Gastrointestinal quality of life following laparoscopic vertical banded gastroplasty

Background: Laparoscopic vertical banded gastroplasty (LVBG) is a safe and effective treatment for morbid obesity. Previous studies disclosed a significant improvement in the health-related quality of life after substantial weight loss following VBG. Data regarding the specific gastrointestinal quality of life following LVBG is lacking. Materials and Methods: 223 patients who underwent LVBG for morbid obesity were studied prospectively. Quality of life was measured by the Gastrointestinal Quality of life Index (GIQLI), a 36- item questionnaire before surgery, and at 6 months, 1 year and 2 years after surgery.The questionnaire is divided into 5 domains, and the maximum score is 144. Results: After LVBG, weight loss has been good. Mean BMI decreased from 43.2 to 31.3 after 2 years. Co-morbidities were eliminated in 71%. 84.3% of patients were satisfied with the results. However, the score of GIQLI remained similar before and after surgery. Preoperative score was 106.2±19 points. The score became 116.6±9, 106.8±21, and 108.5±20 at 6 months, 1 year and 2 years after surgery respectively.The patients had improvement in 3 domains of the questionnaire (social function, physical status and psychological emotions) but decreased in domains of core symptoms and disease-specific items. Conclusion: Although LVBG was effective in reduction of weight and resolution of co-morbidities in morbidly obese patients, the specific gastrointestinal quality of life did not improve. Many patients developed some specific gastrointestinal symptoms in order to obtain weight reduction.     

Starting a successful bariatric surgical practice in the community hospital setting

Background: 3% of the population is morbidly obese and experience many associated medical problems. Surgical procedures have been shown to achieve sustained weight loss not attainable by other measures, lessening the co-morbidities. However, most general surgeons have been reluctant to expand their practice to include bariatric surgery. The current study demonstrates the benefits of including bariatric surgery in a general surgeon's practice in a community hospital. Methods: Hospital charts of patients undergoing a gastric bypass procedure between 1997 and 2000 were reviewed. Demographic data, co-morbid conditions, intra-operative times, and post-operative weight loss were recorded. Follow-up data was obtained using a mailed survey based on the BAROS survey. Results: 168 patients underwent a Roux-en-Y gastric bypass procedure. Follow-up was obtained for 86 patients. Average pre-operative weight was 141 kg (BMI = 50). There was an average loss of 55% of excess weight by the second post-operative year. Operative times decreased as the number of the procedures performed by the surgeon increased. Over half of the patients surveyed reported improvements for each of the co-morbid conditions that were assessed (i.e., diabetes, back pain, etc.). Five categories of quality of life were assessed, and over 66% of patients reported improvements in all areas. In 44% of the patients, payment was obtained from private insurance and 56% from Medicare or Medicaid. There were no deaths. Conclusion: Adding bariatric surgery to a general surgeon's practice in the community setting can be beneficial to patients, intellectually stimulating and emotionally rewarding for the surgeon, and economically feasible for the institution.     

Quality of Life Assessment in the Morbidly Obese

Quality of life (QoL) is an important measure of outcome after bariatric surgery. Impairment in QoL has been well documented in morbidly obese patients before undergoing bariatric surgery and has been shown to improve significantly within 3 months after the operative intervention. Improvement in QoL should be recognized as one of the benefits of bariatric surgery that can be quantified.     

Laparoscopic Vertical Banded Gastroplasty: Early Results with the JOVO Procedure

Background: Vertical banded gastroplasty (VBG) is an established treatment for morbid obesity for selected patients. This study seeks to assess the effectiveness of a laparoscopic version, the JOVO procedure, of the VBG. Methods: An independent surgeon interviewed all patients, who had had the JOVO procedure at one institution, evaluating weight loss, comorbid conditions, satisfaction and quality of life using the 36-item short-form health survey (SF-36). Results: 14 JOVO procedures were done by two surgeons. Mean body mass index was 44 kg/m², mean age 30 years and each patient had at least one comorbid condition. Mean operative time was 165 minutes. There was 1 complication, a suspected gastric leak requiring reoperation. Excluding this patient, mean hospital stay was less than 48 hours. Mean weight loss 4 weeks after surgery was 9 kg or 18% of excess weight. Mean excess weight loss of the 5 patients available for 1-year follow-up was 42% at 6 and 85% at 12 months; 1 did not continue to lose weight. All but 1 preoperative comorbid condition resolved or improved. 13 of the 14 patients were fully satisfied. SF-36 scores were high in the 13 that lost weight, especially in physical and social functioning areas. Conclusion: The JOVO procedure is safe and reproduces laparoscopically the early weight loss of open VBG with much shorter hospital stay and low complication and failure rates. Longer follow-up and larger numbers are needed.     

