Bariatric Analysis And Reporting Outcome System Research Articles

Successful Multi-Intervention Treatment of Severe Obesity: A 7-year Prospective Study with 96% Follow-up

No long-term, high participation study of the outcome of bariatric surgery has examined how a multi-intervention approach to the treatment of severe obesity can achieve and sustain weight loss after an initial bariatric procedure. We employed a multi-intervention treatment that combines adjustable gastric banding with intensive follow-up to support patient life-style change and use of an algorithm allowing reoperation-to bypass, if necessary-in the event of complications. Four hundred four severely obese patients with an average BMI = 42.6 at the outset had initial AGB surgery and were followed with a high rate of face-to-face consultations for 7 years. Seventy-five percent of the patients retained a gastric band throughout the study. Weight loss, complications, and comorbidities were studied, and quality of life was assessed using Bariatric Analysis and Reporting Outcome System (BAROS). Three hundred eighty-eight (96%) patients completed the 7-year follow-up. Average BMI reduction at 5 years was 28% and remained stable through year 7, at which the mean excess weight loss was 61%. The preoperative prevalence of metabolic syndrome, 59.7%, decreased to 13.3% at 7 years and was abolished for patients with more than 40% loss of initial BMI. Similar changes were seen for all components of metabolic syndrome. More than 60% of patients had a "good" or higher BAROS score; 10.1% were considered failures. Patients converted to gastric bypass, and those retaining gastric bands throughout the study had very similar outcomes. Long-term, multi-intervention treatment of severe obesity can achieve and preserve weight loss and thus improved quality of life and sustained reduction or disappearance of all components of metabolic syndrome, for a high proportion of severely obese patients with preoperative BMI between 35 and 55.

Bowel Habits After Bariatric Surgery

Disordered bowel habits might influence quality of life after bariatric surgery. Different types of bariatric operations-gastric banding (AGB), Roux-en-Y gastric bypass (RYGB), or biliopancreatic diversion (BPD)-might alter bowel habits as a consequence of the surgical procedure used. Whether change in bowel habits affects quality of life after AGB, RYGB, or BPD differently is unknown. The study group contained 290 severely obese patients undergoing bariatric surgery between August 1996 and September 2004 [BPD: n = 103, 64.1% women, age 43 +/- 1 years (mean +/- SEM), BMI 53.9 +/- 0.9 kg/m(2), weight 153.4 +/- 2.9 kg; Roux-en-Y gastric bypass: n = 126, 73.0% women, age 43 +/- 1 years, BMI 44.2 +/- 0.3 kg/m(2), weight 123.8 +/- 1.5 kg; adjustable gastric banding (AGB): n = 61, 57.4% women, age 44 +/- 1 years, BMI 49.9 +/- 0.5 kg/m(2), weight 146.1 +/- 2.0 kg). Changes in bowel habits, flatulence, flatus odor, and effects on social life were estimated at least 4 months after surgery using a self-administered questionnaire. Fecal consistency changed significantly after surgery. Loose stools and diarrhea were more frequent after BPD and RYGB (P < 0.001) but more so after BPD than after either RYGB or AGB (P < 0.002). Constipation was more likely after AGB (P = 0.03). In addition, malodorous flatus affecting social life was more frequent after BPD than after either RYGB or AGB (P < 0.003). Furthermore, flatus frequency increased after BPD and RYGB, and patients were more bothered by their malodorous flatus than after AGB (all P < 0.001). Flatus severity score was highest in BPD, intermediate in RYGB, and lowest in AGB patients (all P < 0.001), a difference that was not influenced by frequency of metabolic syndrome before and after surgery. Moreover, observation period after surgery had no influence on overall results of bowel habits. Subsore quality of life bariatric analysis and reporting outcome system (BAROS) scores were largely similar between all three groups. However, flatulence severity score correlated inversely with quality of life estimated by BAROS in BPD and RYGB, but not in AGB patients. The type of bariatric surgery affects bowel habits in an operation-specific manner, resulting mainly in diarrhea after BPD and RYGB, and constipation after AGB. Flatulence severity impairs quality of life most in BPD, is intermediate in RYGB, and is only minor after AGB, a phenomenon that was only partially mirrored in quality-of-life measures of BAROS.

