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Evidence based german guidelines for surgery for obesity: Obesity Surgery and the Treatment of Metabolic Diseases

Has PDF. Abstract Background: Increasing numbers of interventions for obesity and metabolic surgery have led to an increase of primary bariatric operations as well as redo operations and revisional surgery after various primary bariatric procedures.

Ethan Walker
Wednesday, May 1, 2019
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  • At least the following should be checked:.

  • Trends in mortality in bariatric surgery: a systematic review and meta-analysis.

  • The choice of procedure is based on profound knowledge of results, long-term effects, complications, and patient-specific circumstances.

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Runkel and M. Databases were systematically searched for clinical trial results in order to produce evidence-based recommendations. Conclusion: Compared with the primary surgical procedures redo operations and revisional procedures have significantly higher complication rates. These guidelines intend to define the comparative effectiveness and surrounding circumstances of the various types of obesity surgery.

Patients should be seen 3 to 8 times during the first postoperative year, 1 to 4 times during the second year and once or twice a year thereafter. New surgical methods, minimal access techniques, and the enormous increase of scientific studies and evidence, all contribute to the success of bariatric surgery, which is the only realistic chance of permanent weight loss and regression of secondary diseases in many cases. Create Alert Alert. Background: Increasing numbers of interventions for obesity and metabolic surgery have led to an increase of primary bariatric operations as well as redo operations and revisional surgery after various primary bariatric procedures. Some features of the site may not work correctly. Highly Influenced. Related Papers.

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  • Results: Systematic review of databases, record selection, data extraction and synthesis, evidence appraisal and evidence-to-decision frameworks were developed for 42 key questions in the domains Indication; Preoperative work-up; Perioperative management; Non-bypass, bypass and one-anastomosis procedures; Revisional surgery; Postoperative care; and Investigational procedures.

  • Himpens J, Dapri G, Cadiere GB A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years.

  • The key elements of postoperative care are the following:.

  • Following two days of discussion by the experts and a plenary discussion, the final statements were issued. View 1 excerpt, cites background.

Buchwald H, Estok R, Fahrbach K et al Weight cor type 2 diabetes after bariatric surgery : systematic review and metaanalysis. Dietetic preparation of obese patient to bariatric treatment. Many studies of high quality RCTs and meta-analyses have shown the superiority of surgery over conservative treatment in these situations, justifying the recommendations above It is stated in the German Health Report on Diabetes for the year that 6. Effective surgical procedures for the treatment of obesity.

Bariatric surgery and prevention of type 2 diabetes evifence Swedish obese subjects. Antibiotic and antithromboembolic prophylaxis should be used routinely. Wirth and K. A total of 36 recommendations and position statements were formed through a modified Delphi procedure. In addition to standard laboratory testing, chest radiography, electrocardiography, spirometry, and abdominal ultrasonography, the preoperative evaluation of obesity surgery patients also includes upper gastrointestinal endoscopy or radiologic evaluation with a barium meal. MethodsA systematic literature review, classification of evidence, graded… Expand.

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Has PDF. DOI: Surgical versus medical treatment of type 2 diabetes mellitus in nonseverely obese patients: a systematic review and meta-analysis. Role of Bariatric Surgery in Diabetes. Highly Influenced.

Author retracts weight loss surgery paper after admitting most, if not all, of the subjects were guidelinse up. Primary surgery may also be indicated if radical weight loss may not be postponed for medical reasons. Conflict of interest statement Prof. The currently established standard operations are gastric banding, sleeve gastrectomy, proximal Roux-en-Y gastric bypass, omega-loop gastric bypass, and biliopancreatic diversion.

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Psychotherapy: Implementation of an inpatient or outpatient psychotherapy behavioral therapy or depth psychology in cases of an eating disorder binge-eating, night-eating or psychopathology e. Ann Surg — Lacking official terms for such specialists, the guideline refers to these potential specialists as being experienced in the management of obese patients. Effects of bariatric surgery on mortality in Swedish obese subjects. Systematic reviews, meta-analyses, and randomized controlled trials RCTs were sought.

