Bariatric Surgery Program Research Articles

Psychosocial predictors of weight loss and psychological adjustment following bariatric surgery and a weight‐loss program: The mediating role of emotional eating

To examine a structural equation model of the effects of personal and interpersonal factors on treatment outcome of bariatric surgery and weight-loss program. Forty-four participants of the surgery group and 47 participants of the diet group completed questionnaires before treatment and 1 year afterward. Predictor measures are as follows: social support, motivation for control, sense of control, self-esteem, neuroticism, fear of intimacy, and emotional eating (EE). Weight loss, quality of life, and mental health. Neurotic predisposition (NP), a latent variable indicated by neuroticism, low self-esteem, and fear of intimacy, had an effect on weight loss that was fully mediated by EE. NP also had an effect on quality of life improvement that was fully mediated by EE and weight loss in both treatment groups. Both NP and EE predict outcome of obesity treatments, but EE is the more proximal variable that mediates the effect of NP.

When is the best time to deliver behavioral intervention to bariatric surgery patients: before or after surgery?

Background Many comprehensive bariatric surgery programs have implemented preoperative behavioral interventions for patients presenting with problematic eating behaviors in an effort to enhance postoperative weight loss and improve psychosocial adjustment. However, it is unknown whether these interventions are best delivered pre- or postoperatively. The purpose of this study was to determine when bariatric surgery patients are most receptive to a behavioral intervention, before or after surgery. Methods A total of 32 pre- and postoperative patients were referred to a 10-week intervention designed to reduce eating behaviors associated with postoperative weight gain (e.g., loss of control while eating, grazing). The sample was 78.1% female and 84.4% white, with an average age of 49.43 ± 9.13 years and a body mass index of 44.22 ± 6.48 kg/m 2. Of the 32 patients, 21 were referred preoperatively and 11 were referred postoperatively (5.63 ± 2.91 months after surgery). These patients were tracked prospectively to determine whether pre- or postoperative patients were more likely to attend and complete the behavioral intervention. Results Compared with the preoperative patients, the postoperative patients were more likely to follow-up with their referral and initiate treatment [χ 2(1) = 10.06, P = .002]. Of the postoperative patients, 100% attended the first intervention session compared with only 43% of preoperative patients. The postoperative patients also attended more intervention sessions [ t(18) = 2.51, P = .02] and were more likely to complete the intervention [χ 2(1) = 7.21, P = .007]. Only 14% of the preoperative referral patients completed the program compared with 91% of the postoperative patients. Conclusion Comprehensive bariatric surgery programs ought to consider balancing the needs of the preoperative patients presenting with maladaptive eating behavior with the likelihood of them participating in a behavioral intervention before surgery.

Preoperative eating behavior, postoperative dietary adherence, and weight loss after gastric bypass surgery

Background To investigate the relationship between preoperative eating behavior, postoperative dietary adherence and weight loss after gastric bypass surgery in a major, urban medical center with a comprehensive bariatric surgery program. Despite the significant weight loss and dramatic improvements in co-morbidities associated with bariatric surgery, a significant minority of patients appear to experience suboptimal weight loss. The reasons for this are not well understood, but the suboptimal weight loss is often attributed to preoperative psychosocial characteristics and/or eating behaviors, as well as poor adherence to the recommended postoperative diet. Methods A prospective investigation was performed of 200 female and male patients who were studied both preoperatively and 20, 40, 66, and 92 weeks postoperatively. All patients underwent either open or laparoscopic Roux-en- Y gastric bypass surgery. The measures were the percentage of weight loss, macronutrient intake, dietary adherence, and eating behavior. Results Gender, baseline cognitive restraint, and self-reported adherence to the postoperative diet at postoperative week 20 were associated with the percentage of weight loss at postoperative week 92. Those high in dietary adherence had lost 4.5% more weight at postoperative week 92 than those low in dietary adherence. Conclusion Baseline cognitive restraint and adherence to the recommended postoperative diet were associated with the percentage of weight loss after gastric bypass surgery. These results suggest the potential utility of pre- and/or postoperative dietary counseling interventions to improve the postoperative outcomes.