Determinants of Long-Term Satisfaction after Vertical Banded Gastroplasty

Background: The long-term usefulness of vertical banded gastroplasty (VBG) in achieving weight loss is controversial, and adverse effects related to the procedure may attenuate patient satisfaction. Our objective was to evaluate patient satisfaction, and to identify parameters that are related to such satisfaction, 3 to10 years after VBG. Methods: All consecutive patients who underwent VBG in one surgical ward were invited for a follow-up study 3 to 10 years after surgery. Questions relating to symptoms and quality of life were evaluated in a personal interview using a structured questionnaire. Results: Of the 122 patients who underwent VBG from 1986 to 1992, 75 patients were located and agreed to participate in the follow-up study. The average time since surgery was 5.4 ± 1.8 years. The average weight loss was 24.9 ± 12.4%, representing an excess body-weight loss of 58.6 ± 30.4%. Overall, 65% of the patients were satisfied with the results of surgery while 19% expressed dissatisfaction. Significant improvement was seen in respiratory difficulties, ability to perform physical exercise, and mental status. Successful weight loss and the frequency of respiratory difficulties were the only independent parameters associated with patient satisfaction. Although vomiting, gastroesophageal reflux and difficulty in swallowing occurred in over two-thirds of the patients, their presence was not correlated with patient dissatisfaction. Conclusion: Despite the presence of a multitude of adverse effects, the majority of our patients were satisfied with the long-term results of VBG. Successful weight loss and improvement in respiratory difficulties were the major determinants of patient satisfaction.     

Evaluation of Health Status and Quality of Life after Bariatric Surgery: Comparison of Standard Roux-en-Y Gastric Bypass, Vertical Banded Gastroplasty and Laparoscopic Adjustable Silicone Gastric Banding

Background: This study is a trial to compare the effects and outcomes of three different bariatric procedures performed in two centers. Standard Roux-en-Y gastric bypass was performed by Dr. Norman Samuels in Fort Lauderdale (Florida); vertical banded gastroplasty and laparoscopic adjustable silicone gastric banding were done in Hallein (Salzburg) by Dr. Emanuel Hell and Dr. Karl Miller. Methods: In a prospective comparative study 30 matched patients from each group were followed to assess post-operative improvement in health status and quality of life, to compare the three different techniques. The Bariatric Analysis and Reporting Outcome System (BAROS) as described by Oria and Moorehead has been used for evaluation. Results:The observation time was at least 3 years (3 to 8 years) in each individual case. A significant increase in quality of life and health status in 75% of the surgically-treated patients was observed when compared with a non-operated control group of morbidly obese patients. Conclusions: By utilizing BAROS it has been found possible to compare the results of different procedures done by different surgeons with different techniques, utilizing patients from different cultures and with different languages. The results of this comparative study favor the standard gastric bypass for the treatment of morbid obesity.This operation is superior to purely gastric restrictive procedures in weight loss and improvement of quality of life.     

Quality of Life and Psychosocial Adjustment in Patients after Roux-en-Y Gastric Report Bypass: A Brief Report

Background: While Roux-en-Y gastric bypass (RYGBP) appears to be the most effective procedure for weight loss in morbidly obese patients, objective outcome data regarding quality of life (QoL) and psychosocial status following surgery are lacking. Methods: The present study examined the effects of RYGBP in 32 morbidly obese subjects on a variety of outcome measures including QoL and psychosocial functioning. Assessments were conducted before surgery, 1 to 3 weeks post-surgery, and at 6- month follow-up. Results: In addition to weight loss, results show significant improvements in health-related QoL, depression, and self-esteem, as well as a significant reduction in eating pathology following surgery. Results also show that neither the presence of binge-eating disorder nor clinical depression predicted poorer outcome post-surgery. Conclusion: RYGBP results in a dramatic reduction in weight, and marked improvements in health-related QoL, depression, self-esteem, and eating pathology, including binge-eating in the short term. These findings need to be replicated in a larger cohort of patients and followed for a longer time before we can reach more definitive conclusions regarding the psychosocial outcome in RYGBP.     

