Morbid XXXX : medical or surgical treatment? The case for medical treatment.

@entity1 @entity89 @entity353 @entity28
We should ask about any therapy: (1) is it safe? and (2) is it effective? The best therapy is that which has the greatest chance to do good with the least chance to cause harm. Medical treatment is certainly safer than surgery, since (by my definition) surgery always involves a general anaesthetic, and morbidly @entity28 @entity1 are bad anaesthetic risks. @entity28 also increases other surgical risks, so all published series of surgically-treated @entity28 @entity1 report some mortality. Surgeons will claim that surgery is much more effective than medical treatment, which has negligible success in morbid @entity28 . However all surgical bypass or banding procedures cause @entity353 by restricting food intake, so if food intake can be equally restricted without surgery the results are just as good. In our experience @entity89 (which does not require a general anaesthetic) produces similar @entity353 to gastroplasty. However the most difficult problem in morbid @entity28 is the maintenance of reduced weight many years after treatment. We have too few good long-term follow-up data after either medical or surgical treatment, but about half our @entity1 treated with @entity89 and a waist cord maintain their @entity353 on 3 years follow-up, zero mortality from the procedure. The results of surgical and medical treatments depend on the skill and care with which they are applied, and the way in which @entity1 are selected. If @entity1 are given treatment B if they are considered unsuitable for treatment A then the results from treatment A will be better.(ABSTRACT TRUNCATED AT 250 WORDS)