Bariatric Surgery and Bariatric Psychology: Evolution of the Dutch Approach

Success of bariatric surgery is largely dependent on patients' abilities to change their lifestyle and underlying psychosocial and behavioral factors; these factors should be carefully scrutinized. However, no consensus or guidelines exist for these evaluations. To get a better understanding of the practice of bariatric surgery and bariatric psychology in The Netherlands and its evolution, a survey of bariatric surgery programs was conducted. Between 2000 and 2005, performance of bariatric surgery in The Netherlands has increased from 564 to more than 2,000 annually, mostly adjustable gastric banding. Most hospitals have a multidisciplinary selection process, and in 89% of the cases, a mental health specialist was involved. Bariatric surgery in The Netherlands has increased tremendously; however, it is mostly limited to restrictive procedures, and there is no consensus regarding the psychological evaluation of patients.

Revisional bariatric surgery for failed restrictive procedures

Background Revisional bariatric surgery is increasing in frequency, but the morbidity and efficacy have not been well defined. The primary aim of this study was to determine the clinical efficacy with respect to weight loss, and associated morbidity, of revisional bariatric surgery in an academic university hospital bariatric surgery program. Methods A retrospective review of all patients who underwent revisional bariatric surgery for failed primary restrictive procedures, including gastroplasty and gastric bypass, but not including gastric banding or malabsorptive procedures, during a 10-year period at a single university hospital was performed. The perioperative morbidity and long-term weight loss and clinical results were determined from the medical charts. Results A total of 41 patients met the inclusion criteria. The primary bariatric procedures included vertical banded gastroplasty in 20 and Roux-en- Y gastric bypass in 21. The indications for revisional surgery included poor weight loss, weight regain, and various technical problems, including anastomotic stenosis and ulcer. The major morbidity rate was 17%. No patients died. The weight loss results varied depending on the indication for the revisional surgery and reoperative solution applied. The resolution of technical problems was achieved in all patients. Conclusion Revisional bariatric surgery can be performed with minimal mortality, albeit significant morbidity. The efficacy with respect to weight loss appeared acceptable, although the results were not as good as those after primary bariatric surgery. The analysis of patient subsets stratified by surgical history and revisional strategy provided important insights into the mechanisms of failure and efficacy of different revisional strategies.

Psychological Problems Disqualify Many Bariatric Surgery Candidates

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessPsychological Problems Disqualify Many Bariatric Surgery CandidatesJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:7 Dec 2007https://doi.org/10.1176/pn.42.23.0024aNot surprisingly, as America's girth widens, more and more Americans are seeking bariatric surgery to fix the problem. Bariatric surgery is generally considered the most effective treatment for people who are extremely overweight.However, a substantial number of them may not be psychologically fit enough to have the procedure, a new study suggests.The study, which appeared in the October Journal of Clinical Psychiatry, was headed by Mark Zimmerman, M.D., an associate professor of psychiatry at Brown University.Five hundred candidates for bariatric surgery—representative of patients seeking that form of surgery in Rhode Island—were evaluated from 2004 to 2006 to determine whether they were psychologically fit enough to undergo the procedure. They were assessed with DSM-IV-based semi-structured interviews, with supplemental questions about their eating and dieting histories, reasons for wanting the surgery, understanding of the risks involved, and recent stresses experienced.Ninety-two of the subjects (18 percent) were determined to be not psychologically fit enough to undergo the procedure, Zimmerman and his colleagues found. The major reasons for their exclusion were that they were overeating to cope with stress or emotional distress, engaging in binging or had another eating disorder, or had uncontrolled psychopathology (see table).“We have perhaps been most surprised by patients' honesty in revealing emotional problems that they might not have revealed,” Zimmerman told Psychiatric News. “I think this is because we explain to them that our goal is not to prevent them from having surgery. Rather, we seek to identify problems that might interfere with the success of surgery, address these, and thereby increase the likelihood of a positive outcome from surgery.”Almost all the patients who were not cleared for surgery in the study were referred for psychiatric treatment. Those patients who were not cleared because of overeating in response to stress were referred to a psychologist to learn alternative methods of coping with emotional distress. Zimmerman and his colleagues will now determine how many of the individuals who were referred for psychiatric treatment actually accepted it.Another important result to emerge from the study was that the decision of whether to approve candidates for bariatric surgery can be made with high reliability—something that previous studies had not examined. Specifically, each patient in the study was first assessed by a mental health professional, who prepared a comprehensive report and then gave it to a psychiatrist to review. The psychiatrist then reviewed the report with the patient and made the final determination of whether the patient should have surgery. Then, after a final decision had been reached for all 500 patients, a psychiatrist who had not evaluated any of the patients reviewed the decisions in 73 cases and agreed with nearly all of them.“It was therefore reassuring that we found a high reliability of decision making, thereby indicating that, at least within the same clinical setting, clinicians can independently agree on who should or should not be cleared for surgery,” Zimmerman and his team concluded. “It would be of interest to determine the level of reliability among clinicians working at different bariatric-surgery programs.”Most bariatric-surgery programs use psychiatrists or mental health professionals to screen potential candidates, Zimmerman said.“Presurgical Psychiatric Evaluations of Candidates for Bariatric Surgery, Part 1: Reliability and Reasons for and Frequency of Exclusion” can be accessed at<www.psychiatrist.com>.▪ ISSUES NewArchived

