Long-term Outcomes Of Bariatric Surgery Research Articles

Preoperative psychological characteristics affecting mid-term outcome after bariatric surgery: a follow-up study

The purpose of this study was to investigate the relationship between preoperative psychological factors and percentage of total weight loss (%TWL) after laparoscopic Roux-en-Y gastric bypass (LRYGB) to identify possible psychological therapy targets to improve the outcome of bariatric surgery. Seventy-six patients completed the Hamilton's Anxiety and Depression Scales (HAM-A, HAM-D) and Toronto Alexithymia Scale (TAS-20) the day before surgery (T0). The pre-operative body weight and the %TWL at 3 (T1), 6 (T2), and 24-30 (T3) months were collected. At T3, depressed and alexithymic patients showed a lower %TWL compared to non-depressed patients (p = 0.03) and to non-alexithymic patients (p = 0.02), respectively. Finally, patients who had at least one of the three analyzed psychological factors showed less weight loss, at T2 (p = 0.02) and T3 (p = 0.0004). Psychological factors may also affect long-term outcome of bariatric surgery. This study showsan association between alexithymia/depression pre-operative levels and the weight loss at 30months'follow-up after bariatric surgery. Level III, longitudinal cohort study.

A114 Long-term outcomes of bariatric surgery in patients with cirrhosis.

A114 Long-term outcomes of bariatric surgery in patients with cirrhosis.

Mental disorders and weight change in a prospective study of bariatric surgery patients: 7 years of follow-up

BackgroundLong-term, longitudinal data are limited on mental disorders after bariatric surgery. ObjectiveTo report mental disorders through 7 years postsurgery and examine their relationship with changes in weight and health-related quality of life. SettingThree U.S. academic medical centers. MethodAs a substudy of the Longitudinal Assessment of Bariatric Surgery Consortium, 199 adults completed the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition prior to Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric band. Participants who completed ≥1 follow-up through 7 years postsurgery are included (n = 173; 86.9%). Mixed models were used to examine mental disorders over time, and among the RYGB subgroup (n = 104), their relationship with long-term (≥4 yr) pre- to postsurgery changes in weight and health-related quality of life, measured with the Short Form-36 Health Survey, and with weight regain from nadir. ResultsCompared with presurgery (34.7%), the prevalence of having any mental disorder was significantly lower 4 years (21.3%; P < .01) and 5 years (19.2%; P = .01), but not 7 years (29.1%; P = .27) after RYGB. The most common disorders were not related to long-term weight loss postRYGB. However, independent of weight change, mood and anxiety disorders, both pre- and postRYGB, were significantly related to less improvement in mental (but not physical) health-related quality of life. Having a concurrent mood disorder appeared to be associated with greater weight regain (6.4% of maximum weight lost, 95% confidence interval, −.3 to 13.1), but this was not statistically significant (P = .06). ConclusionsBariatric surgery does not result in consistent long-term reductions in mental disorders. Mood disorders may impact long-term outcomes of bariatric surgery.

Bariatric surgery in patients with type 1 diabetes: special considerations are warranted.

Objective:We examined short and long-term outcomes of bariatric surgery in patients with obesity and type 1 diabetes mellitus (T1DM).Methods:We reviewed the records of all adults insured by Maccabi Healthcare Services during 2010 -2015, with body mass index (BMI) ⩾30 kg/m2 and T1DM; and compared weight reduction and glucose control according to the performance of bariatric surgery. BMI and glycated hemoglobin (HbA1c) levels were extracted for baseline and every 6 months, for a mean 3.5 years.Results:Of 52 patients, 26(50%) underwent bariatric surgery. Those who underwent surgery were more often female and with a longer duration of diabetes. Immediately postoperative, 4(15%) developed diabetic ketoacidosis, while 6(23%) experienced severe hypoglycemic episodes. The mean BMI decreased among surgery patients: from 39.5±4.4 to 30.1±5.0 kg/m2 (p < 0.0001); and increased among those who did not undergo surgery: from 33.6±3.9 to 35.1±4.4 kg/m2 (p = 0.49). The mean HbA1c level decreased during the first 6 months postoperative: from 8.5±0.9% to 7.9±0.9%; however, at the end of follow-up, was similar to baseline, 8.6±2.0% (p = 0.87). For patients who did not undergo surgery, the mean HbA1c increased from 7.9±1.9% to 8.6±1.5% (p = 0.09).Conclusions:Among individuals with obesity and T1DM, weight loss was successful after bariatric surgery, but glucose control did not improve. The postoperative risks of diabetic ketoacidosis and severe hypoglycemic episodes should be considering when performing bariatric surgery in this population.

