Newest Research from "Obesity Surgery Journal"
11-Year Experience with Laparoscopic Adjustable Gastric Banding for Morbid Obesity—What Happened to the First 123 Patients?
Background Few long-term studies regarding the outcome of laparoscopic adjustable gastric banding for morbid obesity have so far been published. We report our 11-year experience with the technique by looking closely at the first 123 patients that have at least 5 years (mean 86 months) of follow-up.
Methods Data have been collected prospectively among 280 patients operated since March 1996. Until March 2002 (minimum 5-year follow-up), 123 patients have been operated laparoscopically with the Swedish band. We report major late complications, reoperations, excess weight losses (EWL) and failure rates among these patients, with a mean (range) follow-up time of 86 months (60–132). EWL<25%>50% was considered a success.
Results Mean (range) age of the patients (male/female ratio 31:92) was 43 years (21–44). Mean (range) preoperative weight was 130 kg (92–191). Mean (range) preoperative body mass index was 49.28 kg/m2 (35.01–66.60). Patients lost to follow-up was nearly 20% at 5 years and 30% at 8 years. Major late complications (including band erosions 3.3%, slippage 6.5%, leakage 9.8%) leading to major reoperation occurred in 30 patients (24.4%). Nearly 40% of the reoperations was performed during the third year after the operation. The mean EWL at 7 years was 56% in patients with the band in place, but 46% in all patients. The failure rates increased from about 15% during years 1 to 3 to nearly 40% during years 8 and 9. The success rate declined from nearly 60% at 3 years to 35% at 8 and 9 years.
Conclusions Complications requiring reoperations are common during the third year after the operation, and almost 25% of the patients will need at least one reoperation. Mean EWL in all patients does not exceed 50% in 7 years or 40% in 9 years and failure rates increase with time, up to 40% at 9 years.
High and Low Fat Food Selection with Reported Frequency Intolerance Following Roux-en-Y Gastric Bypass
Background This research compared both food selection and food intolerance frequency of High-fat grouped foods versus Low-fat grouped foods in Roux-en-Y bariatric clients during their dietary adaptation phase (DAP).
Methods Thirty-eight bariatric surgery patients in their dietary transition phase (3 months–2.5 years) filled out a 236-food item questionnaire. From the larger set of primary data, 24 high-fat (30% or greater fat) and 22 low/lower-fat food items were itemized by selection frequency and food intolerance frequency for comparison.
Results High-fat food selection was 38.3% against low fat at 50.4% (p = .0002). For comparison, the complete questionnaire’s 236-item food selection percentage was 41%. Frequency of “Never” experiencing food intolerance was similar between both groups with a combined mean of 1.92%. “Seldom to Sometimes” intolerance in low-fat foods was 13.3%, and 24.9% in high fat (p = .002). Finally, “Often to Always” experiencing food intolerance in the Low-fat food group was 85.5% versus 72.2% for the High-fat group (p = .002).
Conclusion Roux-en-Y bariatric patients in the DAP demonstrated typical “dieting behavior” by selecting low-fat foods at a greater frequency than high-fat foods. Although selected more, these low-fat foods also showed significantly worse intolerance frequencies. Thus, current dietary/nutrition professional recommendations to avoid high-fat foods during this postsurgery transition time are problematic. Future bariatric studies are needed to further explore this and other commonly practiced “dieting behaviors” in bariatric patients.
Prevalence of Iron, Folate, and Vitamin B12 Deficiency Anemia After Laparoscopic Roux-en-Y Gastric Bypass
Background One of the most common bariatric operations is the laparoscopic Roux-en-Y gastric bypass (LRYGBP) in which the gastric capacity is restricted and the absorption by the small intestine is reduced. The objective of this study was to evaluate the incidence of iron, folate, and vitamin B12 deficiency anemia in patients undergoing LRYGBP.
Patients and methods Clinical records of 30 patients who underwent LRYGBP between July 2003 and January 2005 and had a minimum follow up of 24 months at our outpatient clinic were included. Multivitamin supplementation was prescribed to all patients. The complete blood cell count, plasma iron, total iron-binding capacity, transferrin saturation, serum folate, and cobalamin levels before surgery, 6 months, 1, 2, and 3 years after the surgery were analyzed.
Results There were 25 women (83.4%) and five men (16.6%) with ages from 21 to 56 years. Before surgery, two patients (6.6%) presented ferropenic anemia. Iron deficiency was seen in 40 and 54.5% 2 and 3 years after surgery, respectively. Cobalamin deficiency was observed in 33.3% at 2 years and in 27.2% at 3 years. At 2-year follow-up, 46.6% of the patients had already developed anemia and 63.6% at 3 years. Folate deficiency was not observed in any patient.
Conclusion Our routine scheme of vitamin supplementation is not sufficient to prevent iron and vitamin B12 deficiencies in most patients.
Changes in Depression Following Gastric Banding: A 5- to 7-year Prospective Study
Background Long-term outcomes of gastric banding regarding depression and predictors of change in depression are still unclear. This prospective, controlled study investigated depression and self-acceptance in morbidly obese patients before and after gastric banding.
Methods A total of 248 morbidly obese patients (mean body mass index [BMI] = 46.4, SD = 6.9) seeking gastric banding completed questionnaires for symptoms of depression (Beck Depression Inventory) and self-acceptance. One hundred twenty-eight patients were treated with gastric banding and 120 patients were not. After 5 to 7 years, patients who either had (n = 40) or had not (n = 42) received gastric banding were reassessed.
Results In the preoperative assessment, 35% of all obese patients suffered from clinically relevant depressive symptoms (BDI score ≥18). The mean depression score was higher and the mean self-acceptance score was lower than those of the normal population. Higher preoperative depression scores were observed among patients living alone and who had obtained low levels of education. After 5 to 7 years, patients with gastric banding had lost significantly more weight than patients without gastric banding (mean BMI loss 10.0 vs. 3.3). Gastric banding patients improved significantly in depression and self-acceptance, whereas no change was found in patients without gastric banding. Symptoms of depression were more reduced in patients who lost more weight, lived together with a partner, and had a high preoperative depression score.
Conclusion Morbid obesity is associated with depressive symptoms and low self-acceptance. Gastric banding results in both long-term weight loss and improvement in depression and self-acceptance.
It was good to see some longer term research coming out with these. None of it was a big surprise for me. I already knew lap-bands were not the end all be all they make them out to be. I also knew the recommended vitamin regimen was a crock. I also knew that a higher fat diet should be what everyone should be following in the first place.
The last study---while it did not surprise me---I did want to make this one point---the depression post op all hinged on how much weight was lost. I don't for a minute think it has jack shit to do with the losing weight aspect. It is all in how you look at yourself. Most people desperate enough to risk their lives to have WLS in the first place ----do it for the simple reason to be thin. So their entire self worth hinges on what that hunk of metal in the bathroom tells them. That's why the depression is less in those who have lost more weight----they deem themselves to be more worthy just because they are thin.
What a crock the dieting industry has been feeding us all these years. And yes WLS is part of that diet industry--all they want is for more people to believe this so they make more money doing surgery, after surgery, after surgery, ...
We all (me, included)bought the hype hook line and sinker........