Conclusion : No si ngle standard technique can be recommended in all cases. Points 1 and in part 2 in the above list of obesity surgery indications are supported by evidence of the highest level point 2 with respect to the therapeutic objective of weight control and improvement in biochemical markers of cardiovascular risk and correspondingly, recommendations of the highest grade are given. Priority was given to systematic reviews and meta-analyses. Still, any scientific recommendation represents a compromise between practically orientated firmness of language and its underlying scientific basis. Results: Obesity surgery is an integral component of the multimodal treatment of obesity, which consists of multidisciplinary evaluation and preparation, conservative and surgical treatment elements, and a life-long follow-up. Effects of bariatric surgery on mortality in Swedish obese subjects. Evidence-based German guidelines for surgery for obesity.

Has PDF. These recommendations were then for mulated with the aim to obedity the way for obesity surgery within a well-defined spectrum of indications. The most common complications of obesity surgery all of them rare were staple-line fistula, anastomosis insufficiency, abscess, and bleeding. Himpens J, Dapri G, Cadiere GB A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years.

Susewind and S. Highly Influenced. RunkelM. These guidelines intend to define the comparative effectiveness and surrounding circumstances of the various types of obesity surgery. Share This Paper. Diabetes Mellitus Obesity Gastric Balloon.

Shang and M. Following two days of discussion by the experts and a plenary discussion, the final statements were issued. Since a total of 24, primary bariatric procedures, revisional procedures and redo operations were analyzed. Weimann and M. Highly Influenced. Bariatric surgery and the role of the clinical endocrinologist: update.

For all procedures combined, the mean weight loss on last follow-up was Patient care should improve after implementation of these guidelines in clinical practice. Since the results of this consensus conference have been derived directly from the relevant literature by an interdisciplinary panel of official delegates from the surgical, medical, nutritional, and psychological societies, it can be hoped that they find widespread acceptance.

Jens Aberle Bad Rothenfelde: Prof. New surgical methods, minimal access techniques, and the enormous increase of scientific studies and evidence, all contribute to the success of bariatric surgery, which is the only realistic chance of permanent weight loss and regression of secondary diseases in many cases. Weimann and M. Long-term data are available, for example, from the SOS study a prospective interventional study Diabetes Care ; 40 Suppl 1 : 1—

A total of 36 recommendations and position statements were formed through a modified Delphi procedure. Publication types Practice Guideline. Topics from this paper. Skip to search form Skip to main content You are currently offline.

Since the results of this consensus eevidence have been derived directly from the relevant literature by an interdisciplinary panel of official delegates from the surgical, medical, nutritional, and psychological societies, it can be hoped that they find widespread acceptance. Aberle, Prof. The perioperative morbidity and mortality of obesity surgery are relatively low. A systematic review and meta-analysis.

New surgical methods, minimal access techniques, and the enormous increase of scientific studies and evidence, all evidence based german guidelines for surgery for obesity to the success of bariatric surgery, which is the only realistic chance of permanent weight loss and regression of secondary diseases in many cases. Patients with insulin-treated type 2 diabetes mellitus experience a rapid decline in antidiabetic drug dose, with a large proportion of insulin injection, or without insulin after 6 weeks postoperatively. Privacy policy. Thank you, for helping us keep this platform clean. Traditionally, obesity surgery is considered appropriate for. Successful weight loss may necessitate skin-removal surgery, particularly from the abdomen and the thighs, but sometimes even from the arms and chest.

ALSO READ: Factors Contributing To Obesity Epidemic Map

There ofr a strong consensus among the experts that the following types of patients should undergo surgery only in a center with special expertise, and that the specified techniques guidelines for surgery only be performed in such centers however, this is not evidence based :. Effects of bariatric surgery on mortality in Swedish obese subjects. Neither binge-eating nor sweet-eating are predictors of weight loss after surgery EL 4, [16]. JAMA — 3. The patient must be fully in for med about his surgical procedure and alternative treatment options, late effects, morbidity, mortality, and long-term care, elucidating the lifelong supplementation and postbariatric plastic surgery.

