The medical management of obesity www.selleckchem.com/products/AZD2281(Olaparib).html has a poor track record, but bariatric surgery has demonstrated superior weight loss and dramatic improvement in comorbidities in the postoperative period. In the developed world, bariatric surgery is usually performed at designated centers of excellence on the basis that this leads to better outcomes. However, it is debatable if bariatric surgery should be limited to such high-volume centers [10]. In addition to control of obesity, bariatric surgery is also very effective in the management of diabetes mellitus and hypertension, which commonly afflicts this population. Since the prevalence of diabetes mellitus and hypertension is also very high in the Caribbean nations, it may well be argued that bariatric surgery should be commonly available commonplace in these islands regardless of the patient turnover once results are acceptable.

With this background, this paper aims to investigate and report the safety and effectiveness of bariatric surgery in a low-volume center in a third world setting. 2. Methods After necessary approval from Hospital Authorities, data regarding patients who underwent bariatric surgery in a single surgical unit (which offers the bariatric surgery service in the whole island of Trinidad & Tobago) were prospectively recorded for a period of eight years (July 2003 through June 2011) and analyzed retrospectively. Demographic data recorded included age, gender, weight, height, and body mass index (BMI).

Clinical data recorded included preoperative biochemical parameters, comorbid illnesses, drug and medication history, type of surgical procedure undertaken, surgical duration, postoperative complications, repeat procedures, hospital stay, requirement of High Dependency Unit/Intensive Care Unit admission, postoperative biochemical parameters, postoperative medication requirements, weight loss in the postoperative period, and any other serious adverse outcome including mortality if any. All patients were seen personally by the only trained advanced laparoscopic bariatric surgeon on an individual basis. The procedure was detailed and all risks and benefits explained. The endocrinologist then coordinated the entire metabolic and cardiac evaluation with a pulmonologist and gastroenterologist used as needed. The nutritionist provided pre- and postoperative counseling to the patient and family.

The services of a psychologist were used as determined by the surgeon after the initial consult. After medical clearance was obtained, the patient was again seen by the surgeon. This multidisciplinary approach was used for all patients. Procedures were performed at the same facility (with adequate Intensive Care Carfilzomib Unit back up facility) with a small pool of locally trained operating room staff and the same anesthetist.