Is age a real or perceived discriminator for bariatric surgery? A long-term analysis of bariatric surgery in the elderly

BackgroundBariatric surgery is the most effective treatment of obesity. There are few studies evaluating long-term outcomes in elderly patients. ObjectivesOur study was designed to evaluate the safety and long-term outcomes of bariatric surgery in the elderly compared with a contemporary medically managed cohort. SettingUniversity hospital. MethodsThree hundred thirty-seven patients age ≥60 who underwent a sleeve gastrectomy or Roux-en-Y gastric bypass between January 2007 and April 2017 were identified (ElderSurg) and compared with a matched cohort of medically managed elderly patients with obesity (ElderNonSurg). ResultsThirty-two patients underwent laparoscopic sleeve gastrectomy, 190 underwent laparoscopic Roux-en-Y gastric bypass, and 115 underwent open Roux-en-Y gastric bypass. The cohort was a mean of 64.4-years old, 75.4% female, mean preoperative body mass index was 46.9, and 62.6% had type 2 diabetes. During a median follow-up period of 56.2 months (confidence interval 49.5–62.9), mean percent excess weight loss (EWL) at nadir was 72.1 ± 24.7% and EWL at 36 months or beyond was 60.9 ± 27.6%. On regression analysis, diabetes, body mass index, and laparoscopic sleeve gastrectomy were negatively associated with EWL at all time periods (P < .05). Mean %EWL was greater for Roux-en-Y gastric bypass compared with laparoscopic sleeve gastrectomy (61.7 versus 41.2; P = .039). Diabetes remission rate was 45.8%. There was a statistically significant decrease in the risk of death in ElderSurg (hazard ratio .584, 95% confidence interval .362–.941) compared with ElderNonSurg. ConclusionsOur study supports that bariatric surgery is safe in elderly patients with effective long-term control of obesity, diabetes, and with improved overall survival.

Outcomes of Bariatric Surgery in Patients with Cirrhosis.

Information concerning the risk-benefit profile of bariatric surgery in subjects with liver cirrhosis is scarce. Our aim was to describe the long-term outcomes of bariatric surgery in a cohort of patients with liver cirrhosis submitted to bariatric surgery. This was a multicenter, retrospective observational study performed by the Obesity Group of the Spanish Society of Endocrinology and Nutrition (GOSEEN), with a review of patients with cirrhosis who had undergone bariatric surgery during the period from April 2004 to March 2017 in ten public reference hospitals in Spain. Data on 41 patients with cirrhosis submitted to obesity surgery were collected (mean age 53.8±7.9years, 46.3% women, presurgical BMI 45±8.3kg/m2). All but one patient belonged to Child-Pugh class A, and sleeve gastrectomy was conducted in 68.3% of cases. Percentage of total weight loss (%TWL) was 26.33±8.3% and 21.16±15.32% at 1 and 5years after surgery, respectively. This was accompanied by a significant reduction of type 2 diabetes, high blood pressure, and dyslipidemia and by an improvement of liver enzymes over time. Model for End-Stage Liver Disease (MELD) index increased from 7.2±1.9 to 9.8±4.6 after 5years. Seven patients (17%) developed early postsurgical complications. No postsurgical mortality was observed. During follow-up, only five patients developed liver decompensation. Bariatric surgery in selected patients with liver cirrhosis has metabolic benefits that could have a positive impact on liver prognosis. Controlledtrials.com Identifier: 10.1186/ISRCTN15009106.