Prevalence of Obesity and the First Experience of Laparoscopic Adjustable Gastric Banding in Lithuania

Background: The increasing weight of Lithuanians represents one of the greatest challenges confronting the medical society. The most effective treatment for morbid obesity is bariatric surgery, showing low major morbidity and mortality. Modern bariatric surgery was started in Lithuania with laparoscopic adjustable gastric banding (LAGB) in 2004. However, there is no published data concerning its results in the case of this particular ethnic population thus far. Patients and Methods: From April 2004 to June 2006, 100 patients underwent LAGB. Mean age was 45.8 years, preoperative body weight 136.2 kg and body mass index (BMI) 48.4 kg/m². Data of clinical status, complications, initial excess weight loss (%IEWL), BMI and Bariatric Analysis and Reporting Outcome System (BAROS) were used for postoperative evaluation. Results: 15.1% of Lithuanian adults are obese, 20.3% of these have BMI > 35 kg/m² and 7% BMI > 40 kg/m². 100 consecutive patients treated with LAGB were evaluated postoperatively. The postoperative average %IEWL amounted to 38, 57, 72 and 84% after 6, 12, 18 and 24 months, respectively. There were complications in 3 patients but no postoperative deaths. Conclusions: The prevalence of obesity in Lithuanian adults is 15.1%. In a 1-year follow-up period LAGB proved to be effective for treatment of morbid obesity, with low complications rate and improved quality of life according to BAROS. LAGB results need to be verified in long-term follow-up.

Quality of life and alteration in comorbidity following laparoscopic adjustable gastric banding

Objectives: Obesity is an increasing problem in the UK and bariatric surgery is likely to increase in volume in the future. While substantial weight loss is the primary outcome following...

Vertical banded gastroplasty versus adjustable gastric banding: prospective long-term follow-up study

Background Vertical banded gastroplasty (VBG) has been in clinical use since 1979 and adjustable gastric banding (AGB) since 1985. Because promising results were achieved with the adjustable gastric bands available in the market, some surgeons came to the conclusion that VBG might be entirely abandoned and replaced by the adjustable gastric band. The aim of this study was to compare the long-term outcome of the 2 restrictive procedures. Methods Within a 7-year period (1994–2001), 1117 gastric restrictive procedures were performed in the course of a prospective nonrandomized comparative trial. We report the outcomes of 563 VBG and 554 AGB procedures performed by 2 surgeons. The mean body mass index was 46.9 ± 09.9 kg/m 2 for VBG and 46.7 ± 07.8 kg/m 2 for AGB. Patient selection was performed by acceptance by 1 of the 2 surgeons. VBG was performed by laparotomy and AGB using laparoscopy. The Bariatric Analysis and Reporting Outcome System (BAROS) was used to evaluate the postoperative health status and quality of life. Results The mean duration of follow-up was 92 months (range 60–134), with a minimum of 5 years. The overall follow-up rate was 92%. In the short-term 3-year follow-up, no statistically significant difference was registered between AGB and VBG in terms of weight loss, reduction of co-morbidities, or improvement in quality of life. The 30-day mortality rate was .4% (2 patients) for VBG and .2% (1 patient) for AGB. The overall reintervention rate in the long term was 49.7% for VBG and 8.6% for AGB ( P <.0001, odds ratio .0937, 95% confidence interval .065–.133), the reoperation rate was 39.9% for VBG and 7.5% for AGB ( P <.0001). The excess weight loss was significantly greater in the VBG group after 12 months (58% for VBG versus 42% for AGB, P <.05). At long-term follow-up (mean 92 months), no significant difference in weight loss was registered between the 2 study groups (59% for VBG and 62% for AGB, P = .923). The BAROS score in the short term (3 years) was good to excellent in 94% and 90% of the VBG and AGB groups, respectively. In the long-term follow-up period, the BAROS score was significantly in favor of the AGB group (83.9% versus 57.8%, P <.0001, odds ratio 3.797, 95% confidence interval 2.072–7.125). The overall resolution rate of co-morbidities was 80% in both groups. Conclusion This long-term follow-up study shows that VBG and AGB are effective restrictive procedures to achieve weight loss, and loss of co-morbidities. A statistically significant lower re-intervention and re-operation rate and an improved health status and quality of life were registered for AGB.