Weight Loss Following Vertical Banded Gastroplasty: Intermediate Results of a Prospective Study

Background: Morbidly obese patients who undergo purely restrictive bariatric operations may fail to maintain satisfactory long-term results. In an attempt to achieve the best possible outcome after restrictive procedures, we have employed preoperative selection criteria and are following this selected patient group over time in order to evaluate longterm success. Materials and Methods: From June 1994 through August 2000, 166 morbidly obese patients underwent various bariatric procedures at our institution. Of these patients, 35 underwent vertical banded gastroplasty (VBG) based on selection criteria, including degree of obesity and dietary habits and eating behavior. All patients were seen at 1, 3, 6, 9, and 12 months postoperatively and yearly thereafter. Average follow-up time now is 4.1 years (29-75 mos.), and follow-up is 100%. A multivitamin and mineral supplement is administered to all patients for at least 6 months. Radiology examination is performed in all patients on the 4th postoperative day and at each yearly visit, in order to check for staple-line disruption and stomal stenosis. Results: Early postoperative morbidity was 5.7%. Late postoperative morbidity was 22.8%. A significant number of patients had some degree of stomal stenosis as shown by radiology examination, but to date there has been no need for surgical revision. There has been no early or late mortality.Weight loss results expressed as average percent excess weight loss (% EWL) were as follows: 61% (28-90) at 1 year, 61% (20-90) at 2 years, 57% (13-91) at 3 years, 56% (25-87) at 4 years and 37% (24-59) at 5 years following surgery. A significant number of patients with excellent weight loss had a high frequency of vomiting. Evaluation by BAROS showed that 25% of patients had an overall unsatisfactory outcome. Anemia and iron deficiency were found in 46% and 32% ofVBG patients respectively.Recurrence of preexisting comorbidities was significant if lost weight was regained. Conclusions: In spite of preoperative selection of patients for VBG, a significant percentage of patients had poor overall results in terms of weight loss, quality of life, and resolution of preexisting comorbidities. For these reasons and based on the long-term results published by others, VBG is no longer our preferred surgical option in morbidly obese patients.     

Laparoscopic Roux-en-Y gastric bypass for severe gastroesophageal reflux after vertical banded gastroplasty

Background: Vertical banded gastroplasty (VBG) is sometimes associated with complications such as pouch obstruction, dilatation, and gastroesophageal reflux. This occasionally requires surgical revision, in many cases to a Roux-en-Y gastric bypass (RYGBP). Case Report: A 47-year-old woman with severe obesity developed severe symptoms of stenosis of the pouch outlet and gastroesophageal reflux 15 years after VBG. Laparoscopic conversion to a RYGBP was performed. At 9-month follow-up, she lost an additional 32 kg and had complete resolution of her reflux. Conclusion: In this patient, laparoscopic re-operative RYGBP produced additional weight loss, and improved gastroesophageal reflux that occurred many years after having a VBG. Laparoscopic conversion of a VBG to RYGBP is feasible, and may confer the benefits of other minimally invasive abdominal procedures to this high-risk patient group.     

Health-Related Quality of Life in Patients Seeking Gastric Bypass Surgery vs Non-Treatment-Seeking Controls

Background: Previous research has found that health-related quality of life (HRQOL) differs among obese individuals depending on treatment-seeking status, with greater impairments found in obese individuals seeking treatments of greatest intensity. The goals of this study were to determine: 1) if there are differences in obesity-specific HRQOL between seekers of gastric bypass surgery and non-treatment-seeking controls; and, 2) if the presence and number of co-morbid conditions impacts on HRQOL. Methods: Participants were 339 surgical cases (mean age 42.9, mean BMI 47.7, 85.5% women) and 87 controls (mean age 48.8, mean BMI 43.5, 71.3% women). Obesity-specific HRQOL was assessed using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite). Subjects were given a detailed medical history to determine the presence of co-morbid conditions. Results: After controlling for BMI, age, and gender, obesity-specific HRQOL was significantly more impaired (P<.001) in the surgery-seeking group than in the control group on all 5 scales and total score of the IWQOL-Lite. For total score, physical function and sexual life, there was increasing impairment with increasing number of co-morbid conditions. Treatment-seeking status, BMI, gender, and the presence of depression accounted for most of the variance in IWQOL-Lite total score. Conclusions: Persons seeking gastric bypass expe rience poorer HRQOL than non-treatment-seeking individuals after controlling for BMI, age, and gender. The presence of co-morbid conditions contributes to some aspects of HRQOL impairment.     