Minimally Invasive Bariatric and General Surgery Program, Magee-Women's Hospital, University of Pittsburgh Medical Center

Bariatric Nursing and Surgical Patient CareVol. 2, No. 4 Bariatric Surgical Program ProfileMinimally Invasive Bariatric and General Surgery Program, Magee-Women's Hospital, University of Pittsburgh Medical CenterPublished Online:27 Dec 2007https://doi.org/10.1089/bar.2007.9956AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetails Volume 2Issue 4Dec 2007 InformationCopyright 2007, Mary Ann Liebert, Inc.To cite this article:Minimally Invasive Bariatric and General Surgery Program, Magee-Women's Hospital, University of Pittsburgh Medical Center.Bariatric Nursing and Surgical Patient Care.Dec 2007.229-235.http://doi.org/10.1089/bar.2007.9956Published in Volume: 2 Issue 4: December 27, 2007PDF download

Developing a New Bariatric Surgery Program

We initiated a new bariatric surgery program in February 2004. Before starting the program, we initiated a systemic planning process to design, develop, and implement a comprehensive, multidisciplinary program. Between May 2004 and June 2006, 178 patients underwent Roux-en-Y gastric bypass to treat morbid obesity at our institution. We have had no pulmonary emboli and no deaths. Twenty-one patients (11.8%) developed wound infection after surgery. Thirteen patients (7.3%) developed stenosis at the gastrojejunostomy. Five patients (2.8%) bled from the gastrojejunostomy. Four patients (2.2%) developed atelectasis. Three patients (1.6%) developed an internal hernia after surgery. One patient (0.5%) developed deep venous thrombosis. Two patients (1.1%) developed small bowel obstruction from adhesions. One patient developed a leak (0.6%). By 6 months after surgery, our patients have lost an average of 85 pounds (53% excess weight loss). By 12 months, they have lost an average of 104 pounds (65% excess weight loss). A focused effort to reduce infection has dropped our wound infection rate to 0 per cent in the past 6 months. Our results indicate that with proper planning, it is possible to initiate a new program and achieve excellent outcomes. Proper planning, systematic implementation, and a focus on patient education are critical to success.

Presurgical Psychiatric Evaluations of Candidates for Bariatric Surgery, Part 1

Many bariatric surgery programs include psychiatric evaluations as part of the pre-operative screening procedure. Surveys of surgeons and mental health professionals have found variability in opinion regarding what psychosocial problems warrant denial of clearance for surgery. Few studies have reported the number of patients who are not cleared for surgery due to psychiatric reasons, and no study has reported the reliability of decision making. The goals of the present study were to examine the reliability of decisions to clear candidates for surgery, determine the percentage of candidates who were not cleared for surgery, and detail the reasons candidates were not cleared for surgery. Five hundred candidates for bariatric surgery were evaluated from July 2004 until July 2006 with semistructured diagnostic interviews for DSM-IV Axis I and Axis II disorders supplemented by a module specific to this population. Reliability for determining clearance was evaluated in 73 patients. Reasons for not clearing patients were recorded on the Surgery Clearance Form. Eighteen percent (N = 92) of the patients were not cleared for surgery. The kappa coefficient of reliability of determining surgical clearance was 0.83. The most common reasons for the negative recommendation were overeating to cope with stress or emotional distress, current eating disorder, uncontrolled psychopathology, and the presence of significant life stressors. Only 1 patient was excluded for a lack of understanding of the potential risks of surgery. The decision whether to clear candidates for bariatric surgery can be made reliably. Approximately 1 in 5 surgical candidates did not pass the initial psychiatric screening, usually because of current eating pathology, other forms of uncontrolled psychopathology, or difficulty coping with current life stressors.