A480 - Long-term outcomes of bariatric surgery in adolescents with morbid obesity with a follow-up of at least 5 years: A systematic review

A480 - Long-term outcomes of bariatric surgery in adolescents with morbid obesity with a follow-up of at least 5 years: A systematic review

Long-term nutritional follow-up post bariatric surgery.

Bariatric surgery is an effective treatment for classes II and III obesity and its associated diseases. However, many important long-term outcomes of bariatric surgery are still poorly understood, such as neurological and psychological complications, bone health, and so on. This review summarizes the current evidence and expert opinions on nutritional care in the long-term postoperative period. In the first section, we will provide an update of the main long-term complications: risk of anaemia, risk of bone fracture, neurological and psychological complications, and risk of developing Barrett's oesophagus after sleeve gastrectomy. We will also examine the current strategies used to increase weight loss or reduce weight regain. As adherence to long-term follow-up has been shown to decrease over time, the second section aims to identify all measures that improve follow-up rates, to get the maximum benefit from bariatric surgery, while minimizing long-term adverse effects and complications. There is still a significant level of uncertainty regarding the best clinical practices for maintaining the health benefits provided by bariatric surgery. The role of family physician in postsurgery care needs to be clearly defined. More effort is needed to improve psychological care, behaviour management, and therapeutic patient education after bariatric surgery. A more patient-centred approach should probably be considered.

Preoperative Evaluation in Bariatric Surgery.

An adequate preoperative workup is critical for the success of bariatric surgery. A key component of the preoperative evaluation involves a comprehensive patient education about surgical outcomes and the postoperative behavioral regimen required. A complete medical evaluation should include the study of the cardiovascular, pulmonary, and gastrointestinal systems as well as a metabolic status assessment. The nutrition professional should be in charge of the nutritional assessment, preoperative weight loss efforts, and diet education regarding postoperative eating behaviors. A psychological evaluation is also needed because psychosocial factors have a significant impact on the long-term outcomes of bariatric surgery, including adherence to recommended postoperative lifestyle regimen, emotional adjustment, and weight loss outcomes. We recommend preoperative abdominal ultrasound to assess for biliary tract pathology, steatosis, fibrosis, and presence of nonalcoholic steatohepatitis. A routine preoperative esophagogastroduodenoscopy is also recommended to evaluate common gastrointestinal disorders associated with obesity. Preoperative weight loss should be strongly encouraged.

Medium to long-term outcomes of bariatric surgery in older adults with super obesity

BackgroundIndications and outcomes of bariatric surgery in older adults suffering from morbid obesity remain controversial. We aimed to evaluate safety and medium to long-term outcomes of bariatric procedures in this patient population. SettingUniversity Hospital, Canada. MethodsThis is a single-center retrospective study of a prospectively collected database. We included patients aged ≥60 years who underwent sleeve gastrectomy, Roux-en-Y gastric bypass, or biliopancreatic diversion with duodenal switch between January 2006 and December 2014 and had at least 2 years of follow-up. ResultsOf patients, 115 underwent bariatric surgeries (11 patients had 2 procedures). There were 66 were super-obese patients (body mass index>50 kg/m2). Of patients, 74% had sleeve gastrectomy, 16% Roux-en-Y gastric bypass, and 8% underwent biliopancreatic diversion with duodenal switch. Mean age and body mass index were 63.3 ± 2.6 years and 51.7 ± 8.1 kg/m2, respectively. Average follow-up time was 42 ± 19 months. At baseline, 78% had hypertension, 60% had type 2 diabetes, and 30% had obstructive sleep apnea. There was no 30-day mortality. Complication rate was 14% (n = 16): 2 leaks post–Roux-en-Y gastric bypass, 1 leak post–biliopancreatic diversion with duodenal switch, 1 obstruction post–sleeve gastrectomy, 1 bleeding requiring transfusion, 1 liver injury with bile leak, 2 port-site hernias, 1 myocardial infarction, 2 gastrojejunal strictures, 1 wound infection, 1 urinary tract infection, and 3 gastric reflux exacerbations. Mean percent excess weight loss at 2 years was 52.2 ± 23.8. Remission rates of hypertension, type-2 diabetes, and obstructive sleep apnea were 26%, 44%, and 38%, respectively. ConclusionBariatric surgery is safe and effective in improving obesity-related co-morbidities in older patients suffering from morbid obesity. Age alone should not preclude older patients from getting the best bariatric procedure for obesity and related co-morbidities.