Laparoscopic gastric bypass: Risks vs. benefits up to two years following surgery in super-super obese patients

Super-super obesity (body mass index [BMI] >/= 60 kg/m(2)) is thought to be a risk factor for complications and mortality in laparoscopic Roux-en-Y gastric bypass. Excess weight loss has been demonstrated to be diminished compared with less obese patients following surgery. However, we hypothesize that super-super obese patients who undergo laparoscopic gastric bypass can realize major improvements in their health and a good quality of life without a significantly increased risk of complications when compared with less obese patients. From July 2002 to July 2005, University of Wisconsin Health bariatric surgeons performed 288 consecutive laparoscopic Roux-en-Y gastric bypass procedures. Patients were divided into 2 groups: BMI >/= 60 kg/m(2) (n = 28) and BMI < 60 kg/m(2) (n = 260). The groups were compared at defined time intervals during a 2-year period following surgery. Comparison criteria included complications, weight loss, comorbidities, and quality of life. Both groups had similar morbidity and mortality rates. Excess weight loss was shown to be less, but total pounds lost were greater, for the super-super obese patients at all postoperative time intervals specified for postoperative analysis. Despite this fact, overall health improved to a similar degree in each group of patients following surgery; both groups also had similar Moorehead-Ardelt quality of life scores. Using the Bariatric Analysis and Reporting Outcome System (BAROS) to categorize outcomes, the average result for a patient in either group of patients would be considered "very good" at 1 year following surgery. Laparoscopic Roux-en-Y gastric bypass can be accomplished safely even in extremely obese patients. Although excess weight loss in the super-super obese is diminished postoperatively when compared with less obese patients, health is improved and quality of life is good regardless of a patient's preoperative BMI. Therefore, laparoscopic gastric bypass is a good option even in the extremely obese.

European experience with laparoscopic Roux-en-Y gastric bypass in 466 obese patients

Roux-en-Y gastric bypass (RYGBP) is usually considered as the procedure of choice for morbid obesity, but its use has been limited in Europe. It is not known whether results with European patients match those from the USA. A total of 466 patients were followed prospectively regarding weight loss, co-morbidities, quality of life and morbidity after primary laparoscopic RYGBP. Overall assessment was done using the bariatric analysis and reporting outcome system (BAROS). Conversion to open surgery was necessary in three patients. The overall early morbidity rate was 17.0 per cent and the rate of major complications was 4.7 per cent. The mortality rate was 0.2 per cent. Major morbidity decreased over time. Excess weight loss of over 50 per cent was maintained for up to 4 years in 71.4 per cent of the morbidly obese and 65.2 per cent of the super-obese patients. Co-morbidities resolved or improved in most patients and quality of life improved. At 3 years, the BAROS score was excellent or very good in 77.1 per cent and good in 22.8 per cent. Late complications leading to reoperation developed in 19 patients (4.1 per cent). These results are satisfactory and comparable to those reported from the USA. Owing to limitations associated with purely restrictive bariatric procedures, laparoscopic RYGBP is likely to become the procedure of choice for treatment of morbid obesity in Europe.

Impact of Age, Sex and Body Mass Index on Outcomes at Four Years after Gastric Banding

Adjustable gastric banding for weight reduction in severely obese persons allows reversible individualized restriction during postoperative follow-up. It is unknown whether preoperative age, sex and BMI might modulate treatment outcome. 404 severely obese patients (79% women; age 42 +/- 0.5 years [mean +/- SEM]; BMI 42.1 +/- 0.2 kg/m2) completed 4-year follow-up after banding. Weight loss, complications, and Bariatric Analysis and Reporting Outcome System (BAROS) scores were recorded prospectively. 4 years after banding, younger (<50 years) women lost more weight than older (50 years) men (28.2 +/- 0.7% vs 19.4+/- 1.6%; P=0.001); older women and younger men lost similar weight. Patients with preoperative BMI >50 lost more weight than patients with BMI <35 (30.5 +/- 2.3% vs 22.8 +/- 2.6%; P=0.03). 22.3% of patients (n=90) had band system-related complications. Compared to women, men had more band leaks (7.0% vs 1.9%; P=0.007), and older men had more band slippages than younger men (8.4% vs 0.0%; P=0.035). Patients with preoperative BMI >50 were less likely than patients with BMI 35-40 or 40-50 to experience gastric complications (10.6%, 18.8%, 23.0%, respectively), but more likely to experience port/tube complications (15.8%, 2.4%, 7.9%, respectively; P<0.055). BAROS scores were different between men and women (P=0.05), and between younger and older people (P=0.001). Women and younger people were more likely than men and older people to score "very good" (P=0.03, P=0.001, respectively). Adjustable gastric banding is an effective intermediate-term treatment for severe obesity. Preoperative age, sex, and BMI are important modulators of outcome and should be considered during preoperative evaluation.

