[Laparoscopic gastroplasty for morbid obesity: prospective study of 300 cases]

Existe-t-il des facteurs prédictifs de succès dans le traitement de l'obésité morbide par anneau périgastrique modulable ? Étude prospective

BACKGROUND

Surgical treatment of morbid obesity by perigastric adjustable banding give at mid term follow up, contrasted results which associate success, failure and intermediate situations.

AIMS

The objective of this work was to prospectively validate predicting items that would predict success in the surgical treatment of morbid obesity by adjustable gastric banding.

MATERIAL AND METHODS

Eighty patients with morbid obesity have been treated with adjustable gastric banding. Seventy-one women, and nine men with a mean age of 37.8 years (20-59) with a mean follow up of 17 months (12-52). They have been classified in three groups: success, failure, and intermediate results. Uni- and multivariate analysis was performed on six criteria: age, sex, professional activity, metabolic disorders, length of obesity and body mass index (BMI).

RESULTS

Concerning age, sex, professional activity, metabolic disorders, and length of obesity, there was no difference between the three groups. However, a BMI more than 50 kg/m(2) has a strong predictive value. Patients called "super obese", BMI >50, has a high rate of failure (64%) even the weight loss is often important in absolute value, but the BMI at the follow up remain high and more than 40. In this situation: gastric banding does not seem a good treatment because it does not protect these patients against the lethal risk of their comorbidities.

CONCLUSION

In this study, there is not a specific candidate "profile" to a successful treatment of morbid obesity by adjustable gastric banding. Meanwhile the initial BMI appear to be a predictive factor of success or failure. In the case of patients with high BMI >50 (super obese) gastric banding did not seen to be a good treatment and another technical approach (gastric bypass) must be discussed.

Metabolic and psychosocial effects of minimal invasive gastric banding for morbid obesity

Obesity is considered a primary risk factor for cardiovascular disease and related mortality. The current study aimed to investigate the efficacy of minimal invasive gastric banding (GB) surgery for reducing caloric intake in morbid obesity, and to analyze the effects of weight loss on body composition and metabolic and psychosocial outcomes. Twenty-six adult severely obese patients (mean body mass index [BMI], 48.1 kg/m(2); range, 42 to 56) underwent adjustable silicone laparoscopic GB. Nine additional obese patients who declined surgery were treated with metformin (2 g daily) and served as a small additional group (BMI, 50.5 kg/m(2); range, 41 to 68). Presurgery and 17 +/- 2.2 months postoperatively, body composition (fat mass [FM], lean body mass [LBM], body water) and serum parameters (lipids, glucose, thyrotropin-stimulating hormone [TSH]) were determined. Quality of life (QoL) was evaluated by a standardized self-rating questionnaire (Short Form-36 [SF-36]), and supplemented by measures of physical complaints and psychological distress. After GB, weight loss was 21 +/- 14.9 kg (14%, P <.001). It was associated with a decrease in FM by 14 +/- 8.6 kg (18%, P <.001), LBM by 4 +/- 2.7 kg (5%, P <.001), body water by 4 +/- 3.4 L (7%, P <.01), systolic blood pressure by 16 +/- 26.3 mm Hg (10%, P <.05), total cholesterol by 0.69 +/- 1.29 mmol/L (12%, P <.05), and low-density lipoprotein cholesterol (LDL-C) by 0.38 +/- 0.39 mmol/L (10%, P <.05). Highly significant interactions between surgery and time were noted for weight (P <.005), BMI (P <.005), and FM (P <.007, analysis of variance [ANOVA]). Preoperatively, 14 of 26 patients (54%) had high fasting blood sugar levels (type 2 diabetics) and 11 (42%) had impaired glucose tolerance, whereas postoperatively, for baseline glucose levels a trend to decrease was noted. Neither malabsorption nor anemia was observed. QoL improved after GB; in particular, physical functioning and well being increased (P <.01), and somatic complaints (eg, dyspnea and heart complaints, pain in legs and arms) markedly decreased (P =.008). In the metformin group, neither relevant weight loss nor a significant decrease of biochemical values was observed. Minimal invasive GB is a successful therapeutic tool for reducing FM in morbidly obese patients. Weight loss resulted in improved metabolic parameters, suggesting a lowered atherogenic risk.

[Evaluation of laparoscopic bariatric surgery using the BAROS score]

AIM OF THE STUDY

Mid-term assessment of laparoscopic adjustable silicon gastric banding (Lap-Band) by a specific score.

PATIENTS AND METHODS

One hundred consecutive patients received by mail 12 to 54 months after laparoscopic adjustable gastric banding a questionnaire including the Bariatric Analysis and Reporting Outcome System (BAROS) which is the only specific and validated instrument for measuring the quality of life after bariatric surgery. This score includes five categories of results (failure, fair, good, very good, excellent). It uses three major fields: the quality of life, excess weight loss, and medical comorbidities evaluation.

RESULTS

Seventy three patients answered back with a mean follow up of 24.6 +/- 10 months. Forty six (2/3) had lost more than 50% of their weight excess. Sixty six experienced an improvement of their medical conditions following surgery. Final results were good or excellent for 60 patients (82% of those who answered back). Failure was reported in 7 patients (2 "sweet eaters" and 2 pouch dilatations) which needed a surgical treatment.

CONCLUSION

This evaluation based on the BAROS confirms its validation in France and the good mid-term results of bariatric surgery based on the Lap-Band.