Laparoscopic Vertical Banded Gastroplasty: 5-year Results

Background:Vertical banded gastroplasty (VBG) has been a popular bariatric operation for the past 2 decades, and this operation has evolved into a laparoscopic procedure. However, reports of laparoscopic VBG (LVBG) from large series with longer results are limited. Methods: From October 1998 to May 2002, 612 consecutive patients underwent LVBG. Mean age was 30.1 years and mean BMI 43.0 kg/m². Laparoscopic Mason gastroplasty was performed. The change of BMI, obesity-related co-morbidities, and GI quality-of-life index (GIQLI) were studied. Results: The major and minor complication-rate was 1.14% and 4.58% respectively. The mortality-rate was 0.16%. Mean BMI fell from 43.1 kg/m² to 31.2, 31.3, 31.4, 32.2, and 32.8 kg/m² at 1, 2, 3, 4, and 5 years respectively, with 93% follow-up. Revision rate was 9.2%. GIQLI decreased from 113.0 to 106.6, 110.9, 111.9, 112.1, and 106.4 at 1, 2, 3, 4, and 5 years. Conclusion: LVBG is safe and effective in weight reduction. The GIQLI failed to improve postoperatively even with good resolution of obesity-related co-morbidities. In carefully selected patients with diligent postoperative follow-up, LVBG is a bariatric surgery option.     

A Prospective Comparison of Vertical Banded Gastroplasty and Roux-en-Y Gastric Bypass in a Non-Superobese Population

Background: In the non-superobese population, consensus is currently unavailable in bariatric surgery. We report the results of a prospective comparison of vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGBP) in a non-superobese population. Methods: From 1994 to 2000, 179 patients with clinically severe obesity underwent various surgical procedures in our department. During this time a prospective study was undertaken in order to compare VBG with RYGBP in morbidly obese patients with a BMI <50 kg/m². Based on specific criteria including eating behavior, 68 patients were selected to undergo RYGBP and 35 VBG. All patients have undergone complete follow-up evaluation at 1, 3, 6, and 12 months postoperatively and every year thereafter. Results: All patients have now completed their 5th postoperative year. Mean follow-up period to date is 96.5±12.2 months for VBG and 67.6±11.3 months for RYGBP. 3 patients (8.6%) in the VBG group and 9 patients (13.2%) in the RYGBP group are lost to follow-up. Mean excess weight loss (EWL) was always better in the RYGBP group (P=0.0013). The percentage of failure, defined as EWL <25%, was not significantly different between the two procedures. No statistically significant differences were observed between the 2 groups in the total number of non-metabolic complications, and the only statistically significant difference observed in metabolic complications was vitamin B₁₂ deficiency after RYGBP. Frequency of vomiting was significantly less and quality of eating significantly better in RYGBP than in VBG patients. Conclusion: This prospective long-term study, with nearly complete follow-up, suggests that in the non-superobese population, preoperative eating habits may play a role in choosing the most appropriate bariatric operation for each patient. Although RYGBP is associated with better mean weight loss outcomes, the percentage of patients who achieved and maintained ≥50% EWL after VBG in this pre-selected patient population was not significantly different. Each type of operation has advantages and disadvantages, and, if properly chosen, a purely restrictive procedure can be successful for some patients. Therefore, it can be said that the decision regarding which bariatric procedure to perform in non-superobese patients must be based on in-depth preoperative evaluation as well as the patients' own preferences and outcome expectations.     

Evaluation of Quality of Life and Metabolic Improvement after Jejunoileal Bypass in a Community of Low Socioeconomic Status

Background: 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. Methods: 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. Results: 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/m², and the postoperative mean excess weight loss was 58.9% ± 18.9%. Conclusion: 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.     