The Bariatric Quality of Life (BQL) Index: A Measure of Well-being in Obesity Surgery Patients

Quality of life (QoL) is considered to be the true measure for the effectiveness of a surgical procedure, but there are only a few validated instruments available for bariatric surgery. Therefore, a new diseasespecific 30-item instrument was created, which was called Bariatric Quality of Life (BQL) questionnaire. To validate the BQL, we studied 133 patients after 4 different types of bariatric surgery. Initially, mean body mass index (BMI) was 47.2 +/-7.6 kg/m2 and mean age was 38.8 +/-11.0 years. At baseline, and 1, 6, and 12 months after surgery, patients filled in the BQL, the SF-12 (Short Form of SF-36 Health Survey), the GIQLI (Gastrointestinal Quality of Life Index), and the BAROS (Bariatric Analysis and Reporting Outcome System). Internal consistency of the BQL was found to be good, with Cronbach's alpha ranging between 0.71 and 0.86. Factor analyses suggested that the BQL included a highly consistent set of QoL items and a second part on co-morbidities and gastrointestinal symptoms. At the 12 months follow-up, the BQL was closely correlated to SF 12 (Pearson's r = 0.86), GIQLI (0.68), BAROS (0.71), and excess weight loss (0.55). Standardized effect sizes over time were larger for the BQL (1.39 and 1.58) than for the other instruments. The BQL questionnaire is a validated instrument ready for clinical use.

Quality of Life after Bariatric Surgery – Is There a Difference?

Background: Interest in the quality of life (QoL) of patientswith morbid obesity continues to grow. Weight loss has beenshown to improve QoL in obese persons undergoing a varietyof treatments, but there is little data available comparing differentsurgical procedures and QoL questionnaires. Methods:In 133 patients, four different questionnaires where applied:the SF-12v2 (short form of SF-36), the BAROS (Bariatric Analysisand Reporting Outcome System), the GIQLI (GastrointestinalQuality of Life Index) and the BQL (Bariatric Quality ofLife Score). These patients underwent laparoscopic gastricbanding (LAGB; n = 55), laparoscopic Roux-en-Y gastric bypass(RYGB; n = 49), biliopancreatic diversion with duodenalswitch (BDP-DS; n = 23), or vertical banded gastric bypass(VBGB). All these procedures where performed in one bariatriccenter in Germany. Results: In all groups, QoL scores andexcess weight loss (EWL) improved considerably, but EWLwas clearly higher in BPD-DS and RYGB patients (62 and60%) as compared to LAGB cases (47%). Similarly, standardized1-year BQL scores were better for BPD-DS and RYGB (76and 80%) than for LAGB (71%). Furthermore, weight changesover time seemed to reach a plateau phase in the LAGB patients,whereas BPD-DS led to continuing weight loss. Discussion:Although all procedures are effective, our data show importantdifferences between the different procedures. Sinceweight loss after LAGB is smaller and less progressive, smallerimprovements in QoL can be expected although the risk ofcomplications is less. This should be borne in mind when selectingthe type of surgery.

Evaluation of quality of life and metabolic improvement after jejunoileal bypass in a community of low socioeconomic status.

Bariatric operations are currently the only effective treatment for morbid obesity The first operation, jejunoileal bypass (JIB), has been superceded. However, JIB has left a heritage which must be followed. We report the long-term follow-up of a series of patients who had undergone JIB in south Brazil. 49 super-obese patients (85% female) from a poor community were submitted to JIB from 1987 to 2001. 5 deaths occurred and 4 patients were lost during follow-up. Quality of life was evaluated by means of the Bariatric Analysis and Reporting Outcome System (BAROS) applied to 40 patients. Preoperatively, 11 patients (22.4%) were diabetic,13 (26.5%) were dyslipidemic, and 23 (46.9%) had high blood pressure. After a mean postoperative period of 64.3 +/- 40.0 months, there was complete resolution of co-morbidites in all patients. Mean preoperative BMI was 52.8 +/- 10.3 kg/m(2), and the postoperative mean excess weight loss was 58.9% +/- 18.9%. JIB was adequate in reduction of weight, resolution of co-morbidites, and improvement in the quality of life as measured by BAROS. Since February 2001, we perform biliopancreatic diversion with duodenal switch, but we continue to follow our patients with JIB.