Improved Outcomes Using a Systematic and Evidence-Based Approach to the Laparoscopic Roux-En-Y Gastric Bypass in a Single Academic Institution

No standardized approach exists for laparoscopic Roux-en-Y gastric bypass (LRYGB). At a newly instituted bariatric surgery program, four experienced laparoscopic surgeons used the systematic and evidence-based approach consisting of multidisciplinary preoperative evaluation, screening, and education; standardized operative technique; inpatient clinical pathway; and close postoperative follow-up. The outcomes were subsequently analyzed to determine if this approach improved the morbidity and mortality. From January 2003 to June 2006, 835 consecutive LRYGBs were performed. The patient population was 85 per cent women with a mean body mass index (BMI) of 50.4 kg/m2 (range 33-96 kg/m2). The mean age was 44 (range 15-67). Sixty-two per cent of the patients had previous abdominal or pelvic operations. The conversion rate to open surgery was 0.2 per cent. The average length of hospital stay was 2.6 days (range 2-13 days). There were no anastomotic leaks or deaths. The 30-day readmission and re-operation rates were 3.2 per cent and 1.8 per cent, respectively. The incidence of anastomotic stricture, marginal ulcer, bleeding, pulmonary embolism, and internal hernia was 0.8 per cent, 3.5 per cent, 4.2 per cent, 0.1 per cent, and 0.4 per cent, respectively. A systematic and evidence-based approach to the LRYGB by experienced laparoscopic surgeons resulted in a lower incidence of complications when compared with the published results from other comparable institutions.

30-Day readmission rates at a high volume bariatric surgery center: Laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and vertical banded gastroplasty-Roux-en-Y gastric bypass

Recent studies suggest that weight loss operations may actually increase the costs to society due to increased hospital readmission rates. The purpose of this study was to determine the 30-day readmission rates following bariatric operations at a high volume bariatric surgery program. Records for all patients undergoing bariatric operations during a 3-year period were harvested from the hospital electronic medical database. All hospital readmissions within 30 days of surgery were reviewed to determine the cause, demographics, and patient characteristics. Logistic regression analysis assessed the impact of various factors on the risk of readmission. 2,823 consecutive patients were identified using the corrected operative log. Of these patients, 165 (5.8%) patients required 184 (6.5%) readmissions within 30 days of their index bariatric operation. Laparoscopic adjustable gastric banding (LAGB) had the lowest patient readmission rate of 3.1%; vertical banded gastroplasty-Roux-en-Y gastric bypass (VBG-RYGBP) 6.8% and Laparoscopic Roux-en-Y gastric bypass (LRYGBP) 7.3%. Technical considerations were the most common cause for readmission (41% of readmissions). White race and undergoing LAGB decreased the odds for readmission, while total operating-room time >120 minutes, initial hospital stay of >3 days and deep venous thrombosis increased the odds for readmission. This study found an overall 30-day readmission rate of 6.5% following bariatric operations at a high volume bariatric surgery program. This study supports the concept of bariatric surgery Centers of Excellence and accreditation of Bariatric Surgery Programs based on hospital volume of bariatric operations.