Effects of bariatric surgery on mortality in Swedish obese subjects. Research Feed. Evidence-based guidelines for indications and choice of procedure for revisional surgery do not currently exist. View 4 excerpts, references background.

The structured consensus process was carried out at specified steps. The guidelines also highlight the need for future studies. More magazines by this user.

Evidence - based German guidelines for surgery for obesity. Methods Citations. Close Flag as Inappropriate. Successful weight loss may necessitate skin-removal surgery, particularly from the abdomen and the thighs, but sometimes even from the arms and chest. The frequency of follow-up appointments will depend on the surgery per for med, the dynamic of weight loss and for any problems or complications. Int J Obes —

View 1 excerpt, references background. It is of upmost importance to prove the effectiveness of surgery beyond guideliines traditional borders. At the same time, the society is strongly interested to implement a quality control system. Many studies of high quality RCTs and meta-analyses have shown the superiority of surgery over conservative treatment in these situations, justifying the recommendations above

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Some features of the site may not work correctly. View 2 excerpts, references background. Privacy policy.

Jens Aberle Bad Rothenfelde: Prof. View on Springer. Patients with insulin-treated type 2 diabetes mellitus experience a rapid decline in antidiabetic drug dose, with a large proportion of insulin injection, or without insulin after 6 weeks postoperatively. Magazine: Evidence-based German guidelines for surgery for obesity.

  • The treating team that establishes the indication for surgery should consist of the following members:.

  • Psychiatric consultation and polysomnography can safely be restricted to patients with clinical symptoms on preoperative screening. Save to Library Save.

  • Author retracts weight loss surgery paper after admitting most, if not all, of the subjects were made up.

More Filters. For all procedures combined, the mean weight loss on last follow-up was Version 2. Delete template? Lacking official terms for such specialists, the guideline refers to these potential specialists as being experienced in the management of obese patients.

Background Citations. Group therapy: Modification of life style should be conducted and supervised within a group, if possible. Colles SL, Dixon JB, Marks P et al Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Prophylactic dietary supplementation is indicated after any type of surgery for obesity or a metabolic indication. Citation Type.

Runkel and Obesiyy. In addition to standard laboratory testing, chest radiography, electrocardiography, spirometry, and abdominal ultrasonography, the preoperative evaluation of obesity surgery patients also includes upper gastrointestinal endoscopy or radiologic evaluation with a barium meal. View 6 excerpts, cites methods and background. The choice of procedure therefore should be tailored to the individual situation. Following two days of discussion by the experts and a plenary discussion, the final statements were issued.

Publication Type. Highly Influential. Dietetic preparation of obese patient to bariatric treatment. Psychological and psychosomatic aspects of bariatric surgery for the treatment of obesity in adults. A total of 36 recommendations and position statements were formed through a modified Delphi procedure. Diabetes Mellitus Obesity Gastric Balloon. Mann and R.

Methods Citations. View 6 excerpts, cites methods and background. View 1 excerpt, references background. Following two days of discussion by the experts and a plenary discussion, the final statements were issued. Background: The increasing prevalence of morbid obesity together with the development of laparoscopic approaches has led to a steep rise in the number of bariatric operations.

Cor loss is greater in patients with regular postoperative supervision EL [4, 27, 28]. At the same time, the society is strongly interested to implement a quality control system. By clicking accept or continuing to use the site, you agree to the terms outlined in our Privacy PolicyTerms of Serviceand Dataset License.

Wirth and K. View 2 excerpts, references background. Bariatric surgery and the role of the clinical endocrinologist: update. MethodsA systematic literature review, classification of evidence, graded… Expand. Sauerland Published Medicine International Journal of Colorectal Disease BackgroundThe young field of obesity surgery bariatric surgery in Germany expands as a consequence of the rapid increase of overweight and obesity.

Role of Bariatric Surgery in Diabetes. Aim: The spectrum of various revisional and redo operations following standard operative procedures for obesity and metabolic surgery is presented based on current data from the German bariatric surgery registry GBSR, German nationwide survey on quality assurance in bariatric surgery and a literature search. Topics from this paper. View on Springer. Highly Influenced.

