Psychological classification as a communication and management tool in obese patients undergoing bariatric surgery

Prospective longitudinal assessment of change in health-related quality of life after adjustable gastric banding

BACKGROUND

Gastric banding remains a common procedure worldwide. Improving health-related quality of life (HRQOL) has become a major goal in the treatment of patients with chronic diseases, yet there are few comprehensive data regarding the effect of gastric banding on HRQOL. The aim of this study was to evaluate the impact of laparoscopic gastric banding on HRQOL with particular regard to change over time.

METHODS

The 262 consecutive patients included between May 2005 and September 2006 in a French multicenter prospective study designed to assess the safety and efficacy of a gastric band were asked to complete the SF36 questionnaire preoperatively and each 6 months during 3 years. The HRQOL scores were compared with community norms, and their longitudinal change was assessed using cross-sectional analysis and mixed-effects linear modeling (individual growth model).

RESULTS

One hundred sixty-four patients (63%) provided a preoperative and at least one postoperative SF-36 questionnaire from 12 to 36 months and form the basis of the present study. In all dimensions, the scores of HRQOL were significantly impaired preoperatively and were significantly improved at 3 years. The increase in HRQOL scores was most marked during the first postoperative months; it continued more slowly after 6 months and stabilized after 1 year. The improvement in HRQOL was associated with the decrease in BMI, in all dimensions.

CONCLUSION

Gastric banding results in a significant improvement in HRQOL. A return to normal can be expected at 1 year and persists at 3 years. The postoperative improvement in HRQOL is strongly related to weight loss.

Wide topical negative pressure wound dressing treatment for patients undergoing abdominal dermolipectomy following massive weight loss

Postbariatric plastic surgery is considered to be a high-risk procedure, which entails such frequent minor complications as postoperative seroma, bleeding and wound dehiscence. These occur with a high incidence, especially, following postbariatric abdominal dermolipectomy. In order to reduce these complication rates, a new type of dressing with wide abdominal topical negative pressure (TNP) application was applied. We performed abdominal dermolipectomy in 23 obese patients. The average body mass index was 32.8 kg/m(2), and the median age of the patients was 42.9 years. Ten patients received conventional standard dressings (control group I), whereas the other 13 patients received a wide TNP dressing including the ventral and lateral trunk (negative pressure group II). Postoperative exudate volumes were collected, tallied and documented for each group separately until all drains could be removed. The conventionally treated control group (I) showed a significantly higher postoperative secretion volume compared with the negative pressure group (II). In addition, the average time to postoperative final drain removal was significantly lower in the negative pressure group (II) compared with the control group (I). The results indicate that widely applied external TNP wound dressing on the ventral and lateral trunk following postbariatric abdominal dermolipectomy leads to a significant reduction in exudate formation, enables early drain removal and thus, decreases length of hospitalization.

[Recommendations for the peri-operative management of bariatric surgery patients: results of a national survey]

To standardise possible peri-operative bariatric surgery protocols, a survey was prepared to be filled in by members of the Spanish Society for Obesity (Sociedad Española de Cirugía de la Obesidad) (SECO), and to approve it at the XII National Congress. A total of 47 members of SECO from 14 autonomous communities responded, and it unanimously approved by the Congress. As highly recommended peri-operative procedures, were proposed: full laboratory analysis (98%) with an endocrine study (90%), ECG (96%), chest x-ray (98%), an oesophageal-gastric imaging test (endoscopy or gastro-duodenal transit study (98%), antibiotic prophylaxis (92%) and use of low molecular weight heparins pre-operatively (96%), and for 2 weeks (83%). Pre-surgical, abdominal ultrasound (86%), spirometry (80%), diet (88%) and psychological study (76%), and during surgery, use of elastic stockings (76%), leak tests (92%) and drainages (90%), were established as advisable procedures.

Positive response to binge eating intervention enhances postoperative weight loss

BACKGROUND

Binge eating disorder has been suggested as a predictor of negative outcomes, including weight regain and poorer weight loss, particularly if the symptoms (e.g., loss of control eating) remain after surgery. Binge eating disorder has been viewed by some as a contraindication for weight loss surgery, and preoperative treatment has been recommended to help reduce binge eating behaviors. The objective of the present study was to evaluate whether the response to a preoperative binge eating intervention related to differential postoperative weight loss at an academic medical center.

METHODS

A total of 128 bariatric surgery candidates completed a brief cognitive behavioral group treatment for binge eating behaviors. The patients were categorized as positive responders or nonresponders according to the postintervention outcomes, including binge eating symptoms and episodes. The percentage of excess body weight loss (%EBWL) was measured at 6 and 12 months after surgery.

RESULTS

Across all bariatric procedures, the positive responders to the brief binge eating intervention had lost significantly more weight at 6 months (46% EBWL versus 38% EBWL) and 12 months (59% EBWL versus 50% EBWL) postoperatively. The results for a subsample of Roux-en-Y gastric bypass patients (n = 89) were also significant, with 53% EBWL for the responders and 42% EBWL for the nonresponders at 6 months and 68% EBWL versus 54% EBWL at 12 months postoperatively, respectively.

CONCLUSION

The response to binge eating treatment could be an important predictor of postoperative weight loss. The results from the present study provide support for patients who respond to preoperative binge eating treatment having enhanced surgical outcomes.