Impression management or real change? Reports of depressive symptoms before and after the preoperative psychological evaluation for bariatric surgery

Many bariatric surgery programs require that candidates undergo a preoperative mental health evaluation. Candidates may be motivated to suppress or exaggerate psychiatric symptoms (i.e., engage in impression management), if they believe doing so will enhance their chances of receiving a recommendation to proceed with surgery. 237 candidates for bariatric surgery completed the Beck Depression Inventory-II (BDI-ll) as part of their preoperative psychological evaluation (Time 1). They also completed the BDI-II approximately 2-4 weeks later, for research purposes, after they had received the mental health professional's unconditional recommendation to proceed with surgery (Time 2). There was a small but statistically significant increase in mean BDI-II scores from Time 1 to Time 2 (11.4 vs 12.7, P<.001). Clinically significant changes, defined as a change from one range of symptom severity to another, were observed in 31.2% of participants, with significant increases in symptoms occurring nearly twice as often as reductions (20.7% vs 10.5%, P<.008). Demographic variables were largely unrelated to changes in BDI-II scores from Time 1 to Time 2. Approximately one-third of bariatric surgery candidates reported a clinically significant change in depressive symptoms after receiving psychological "clearance" for surgery. Possible explanations for these findings include measurement error, impression management, and true changes in psychiatric status.

Weight Loss and Health Outcomes in African Americans and Whites After Gastric Bypass Surgery

The objective was to describe differences in weight loss, dietary intake, and cardiovascular risk factors between white and African-American patients after gastric bypass (GBP). This was a retrospective database review of a sample of 84 adult patients (24 African-American and 60 white women and men) between the ages of 33 and 53 years. All subjects had GBP surgery in 2001 at the Bariatric Surgery Program at Boston Medical Center in Boston, MA, and were followed for one year postoperatively. Patients were excluded if weight data were missing at baseline, 3 months, or 1 year after GBP. A total of 9 African Americans and 41 whites provided data at all 3 time-points and were included in the study. Differences in weight loss, diet, and cardiovascular risk factors were analyzed. There were no differences in baseline characteristics between African Americans and whites. Mean weight loss for the entire sample was 36 +/- 9%, with a range of 8% to 54% relative to initial body weight. Whites lost more weight (39 +/- 8%) than African Americans (26 +/- 10%) (p < 0.05). Dietary parameters, as well as improvements in blood pressure and lipid profiles, were similar in the two racial groups. Differences in weight loss between severely obese African Americans and whites undergoing open GBP are unlikely to be related to postoperative dietary practices. Our data are consistent with previous reports implicating metabolic differences between the two racial groups.

Bridging the Divide between Bariatric Surgery and Traditional Weight Loss Programs

The obesity trend in the United States has caused great alarm among clinicians working in the field of weight management. Maps published by the Centers for Disease Control and Prevention detailing the rapidly expanding prevalence of obesity have been widely circulated and discussed. The appropriate clinical response to this trend, however, has generated significant debate. While some adamantly maintain that a traditional approach consisting of diet and exercise is the best treatment option for obese patients, there is growing support for use of weight-loss inducing drugs and surgery. Too often the attitudes of health care providers are polarized in relation to these very different approaches, favoring either the medical/surgical approach, or the traditional approach. We review these differing approaches to managing obesity, and recommend that treatment be determined on an individual basis.

Bariatric Surgery in Adolescents

To analyze recent nationwide trends in the use of adolescent bariatric surgery and to compare early postoperative outcomes of adolescents and adults undergoing these procedures. Analysis of national administrative data by using survey analysis techniques. Data obtained from the Nationwide Inpatient Sample from 1996 to 2003. Adolescents (aged <20 years) and adults undergoing bariatric surgery. Intervention Bariatric surgery. Population-based case rates, major postoperative complications, length of hospital stay, hospital charges, and mortality. The population-based annual adolescent bariatric case volume varied little between 1996 and 2000 but more than tripled from 2000 to 2003. Despite this trend, only 771 bariatric procedures were performed in adolescents in 2003, representing fewer than 0.7% of bariatric procedures performed nationwide. Univariate comparison with data from 2003 showed a similar in-hospital complication rate in adolescents and adults but a significantly shorter length of stay among adolescents. Although in-hospital mortality was observed in 0.2% of adults, no in-hospital deaths were observed in any adolescents. Although procedure rates have increased recently, bariatric surgery in adolescents remains an uncommonly performed procedure. These data support efforts to align bariatric surgery programs for adolescents initially with higher volume programs for adults and to develop multicenter collaborative studies directed at defining the short- and long-term effect of bariatric surgery in morbidly obese adolescents.