Evidence tables to be used as a foundation for the creation of the guideline were prepared for 56 systematic reviews and meta-analyses, one RCT, and five cohort studies; these tables were then evaluated by the SIGN procedure 6. Share from page:. JAMA — 3. Wolff and Ricarda Wunder and A.

Psychological and psychosomatic aspects of bariatric surgery for the treatment of obesity in adults. Launch Research Feed Feed. Long-term data are available, for example, from the SOS study a prospective interventional study Arch Gen Psychiatry — Runkel and M.

Background: Increasing numbers of interventions for obesity and metabolic surgery evidence based german guidelines for surgery for obesity led to an increase of primary bariatric operations as well as redo operations and revisional surgery after various primary bariatric procedures. Runkel and M. By clicking ebidence or continuing to use the site, you agree to the terms outlined in our Privacy PolicyTerms of Serviceand Dataset License. Wolff and Ricarda Wunder and A. The study evaluated revisional and redo operations after gastric banding GBredo operations after sleeve gastrectomy SG and revisional procedures and 10 redo operations after a Roux-en-Y gastric bypass RYGBP. Conclusion: Compared with the primary surgical procedures redo operations and revisional procedures have significantly higher complication rates. Role of Bariatric Surgery in Diabetes.

New surgical methods, minimal access techniques, and the enormous increase of scientific studies and evidence, all contribute to the success of bariatric surgery, which is the only realistic chance of permanent weight loss and regression of secondary diseases in many cases. Highly Influenced. Publication types Comparative Study.

Role of Bariatric Surgery in Diabetes. Review of the key results from the Swedish Obese Subjects SOS trial — a prospective controlled intervention study of bariatric surgery. Dietetic preparation of obese patient to bariatric treatment. Colombo-Benkmann and T.

Conclusion: The S3-guidelines contain evidence-based recommendations for the indication, selection of procedure, technique, and follow-up. Author retracts weight loss surgery paper after admitting most, if not all, of the subjects were made up. Diabetes Care ; 40 Suppl 1 : 1— Furthermore, patients should be prepared and set for the postoperative course. In addition, bariatric surgery may prevent the development of type 2 diabetes mellitus in a longitudinal comparative analysis EL 1b, [22]. The goals of treatment should always be individually defined and adapted to any changes that take place.

RunkelM. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. View 2 excerpts, references background. Results Citations. In addition to standard laboratory testing, chest radiography, electrocardiography, spirometry, and abdominal ultrasonography, the preoperative evaluation of obesity surgery patients also includes upper gastrointestinal endoscopy or radiologic evaluation with a barium meal.

View 6 excerpts, cites methods and background. Review of the key results from the Swedish Obese Subjects SOS trial — a prospective controlled intervention study of bariatric surgery. Publication Type. Recommendations: After the patient's multidisciplinary evaluation, obesity surgery should be considered in adults with a documented BMI greater than or equal to 35 and related comorbidity, or a BMI of at least Psychiatric consultation and polysomnography can safely be restricted to patients with clinical symptoms on preoperative screening.

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Recommendations: After the patient's multidisciplinary evaluation, obesity surgery should be considered in adults with a documented BMI greater than or equal to 35 and related comorbidity, or a BMI of at least Research Feed. More Filters. In addition to standard laboratory testing, chest radiography, electrocardiography, spirometry, and abdominal ultrasonography, the preoperative evaluation of obesity surgery patients also includes upper gastrointestinal endoscopy or radiologic evaluation with a barium meal. Weimann and M.

Furthermore, patients should be prepared and set for the postoperative course. Background Citations. The rate of complete fr of pre-existing type 2 diabetes for all procedures combined was Dietetic preparation of obese patient to bariatric treatment. Ann Intern Med — JAMA — These recommendations were then for mulated with the aim to prepare the way for obesity surgery within a well-defined spectrum of indications.