Gastric Cancer Occurring After Vertical Banded Gastroplasty

A case of gastric cancer after vertical banded gastroplasty (VBG) is presented. A 44-year-old man presented with vomiting and weight loss 6 years after VBG. Endoscopy revealed a poorly differentiated gastric adenocarcinoma. The patient underwent a Whipple pancreaticoduodenectomy and received chemotherapy. He expired 6 months later. From our case and review of the literature, development of gastric cancer after VBG is very rare. The authors suggest that patients undergoing VBG be monitored by endoscopy after the operation.     

Perceived psychosocial outcomes of gastric bypass surgery: a qualitative study

Background: Attempts to understand postoperative psychosocial changes in the lives of individuals who have undergone gastric bypass surgery for morbid obesity have 1) been guided by constructs emanating from the assumptions of researchers, and 2) have resulted in fragmented conclusions that catalogue changes without theoretically integrating them. Materials and Methods: Using unstructured and semi-structured interviews and in-depth focus groups, 31 patients were asked in an open-ended fashion about the ways, if any, in which gastric bypass surgery had affected their lives. Grounded theory methodology was utilized in order to identify emergent themes and their interrelations, and build a meaningful, comprehensive theory of life after gastric bypass. Results: Patients' report of a rebirth/transformation was identified as the core process of the theory. The changes marking this process were clearly conceptualized in dichotomous terms comparing pre to postsurgical life. Patients reported changes that they regarded as unequivocally positive, a number of which had not been previously reported in the literature. Unique to this particular study was the finding of numerous life changes that generated tension and posed challenges in various aspects of patients' lives. Conclusion: The grounded theory proposes that the extent to which patients successfully negotiate tension-generating changes may be a major determinant in the long-term outcome of gastric bypass, both weight loss and psychosocial adjustment.     

Laparoscopic Vertical Banded Gastroplasty and Laparoscopic Gastric Bypass: a Comparison

Background: Vertical banded gastroplasty (VBG) and gastric bypass (GBP) are the two bariatric procedures recommended by NIH consensus conference. Recent advancement in laparoscopic (L) techniques has made LVBG and LGBP alternatives for the conventional open approach. Methods: From December 2000 to February 2002, 80 patients (24 men and 56 women; mean age 32 years, range 18-57) with morbid obesity (mean BMI 43.2 kg/m², range 36-59.8) were enrolled in a prospective trial and randomly assigned to LVBG or LGBP. Changes in quality of life were assessed using the Gastro-intestinal quality of life index (GIQLI). Results: The conversion rate was zero for LVBG and 2.5% (1/40) for LGBP. There has been no mortality. Surgical time was significantly longer for LGBP (209 minvs 126 min for LVBG, P<0.001).Mean hospital stay was 3.5 days for the LVBG vs 5.7 days for LGBP (P<0.001). Postoperative analgesic usage was also less for LVBG patients (mean dose 1.4 vs 2.4, P<0.05). Early complication rate was higher in the LGBP group (17.8% vs 2.5%, P<0.001). All 3 major complications were in the LGBP group, of which 2 were related to anastomotic leakage (5%). Late complications consisted of upper GI bleeding, stenosis and others observed in 4 LGBP patients (10%) and 2 LVBG patients (5%). Mean follow-up was 20 months (range 18 to 30). BMI fell significantly in both groups, with significant improvement of obesity-related co-morbidities. LGBP had significantly better excess weight loss than LVBG (62.9% vs 55.4% at 1 year and 71.4% vs 53.1% at 2 years), as well as lower BMI than LVBG (29.6 vs 31.1 at 1 year and 28.5 vs 31.9 at 2 years). There was no difference in the reduction of obesity-related laboratory abnormalities at 1 year except a lower hemoglobin in LGBP (11.8 vs 13.8, P<0.05). Preoperative GIQLI scores were similar between the groups; however, at 1 year, LGBP patients had better GIOLI scores than LVBG patients (121 vs 106, P<0.01). LVBG had improvement in physical condition, social function and emotional conditioning but deterioration in GI symptoms which resulted in no increase in total GIQLI score. Conclusion: LGBP was a time-consuming demanding technique with a higher early complication rate compared with LVBG. Although both operations resulted in significant weight reduction and decrease in obesity-related co-morbidities, LGBP had a trend of greater weight loss and significantly better GIQLI than LVBG at the cost of a significant long-term trace element deficiency state. Each patient should be individualized for the operations according to the patient's decision.     