A comparison of 399 open and 568 laparoscopic gastric bypasses performed during a 4-year period

Laparoscopic Roux-en-Y gastric bypass surgery (RYGB) was introduced at the authors' institution 5 years ago. The authors analyzed the short- and long-term results of this procedure compared with those for the same procedure using the laparotomy approach over the same period. Retrospective analysis of a prospectively collected bariatric database used the outcome end points used by the American Society of Bariatric Surgery (ASBS) and the American College of Surgeons (ACS) in their center of excellence programs. From January 2001 to July 2005, 568 laparoscopic and 399 open gastric bypasses were performed at Vanderbilt University. The patients were from the same bariatric surgery program and therefore received the same pre- and postoperative care. The hospital length of stay in the laparoscopic group was significantly shorter (2.5 +/- 2.4 days) than in the open group (3.7 +/- 3.7 days; p = 0.001). The procedure time was significantly shorter in the laparoscopic group (164 +/- 50 min) than in the open group (195 +/- 50 min; p = 0.0001). The follow-up assessment response at 2 years was 76.6%. At 2 years, the excess weight loss (EWL) was significantly greater in the laparoscopic group (71.3% +/- 18.4%) than in the open group (67.3% +/- 15.3%; p = 0.03). The wound infection rate was significantly higher in open group (9.2%) than in the laparoscopic group (1.7%; p = 0.001). There was no significant difference in 30-day mortality: open (0.50%) versus laparoscopic (0.17%; p = 0.371). There was no significant difference in the 30-day reoperation rate between the open (2.4%) and laparoscopic (2.6%; p = 0.705) groups. The 30-day readmission rate was similar in the open (5.0%) and laparoscopic (5.2%; p = 0.852) groups, as was the rate of leakage from the gastrojejunostomy in the open (0.50%) and laparoscopic (0.35%; p = 0.127) groups. The conversion rate from laparoscopic procedure to laparotomy was 1.7%. In the authors' institution, a laparoscopic bariatric surgery program with a very low rate of morbidity and mortality has been introduced. Operative time, hospital stay, and wound complications are reduced with the laparoscopic approach. The laparoscopic and open procedures are equally safe, with equivalent 30-day mortality, readmission, reoperation, and gastrojejunostomy leakage rates.

Overcoming the Complexities of Establishing an Adolescent Bariatric Surgery Program

This paper analyzes the barriers to starting an adolescent bariatric program, and the steps taken by early adapters to overcome these barriers. As both obstacles and solutions are better clarified and discussed, more programs may begin to investigate using bariatric surgery as a means to ameliorating an alarming public health epidemic and offering teenagers longer and healthier lives.

Does experience preclude leaks in laparoscopic gastric bypass?

Improved outcomes of laparoscopic Roux-en-Y gastric bypass (LRYGB) have been demonstrated once pratice has moved beyond the learning curve. However, there is no evidence that experience has a favorable impact on the incidence of leaks. This study evaluated the incidence of staple-line leaks as experience accrued in a university-based bariatric surgery program. Prospectively collected data on our first 200 patients undergoing LRYGB since July 1998 were analyzed. Linear staplers were used to divide the stomach and to create a side-to-side jejunojejunostomy. A side-to-side cardiojejunostomy was created using a 21-mm circular stapler. Patient characteristics, operative data, and outcomes were evaluated chronologically with comparison of outcomes between quartiles. Staple-line leaks developed in 9 (4.5%) of the first 200 patients undergoing LRYGB. Among the 200 patients were 190 women (95%). The median age of the patients was 48 years (ranges, 24-62 years), and their body mass index was 43 kg/m(2) (ranges, 32-59 kg/m(2)). As surgeons' experience increased over time, there was a significant increase in the weight of patients and the percentage of patients with previous abdominal operations. There also was a significant decrease in conversion rates and operative times. Leaks occurred in six patients at the cardiojejunostomy (3%), in two patients jejunojejunostomy (1%), and in one patient at the excluded stomach (0.5%). Of the 50 leaks that occurred in each quartile, there were in the 3 in the 1st quartile, 1 in the 2nd quartile, 2 in the 3rd quartile, 3 in the 4th quartile. The differences were not significant. There was no correlation between the number of LRYGBs, and the occurrence of a leak (p = 0.59 confidence interval -0.13-0.22). The incidence of staple-line leaks appears to be independent of the number of LRYGBs performed. These data suggest that surgeons' experience may not eliminate anastomotic complications experienced by patients undergoing LRYGB.

