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Background:
Aim of this study was to evaluate the role of bariatric surgery in a population of morbidly obese patients versus a medical treated cohort. We prospectively compared patients submitted to surgery with a cohort of surgically fit patients waiting for surgery and not operated for extra surgical reasons.

Materials and methods:
We divided the patients into two groups: not operated (group A) and operated (group B).
The recruitment of the patients started in January 2003 and the study ended in November 2011. Median follow-up was 29.2 months (range 13.8-105.3 months) for group A and 38.2 months (range 11.8-106.7 months) for group B. Two hundred eighty-nine patients (M=80; F=209) entered the study, 81 in group A (M=16; F=65) and 208 in group B (M=64; F=144). In group B, we performed laparoscopic gastric bypass in 100 patients, laparoscopic sleeve gastrectomy in 71 patients and laparoscopic gastric banding in 37. Mortality, variation of BMI and comorbidities (diabetes, hypertension, obstructive sleep apnea syndrome and need for pharmacologic treatment) have been evaluated in both groups.

Results:
Initial BMI was 41.5±5.9 Kg/m2 for group A and 42.2±7.0 Kg/m2 at last follow up visit (p=0.56). The difference of comorbidities in group A are shown in table 1. Four patients in group A (4.9%) died during the follow up for heart attack.
Initial BMI for group B was 46.6±7.0 Kg/m2 and 30.9±6.4 Kg/m2 at the end of the follow up period (p<0.001). Variation of comorbidities during follow-up are shown in table 1. There was one death in group B.
The difference between the two groups at last follow up visit are shown in table 2.

Conclusion:
We observed no significant changes in weight loss and comorbidities in group A during the follow up. In group B we observed a significant reduction of BMI and all comorbidities. We observed significant changes in BMI and comorbidities variation between the two groups. In our study bariatric surgery influences the natural history of morbidly obese patients, determining a reduction of BMI, comorbidities and mortality.

Table 1

Medical treatment group	First Visit (n° pts)	Last Follow-up Visit	p
Diabetes	18	23	0.37
Hypertension	22	25	0.61
Obstructive Sleep Apnea Syndrome	10	14	0.39
Pharmacologic treatment	26	32	0.33
Surgery group	Pre-operative (n° pts)	Last Follow-up after surgery (n° pts)	p
Diabetes	64	9	<0.001
Hypertension	96	25	<0.001
Obstructive Sleep Apnea	21	2	<0.001
Pharmacologic treatment	106	29	<0.001

Table 2

	Group A (81 pts)	Group B (208 pts)	p
BMI	42.2±7.0	30.9±6.4	<0.001
Diabetes	23	9	<0.001
Hypertension	25	25	<0.001
Obstructive Sleep Apnea Syndrome	14	2	<0.001
Pharmacologic treatment	32	29	<0.001
Mortality	4	1	=0.02