Wirth, Prof. A psychologist or psychiatrist is included into the preoperative work-up only selectively, although the prevalence of mental disorders rises with increasing BMI EL 2b, [12, 13]. The long-term follow-up was reported in only 26 patients EL 4, [25] and 41 patients EL 4, [26], respectively. These include the differential diagnosis and also an upper GI-endoscopy.

The conservative multimodal treatment options have failed when the treatment goal has not been achieved within 6—12 months. Subgroup analyses revealed no statistically significant differences across procedures with respect to either weight loss or diabetes remission. JAMA — 3. Background: The young field of obesity surgery bariatric surgery in Germany expands as a consequence of the rapid increase of overweight and obesity. These contraindications are relative, except for pregnancy, and they are not supported by evidence. View 1 excerpt, references methods.

An indication is also present if this degree gudielines weight loss has indeed been reached, but obesity-associated illnesses persist that could be improved by obesity surgery, or by surgery for a metabolic indication i. View 4 excerpts, references background. Wirth and K. Advantages and disadvantages of various types of primary obesity surgery and of primary surgery for metabolic indications. Retraction Watch.

The patient must be fully in for med about his surgical procedure and alternative treatment options, late effects, morbidity, mortality, and long-term care, elucidating the lifelong supplementation and postbariatric plastic surgery. Methods : The guideline was created by a multidisciplinary panel of experts on the basis of publications retrieved by a systematic literature search. The follow-up serves primarily for the necessary adjustments of the gastric band and the prevention of late complications and deficiencies that may occur despite supplementation.

Dietetic preparation of obese patient to bariatric treatment. Background Citations. Related Papers. Surgical Treatment of Metabolic Syndrome.

In addition to standard laboratory testing, chest radiography, electrocardiography, spirometry, and abdominal ultrasonography, the preoperative evaluation of obesity surgery patients also includes upper gastrointestinal endoscopy obesiyy radiologic evaluation with a barium meal. New surgical methods, minimal access techniques, evidence based german guidelines for surgery for obesity the enormous increase of scientific studies and evidence, all contribute to the success of bariatric surgery, which is the only realistic chance of permanent weight loss and regression of secondary diseases in many cases. View 4 excerpts, references background. EAES has sponsored an update of previous guidelines on bariatric surgery. Review of the key results from the Swedish Obese Subjects SOS trial — a prospective controlled intervention study of bariatric surgery. Abstract Background: Surgery for obesity and metabolic diseases has been evolved in the light of new scientific evidence, long-term outcomes and accumulated experience.

  • Shang and M. Surgery for obesity and metabolic disease is less common in Germany than in the neighboring Western European countries Germany,

  • Highly Influential.

  • Still, the number of procedures has increased in recent years but runs far behind other western countries. Evidence-based German guidelines for surgery for obesity.

  • View 1 excerpt, cites background.

These are mainly affective disorders, anxiety disorders, eating disorders, and personality disorders. Main obesity opuszek. The increased prevalence of obesity obewity Germany, particularly among young adults, presents a challenge to the healthcare system with major socioeconomic effects both now and in the future. Akt Ernahrungsmed ; —74 CrossRef. Each chapter of recommendations is followed by a text commenting them for better understanding and practical use. The follow-up serves primarily for the necessary adjustments of the gastric band and the prevention of late complications and deficiencies that may occur despite supplementation.

RunkelM. Conclusion: This document baased the latest evidence on bariatric surgery through state-of-the art guideline development, aiming to facilitate evidence-based clinical decisions. The data evaluated show that strong and differentiated indications are necessary for revisional and redo operations particularly in cases of therapy or metabolic failure. View 1 excerpt, references background.

Highly Influential. Centers were defined in accordance with the certification rules of the DGAV 7 and the Swiss guideline on the surgical treatment of obesity 8. Abstract Background: The young field of obesity surgery bariatric surgery in Germany expands as a consequence of the rapid increase of overweight and obesity.