Long-term Results, Late Complications and Quality of Life in a Series of Adjustable Gastric Banding

Adjustable gastric banding is currently the most common bariatric operation. This study is a retrospective analysis of the Finnish experience with this procedure over the last 10 years. Between March 1993 and June 1999, 123 patients underwent either open (36) or laparoscopic (87) surgery for morbid obesity by the application of an adjustable gastric band. Data on preoperative clinical characteristics and postoperative outcome and weight-loss patterns up to 9 years (mean 55 months) are presented and also evaluated by the Bariatric Analysis and Reporting Outcome System (BAROS). Sex ratio was 31% males / 69% females, mean age 44 years and mean +/- SD preoperative BMI 49 +/- 8 kg/m(2) (range 33.6-85.1). During the evaluation period (March 1993 December 2002), 54% of patients experienced postoperative complications requiring hospital treatment >or= 7 days, and 52% underwent a reoperation. 33% of bands were removed. The most important late complications were esophagitis (30%), obstruction due to slippage / pouch dilatation (21%), incisional hernia (9%) and band erosion (9%). Mean excess weight loss at 1 and 2 year follow-up was 36% and 38%, which later stabilized to 30%. During the evaluation period, there were 10 deaths, 2 of which were 30-day deaths, and the remainder were not associated with the band. According to BAROS, the outcome was regarded as "very good" in 3%, "good" in 7%, "fair" in 40% and "failure" in 50%. Our long-term data found that weight reduction is acceptable,but the incidence of late complications and reoperations was high.

Quality of life after gastric bypass surgery: a cross-sectional study.

Numerous reports document significant weight loss after gastric bypass; however, there is little objective data on postsurgical changes in health-related quality of life (HRQL). This study examined HRQL in four groups of patients: presurgery (T1), several weeks postsurgery (T2), 6 months postsurgery (T3), and 1 year postsurgery (T4). Subjects were given three HRQL measures: the short form 36 (SF-36), the Impact of Weight on Quality of Life-Lite Questionnaire (IWQOL-Lite), and the Bariatric Analysis and Reporting Outcome System (BAROS). Subjects also completed the Beck Depression Inventory (BDI) and the Rosenberg Self-Esteem Scale (RSE). There were no significant differences among the groups on demographics or presurgical body mass index. Results showed significant differences between T1 and T2 on several SF-36 and IWQOL-Lite subscales, as well as the RSE and BDI. Significant differences were found on all measures between T2 and T3. Significant differences were found on all subscales of the IWQOL-Lite, but no subscales of the SF-36, the RSE, or the BDI between T3 and T4. This study is the first to objectively document these differences in several objective measures of HRQL, depression, and self-esteem after gastric bypass in a large sample. It is notable that many differences are apparent within several weeks after surgery. Furthermore, results indicate that the IWQOL-Lite may be more sensitive than the SF-36 to the changes of quality of life that gastric bypass patients report.

Évaluation de la chirurgie cœlioscopique de l’obésité par le score BAROS

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 co-morbidities 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®.

BAROS: an effective system to evaluate the results of patients after bariatric surgery.

Success in bariatric surgery is most often evaluated by a sufficient loss of excess weight and an improvement in the medical conditions. The expected increase in quality of life (QoL) after weight loss, however, has not often been systematically analyzed. BAROS (Bariatric Analysis and Reporting Outcome System) is a scoring system which, along with easy handling, allows comparisons to be made internationally. 386 morbidly obese patients who had undergone bariatric surgery in our hospital were evaluated with BAROS. Five categories- failure, fair, good, very good, excellent- were taken from the scoring system that BAROS offers. This system has three major points: excess weight loss, medical co-morbidities and QoL. Points are subtracted for reoperations and defined complications. The operations performed were silastic ring vertical gastroplasty (72%), adjustable gastric banding (23%), biliopancreatic diversion (3%), vertical banded gastroplasty (1%) and gastric banding of Molina (1%). In 1991 and 1993, we had a fair result in 3% and 10% of the patients. A good score with a mean of 3.6 to 4.1 was reached in 1992, 1994 and 1995. In the last 3 years, 1996 to 1998, the mean score was 5.0 to 5.7, which is a very good result when compared with the scoring key. BAROS is a valuable tool to access the QoL of patients who have undergone bariatric surgery.

Bariatric analysis and reporting outcome system (BAROS) applied to laparoscopic gastric banding patients.

The definition of success and failure of a bariatric procedure should include weight loss as well as improvement in comorbidity and quality of life assessment. The Bariatric Analysis and Reporting Outcome System (BAROS), introduced by Oria and Moorhead in 1997, seems to provide a standard for comparison in the surgical treatment of morbid obesity. 180 morbidly obese and super-obese patients, who underwent laparoscopic gastric banding (lap-band) at our institutions and had a follow-up >18 months (19-55 months) were evaluated with BAROS. The patients were divided into four outcome groups (failure, fair, good, and excellent) based on a scoring table that adds or subtracts points while evaluating three main areas: percentage of excess weight loss, changes in medical conditions, and assessment of quality of life. Points were deducted for complications and reoperative surgery. The BAROS outcome system has proved to be a useful instrument in evaluating midterm results in our series of lap-band patients.