loss and trend toward greater comorbidity resolution compared with diet and exercise.
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Kristen
authors.initials: K
authors.lastname: Buttelmann
authors.forename: John G
authors.initials: JG
authors.lastname: Linn
authors.forename: Woody
authors.initials: W
authors.lastname: Denham
authors.forename: Melissa
authors.initials: M
authors.lastname: Ruiz
authors.forename: Amy
authors.initials: A
authors.lastname: Yetasook
authors.forename: Michael
authors.initials: M
authors.lastname: Ujiki
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D015992:Body Mass Index; D031204:Caloric Restriction; D037001:Directive Counseling; D004724:Endoscopy; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000628:therapy*; D019233:Retreatment; D012189:Retrospective Studies; D016896:Treatment Outcome; D015430:Weight Gain; D015431:Weight Loss