Long-Term Outcome of Bariatric Surgery in Morbidly Obese Adolescents: A Systematic Review and Meta-Analysis of 917 Patients with a Minimum of Three Years Follow-Up

Journal of the American College of Surgeons 225(4):p e57, October 2017. | DOI: 10.1016/j.jamcollsurg.2017.07.672

Long-Term Outcome of Bariatric Surgery in Morbidly Obese Adolescents: a Systematic Review and Meta-Analysis of 950 Patients with a Minimum of 3years Follow-Up.

Obesity in pediatric and adolescent population has reached a universal pandemic. This study aimed to summarize the literature on the longest available outcome of bariatric surgery in morbidly obese adolescents. A systematic review was conducted to pool available data on the longest available (>3years) weight loss and comorbidity resolution outcome in adolescent bariatric surgery. A total of 14 studies reporting the result of bariatric surgery after 3years in 950 morbidly obese adolescents were included. Preoperative age and BMI ranged from 12 to 19years and from 26 to 91kg/m2, respectively. Females were the predominant gender (72.8%). Laparoscopic roux-en-Y gastric bypass (n=453) and adjustable gastric banding (n=265) were the most common bariatric procedure performed. The number of patients at the latest follow-up was 677 (range from 2 to 23years). On average, patients lost 13.3kg/m2 of their BMI. Among comorbidities, only diabetes mellitus resolved or improved dramatically. Of 108 readmissions, 91 led to reoperation. There was a weight regain <5kg/m2 between 5 and 6years of follow-up. Removal, exchange, or conversion of the previous band constituted the majority of the revisional procedures. Three deaths were reported. No long-term data was obtainable on nutritional deficiency or growth status of adolescents who underwent a bariatric procedure. Although bariatric surgery is a safe and effective procedure in the treatment of adolescent morbid obesity, long-term data is scarce regarding its nutritional and developmental complication in this growing population of patients.

Obesity: Assessing the long-term outcomes of bariatric surgery in adolescents.

Obesity: Assessing the long-term outcomes of bariatric surgery in adolescents.

Long-term outcomes of bariatric surgery in adolescents with severe obesity (FABS-5+): a prospective follow-up analysis

Background:Little is known about long-term outcomes of bariatric surgery for severe adolescent obesity, raising questions about durability of early responses to surgery. We therefore analyzed long-term (> 5 years) weight, comorbidity, and safety outcomes of Roux-en-Y gastric bypass (RYGB) in a cohort of young adults who had undergone the operation during adolescence.Methods:Outcomes of 58 individuals who underwent RYGB for clinically severe obesity at 13–21 years of age were examined. Body mass index (BMI), comorbidities, micronutrient status and other risks were assessed at 5 to 12 years following surgery.Findings:The cohort had baseline mean (±SD) age of 17± 2 years and median BMI 56 kg/m2. At mean follow up of 8 ± 2 years, mean age was 25 years and mean BMI change was −29 ± 14%. Prevalence of elevated blood pressure, dyslipidemia, and type 2 diabetes significantly declined. Mild anemia, hyperparathyroidism, and low vitamin B12 levels were observed in 46% (n=25), 45% (n=22), and 16% (n=8), respectively, at follow-up.Interpretation:RYGB in adolescence resulted in significant and durable weight reduction and cardiometabolic benefits in young adulthood. Long-term health maintenance following RYGB should focus on adherence to supplements, and screening and management of micronutrient deficiencies.Funding:This research was supported by investigator initiated grants from Ethicon Endosurgery (grants # 15161 and # 15151·3). The project was also supported by the National Center for Advancing Translational Sciences of the National Institutes of Health, under Award Number UL1TR000077. The content is solely the responsibility of the authors and does not necessarily represent the official views of Ethicon Endosurgery or the NIH.