This formulation met with a strong consensus among the experts. Himpens J, Dapri Obesity opuszek, Cadiere GB A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. By clicking accept or continuing to use the site, you agree to the terms outlined in our Privacy PolicyTerms of Serviceand Dataset License. The standard techniques are gastric balloon, gastric banding, gastric bypass, gastric sleeve, and biliopancreatic diversion. It is stated in the German Health Report on Diabetes for the year that 6. Surgery is indicated to treat a metabolic disturbance in the following situations:. Often, the scarceness of reliable evidence precluded the panel from for mulating important decisions.

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The Barmer Health Report 9 and evjdence German registry data 10 reveal that perioperative morbidity and mortality are lower in certified centers e. Ann Intern Med — There are also differences between the various types of certified center. Rubino F, Gagner M Potential of surgery for curing type 2. Arch Gen Psychiatry —

All of the standard procedures of obesity surgery were rated as positive over the long term in a risk—benefit analysis 1820 The postoperative day mortality for all laparoscopic restrictive procedures was 0. Surgery for obesity and metabolic disease is less common in Germany than in the neighboring Western European countries Germany, MethodsA systematic literature review, classification of evidence, graded… Expand.

Related Papers. View 4 excerpts, references background. Successful weight loss may necessitate skin-removal surgery, particularly from the abdomen and the thighs, but sometimes even from the arms and chest.

The choice of procedure therefore should be tailored to the individual situation. Publication types Comparative Study. Weimann and M. The complication rate for GB removal and SG showed a significantly higher leakage rate for one step operations than for two step procedures of 3. DOI:

Arne Dietrich III. This article includes all evidence- based recommendations for preoperative evaluation, indication, choice of procedure, technique, and follow-up, but it is a version shortened on methodology and the evidence based german guidelines for surgery for obesity review. Shang and M. An indication is also present if this degree of weight loss has indeed been reached, but obesity-associated illnesses persist that could be improved by obesity surgery, or by surgery for a metabolic indication i. This effect remains stable for many years EL 2b, [5]. Long-term data are available, for example, from the SOS study a prospective interventional study

Bariatrische Chirurgie und Endoskopie. Surgery — 4. The strength of these guidelines is a strong consensus with the nonsurgical panel members. Ann Surg — Conclusion: The S3-guidelines contain evidence-based recommendations for the indication, selection of procedure, technique, and follow-up.

The guidelines recommend a team of specialists for the management of obese patients. JAMA — In addition, bariatric surgery may prevent the development of type 2 diabetes mellitus in a longitudinal comparative analysis EL 1b, [22]. Long-term after-care A systematic approach to aftercare is needed in all patients regardless of the operation. The frequency of follow-up appointments will depend on the surgery per for med, the dynamic of weight loss and for any problems or complications.

Close Flag as Inappropriate. View 6 excerpts, cites methods and background. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. Ghidelines older guidelines, weight loss was often said to be the therapeutic objective of obesity surgery. Review of the key results from the Swedish Obese Subjects SOS trial — a prospective controlled intervention study of bariatric surgery.

Recommendations for the standards of equipping of the Bariatric and Metabolic Surgery Center. The guidelines abolish traditional age limits up at 65 years and down at 18 years. For example, morbidity was lower in reference and excellence centers than in competence centers

Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Recommendations: After the patient's multidisciplinary evaluation, obesity surgery should be considered in adults with a documented BMI greater than or equal to 35 and related comorbidity, or a BMI of at least Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Sauerland Published Medicine International Journal of Colorectal Disease BackgroundThe young field of obesity surgery bariatric surgery in Germany expands as a consequence of the rapid increase of overweight and obesity.

New surgical methods, minimal access techniques, and the enormous increase of scientific obesity opuszek and evidence, all contribute to the success of bariatric surgery, which is the only realistic chance of permanent weight oebsity and regression of secondary diseases in many cases. Psychological and psychosomatic aspects of bariatric surgery for the treatment of obesity in adults. Create Alert Alert. By clicking accept or continuing to use the site, you agree to the terms outlined in our Privacy PolicyTerms of Serviceand Dataset License. Patients should be seen 3 to 8 times during the first postoperative year, 1 to 4 times during the second year and once or twice a year thereafter. Surgical versus medical treatment of type 2 diabetes mellitus in nonseverely obese patients: a systematic review and meta-analysis.

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