Predictors of Weight Status following Laparoscopic Gastric Bypass

Weight loss after bariatric surgery varies and depends on many factors, such as time elapsed since surgery, baseline weight, and co-morbidities. We analyzed weight data from 494 patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGBP) by one surgeon at an academic institution between June 1999 and December 2004. Linear regression was used to identify factors in predicting % excess weight loss (%EWL) at 1 year. Mean patient age at time of surgery was 44 +/- 9.6 (SD), and the majority were female (83.8%). The baseline prevalence of co-morbidities included 24% for diabetes, 42% for hypertension, and 15% for hypercholesterolemia. Baseline BMI was 51.5 +/- 8.5 kg/m(2). Mean length of hospital stay was 3.8 +/- 4.6 days. Mortality rate was 0.6%. Follow-up weight data were available for 90% of patients at 6 months after RYGBP, 90% at 1 year, and 51% at 2 years. Mean %EWL at 1 year was 65 +/- 15.2%. The success rate (> or = 50 %EWL) at 1 year was 85%. Younger age and lower baseline weight predicted greater weight loss. Males lost more weight than females. Diabetes was associated with a lower %EWL. Depression did not significantly predict %EWL. The study demonstrated a 65 %EWL and 85% success rate at 1 year in our bariatric surgery program. Our finding that most pre-surgery co-morbidities and depression did not predict weight loss may have implications for pre-surgery screening.

Laparoscopic adjustable gastric banding for patients with body mass index of ≤35 kg/m 2

Background Many mild-to-moderately obese individuals (body mass index [BMI] 30–35 kg/m 2) have serious diseases related to their obesity. Nonoperative therapy is ineffective in the long term, yet surgery has never been made widely available to this population. Methods Between 1996 and 2004, 93 patients with a BMI of 30–35 kg/m 2 underwent laparoscopic adjustable gastric banding with the LAP-BAND. All patients were referred by their primary physician, entered into a comprehensive bariatric surgery program at one Australian center, and operated on by one surgeon. Data on all patients were collected prospectively and entered into an electronic registry. The study parameters included preoperative age, gender, BMI, presence of co-morbidities, percentage of excess weight loss, and resolution of co-morbidities. Results The mean age was 44.6 years (range 16–76), mean weight was 98 kg, and the mean BMI was 32.7 kg/m 2 (range 30–34). Of the 93 patients, 42 (45%) had co-morbidities, including asthma, diabetes, hypertension, and sleep apnea. The proportion of patients in follow-up was 79%, 85%, and 89% at 1, 2, and 3 years, respectively. The mean weight was reduced to 71 kg at 1 year, 72 kg at 2 years, and 72 kg at 3 years. The mean BMI was reduced to 27.2 ± 2.2, 27.3 ± 3.1, and 27.6 ± 3.7 kg/m 2, respectively, and the mean percentage of excess weight loss was 57.9% ± 24.5%, 57.6 ± 29.3%, and 53.8% ± 32.8% at 1, 2, and 3 years, respectively. At 3 years, the BMI was 18–24 kg/m 2 in 34%, 25–29 kg/m 2 in 51%, and 30–35 kg/m 2 in 10%. At 3 years, the percentage of excess weight loss was <25% in 10%, 25–50% in 24%, 50–75% in 51%, and >75% in 10%. The co-morbidities improved or completely resolved in most patients. No mortality occurred. Conclusion We are very encouraged by this series of low BMI patients treated with the LAP-BAND. Their weight loss has been good, the complications have been minimal, and the co-morbidities have partially or wholly resolved. With additional study, it is reasonable to expect the weight guidelines for bariatric surgery to be altered to include patients with a BMI of 30–35 kg/m 2.