Long-Term Outcomes in Patients with Morbid Obesity and Type 1 Diabetes Undergoing Bariatric Surgery.

This study aims to describe the long-term outcomes of bariatric surgery in a cohort of patients with type 1 diabetes (T1DM). Thirty-two patients with T1DM and initial BMI of 41.3±4.8kg/m2 were studied, 18.7% undergoing duodenal switch (DS), 34.4% gastric bypass, and 46.9% sleeve gastrectomy and followed-up after surgery for 4.6±2.6years. Changes in BMI, HbA1c, insulin requirements, evolution of comorbidities, and microvascular complications were registered annually after surgery. Percentage of total weight loss (%TWL) 12months after surgery was 30.4±9.2% and at 5years, it decreased to 28.1±11.5% (p=0.02). HbA1c was reduced during the first year from 8.5±1.3 to 7.9±1.4%, p=0.016. In the long-term, HbA1c returned to baseline values. There was a sustained reduction of 51% in total daily insulin dose, and the decrease in the number of patients with hypertension, dyslipidemia, and obstructive sleep apnea was 42.8, 25, and 66%, respectively. Retinopathy remained mainly unaffected, and 25% of patients with microalbuminuria regressed to normoalbuminuria. Bariatric surgery in patients with T1DM mainly provides benefits of weight reduction, on insulin requirements, obesity comorbidities, and some benefits in diabetes complications, but might have only minimal effect on the glycemic control in the long term. This trial was registered at www.controlledtrials.com as ISRCTN49980913.

Bariatric Surgery for Patients With Early-Onset vs Late-Onset Type 2 Diabetes

The prevalence of early-onset type 2 diabetes mellitus (T2DM), which responds poorly to medical treatment, is increasing. Bariatric surgery has been well recognized for its effectiveness in the remission of T2DM, but its effectiveness and durability in the remission of early-onset T2DM has not yet been explored. To compare the short- and long-term outcomes of bariatric surgery with a specific focus on the rate of remission of T2DM in patients with early-onset (age <40 years) and late-onset (age ≥40 years) T2DM. In this cohort study, 558 Taiwanese patients (339 with early-onset T2DM and 219 with late-onset T2DM) with a body mass index (calculated as weight in kilograms divided by height in meters squared) above 25 underwent bariatric surgery to ameliorate T2DM between January 1, 2007, and December 31, 2013. Patients were followed up for at least 1 year. Preoperative, perioperative, and postoperative clinical and laboratory data were prospectively collected and compared between the 2 groups. Rate of remission of T2DM (hemoglobin A1C <6.0% without antiglycemic medication) was the primary outcome measure. Of the 558 patients (345 women) in the study, mean (SD) ages were 33.5 (7.5) for those with early-onset T2DM and 50.6 (6.5) with late onset T2DM. Those with early-onset T2DM had higher mean (SD) preoperative BMI and hemoglobin A1C values (39.4 [8.5] and 8.7% [3.8%] of total hemoglobin [to convert hemoglobin to a proportion of total hemoglobin, multiply by 0.01], respectively) than did patients with late-onset T2DM (36.7 [7.5] and 8.2% [1.6%], respectively). Distribution of surgical procedures and major complications were similar between the 2 groups. At 1 year, patients with early-onset T2DM achieved greater weight loss than those with late-onset T2DM, although the difference was not statistically significant. A higher rate of complete remission of T2DM was observed in patients with early-onset T2DM than in those with late-onset disease (193 [56.9%] vs 110 [50.2%]; P = .02). At 5 years, patients with early-onset T2DM still maintained a higher rate of weight loss (mean [SD], 30.4% [11.8%] vs 21.6% [11.7%]; P = .002) and higher rate of remission (47 of 72 [65.3%] vs 26 of 48 [54.2%]; P = .04) than did those with late-onset disease. Age at bariatric surgery, duration of T2DM, and preoperative C-peptide level were independent predictors of remission. The remission rate was directly related to extent of weight loss. Multivariate analysis confirmed the higher rate of remission in the group with early-onset T2DM. This article describes the largest long-term study examining bariatric surgery for patients with early-onset T2DM. Bariatric surgery may achieve better and more long-lasting glycemic control in select patients with early-onset T2DM than in those with late-onset T2DM.

Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients

Psychosocial factors have significant potential to affect long-term outcomes of bariatric surgery, including emotional adjustment, adherence to the recommended postoperative lifestyle regimen, weight loss outcomes, and co-morbidity improvement and or resolution. Thus, it is recommended that bariatric behavioral health clinicians with specialized knowledge and experience be involved in the evaluation and care of patients both before and after surgery. The evaluating clinician plays a number of important roles in the multidisciplinary treatment of the bariatric patient. Central among these is the role of identifying factors that may pose challenges to optimal surgical outcome and providing recommendations to the patient and bariatric team on how to address these issues. This document outlines recommendations for the psychosocial evaluation of bariatric surgery patients, appropriate qualifications of those conducting these evaluations, communication of evaluation results and suggested treatment plan, and the extension of behavioral healthcare of the bariatric patient to the entire span of the surgical and postsurgical process.

No Rush to Judgment for Bariatric Surgery

It isunclearwhether current studieswill address critical questions about the long-term outcomes of bariatric surgery, including the sustainability ofweight loss and comorbidity control and long-term complication rates.1 These critical gaps in knowledge pose a significant problem for people considering a potential surgical option to treat severe obesity. Contributing to these deficits are the paucity of comparative trials, incomplete follow-up, a lack of standardized definitions for changes inhealth status (eg, diabetesmellitus remission), and the tendency to a rush to judgment in favor of surgical treatment options. Laparoscopic sleeve gastrectomy is a good case in point, evolving very quickly during the last several years into the dominant procedure in use2 despite a complete void of information about the longer-termeffects. Golomb et al3 try to address this by documenting 1-, 3-, and 5-year results in a cohort of 443 sleeve gastrectomy cases but clearly raise more issues than they can answer. They show that bothweight loss and type2diabetes remissiondegrade substantiallyover time: excess weight loss from 77% to 56% and complete remission of diabetes from 51% to 20%between 1 and 5 years. Those results are fromonly56people available for 5-year followupand with rates of loss to follow-up of 50%, on average, at 1 and 3 years.Onemust assume that people lost to follow-upmaydiffer in important ways. In addition, there are no standards to report comorbid health changes following bariatric surgery, which limits the ability to compare results across studies. Golomb and colleagues do an excellent job of outlining the study’s ownspecific definitions of prevalence, incidence, and remission of type 2 diabetes and other health outcomes, but theseareneither standardnor sharedbetweenmembersof the research community. How can these problems be addressed? Large, prospective observational studies such as the Longitudinal Assessment of Bariatric Surgery Consortium study report standardized definitions and do better with long-term retention,4 but the burden ofwork and subsequent high cost are problematic inahighlycompetitive fundingenvironment.The issuesofcost and feasibility also make a large randomized trial that could compare surgical procedures across heterogeneous populations impractical. There is hope for the use of large electronic databases to contribute to these knowledge gaps, but thehandling of large amounts ofmissing data is a critical feature that is often not well articulated by the authors or well understoodby the readers. Theanswerswill likelybegeneratedover time not only by a few of these large-scale efforts but also by thoughtful inference thatwill bemade throughpooled analyses of data like that from Golomb and colleagues and from many other disparate randomized and nonrandomized studies of bariatric surgery.5 It will take time, patience, and awillingness to avoid a rush to judgment. In the meantime, clinicians andprospective patientswill need to discuss andweigh the evidence in a dynamic exchange driven not always by final conclusions but by the most current available data.

Presurgical assessment of bariatric patients with the Patient Health Questionnaire (PHQ)--a screening of the prevalence of psychosocial comorbidity.

BackgroundBariatric surgery has gained increasing relevance due to the dramatic rise in morbid obesity prevalence. A sound body of scientific literature demonstrates positive long-term outcome of bariatric surgery in decreasing mental and physical health morbidity. Still, there is a need for a manageable presurgical screening to assess major mental disorders. The aim of this study was to assess the frequency of common psychiatric syndromes in bariatric surgery candidates using a computerized version of the Patient Health Questionnaire (PHQ).MethodsIn a prospective cohort study from August 2009 to July 2011 morbidly obese individuals seeking bariatric treatment were evaluated for mental health disorders using the PHQ (computerized German version).ResultsA total of 159 patients were included in this study. The median age of participants was 42 years, the median BMI was 49 kg/m2. The PHQ revealed a prevalence of 84 % for mental health disorders, 50 % of the participants had three or more mental health disorders. A high somatic symptom burden (46 %), depressive syndromes (62 %) and anxiety disorders (29 %) were the most frequent psychiatric syndromes. The median number of psychiatric syndromes was 3 for women and 1 for men (p = 0.007). No correlation between BMI and a single syndrome or the sum of syndromes was observed.Conclusion84 % of the patients seeking bariatric treatment were screened positive for at least one mental health disorder. The computerized PHQ with automated reporting appears to be a useful instrument for presurgical assessment of bariatric patients in routine medical settings.

Does pregnancy influence long-term results of bariatric surgery?

BackgroundBariatric surgery is performed mostly on obese women of reproductive age. Many authors have studied pregnancy outcomes after bariatric surgery. Only a small number of studies have analyzed the impact of maternity on the results of bariatric surgery. ObjectivesTo study the effect of pregnancy on long-term outcomes of bariatric surgery. SettingLille University Hospital. MethodsA retrospective study was conducted on 591 women aged 18 to 42 years who had undergone laparoscopic adjustable gastric band (LAGB) surgery or laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery between 1996 and 2012. A comparison of the results after a 5-year follow-up was performed between patients who became pregnant after their bariatric surgery (pregnant group, n = 84) and postoperative nonpregnant women (nonpregnant group, n = 507). ResultsAt the 5-year visit, 84.8% patients were seen. The preoperative body mass index (BMI) was the same in the 2 groups (pregnant group: 47.8±6.9 kg/m2; nonpregnant group: 47.5±7.2 kg/m2; P = .755). The percentage of excess weight loss (%EWL) was lower in the pregnant group at 2 years (pregnant group = 45.9±24.6%; nonpregnant group = 56.9±28.6%, P = .002) but was similar at 5 years (47.7±27.7% versus 49.9±28.9%, P = .644). The decrease in co-morbidities was similar after 5 years. The gestational weight gain (GWG) was higher when the band was deflated during pregnancy (GWG =+12.7±10.5 kg) compared to the band without fluid removal (GWG =+4.9±7 kg) or laparoscopic Roux-en-Y gastric bypass (GWG =+4.4±1.1 kg) (P< .05). ConclusionsPregnancy after bariatric surgery slows down postoperative weight loss but does not affect weight results at 5-year follow-up.