Vertical Isolated Gastroplasty with Gastro-enteral Bypass: Preliminary Results

Background: The authors present a new restrictive and malabsorptive operation for treatment of morbid obesity, called vertical isolated gastroplasty (VIG). Methods: From Feb 2004 to May 2005, 30 patients with BMI ≥40 kg/m² or >35 kg/m² with co-morbidities underwent VIG via laparoscopy or laparotomy. The technique consisted in creation of a gastric tube preserving pylorus, and a Roux-limb of 300 cm to the bypassed stomach with the division 30 cm distal to the ligament of Treitz. Excess weight loss (EWL), BMI, complications and co-morbidities were assessed. Results: BMI and average preoperative weight were 41.2 kg/m² and 110.7 kg, respectively. At 12 months postoperatively, BMI and average weight were 23.4 kg/m² and 65.1 kg, respectively, with EWL 90.2%. None of the patients presented dumping. Improvement in co-morbidities was >90%. Complications consisted of: 1 dehiscence of gastric sutureline, 1 hemoperitoneum, 1 gastroenterostomy ulcer, 1 anemia of undetermined cause, and 3 cholelithiasis. There was no mortality. Conclusion: VIG has thus far been safe and effective, with the same results as other bariatric operations. VIG has certain advantages, such as lack of dumping and lack of clinically significant stenosis of the gastroenterostomy, which can occur with other techniques. Because a duodenal bypass is not performed, it allows physiologic absorption of iron and diagnostic and/or therapeutic access to the ampulla of Vater.     

Laparoscopic Swedish Adjustable Gastric Banding: 6-year Follow-up and Comparison to other Laparoscopic Bariatric Procedures

Background: The advantages of laparoscopy over open surgery are well known. The aim of this study was to compare our results with Swedish adjustable gastric banding (SAGB) with other laparoscopically performed bariatric procedures (gastric bypass, LapBand^?, vertical banded gastroplasty). Methods: Between January 1996 and December 2001, 454 patients (381 women, 73 men) underwent laparoscopic SAGB. All data (demographic and morphologic, co-morbidities, operative, and follow-up) were prospectively collected in a computerized databank. Results: Mean follow-up was 30 months (range 1-66). Average total weight loss was 35.5 kg after 1 year, reaching an average total of 54 kg after 3 years. Mean excess weight loss was 72% after 3 years, and the BMI decreased from 46.7 to 28.1 kg/m². Patients with co-morbidities reported marked improvement of their accompanying diseases. Complications requiring reoperation occurred in 7.9%. There was no mortality. The clinical outcome compared with the other laparoscopic bariatric procedures showed no significant difference. Conclusion: All laparoscopically performed bariatric procedures are very promising. The great advantage of laparoscopic adjustable gastric banding is that this operation is minimally invasive to the stomach, totally reversible and adjustable to the patients' needs.     

Psychological Condition and Quality of Life in Patients with Morbid Obesity Before and After Surgical Weight Loss

Background: Bariatric surgery results in significant weight loss, improvement or cure of accompanying illnesses, and may lead to important changes in psychological conditions. The aim of this paper is to study the changes in the psychological and emotional lives of patients as well as quality of life during the first 2 years after vertical banded gastroplasty (VBG). Methods: The study population comprised 59 patients, 45 women (76.3%) and 14 men, between 18 and 64 years old. Patients were asked to complete an SCL-90R questionnaire before VBG. 2 years after VBG, patients were again asked to complete an SCL-90R as well as a BAROS questionnaire. Comparisons were made between loss of weight, alteration in the psychological condition and quality of life postoperatively, within the parameters of sex, age, marital status, level of education, duration of obesity and family history of obesity. Results: Women had a greater degree of depression from obesity than their male counterparts before the procedure (P=0.001), while their postoperative emotional improvement was more marked (P=0.008). The General Mental Health Index was higher in female than male patients (P=0.008). At 2 years after VBG, BMI was significantly reduced (P<0.001). Oversensitivity in personal relationships and anxiety affected patients more both pre- and postoperatively. The averages of all the indexes of the subgroups of the SCL-90R, which relates to psychological condition of patients, showed a statistically significant reduction at 2 years following VBG, indicative of the improvement of the patients' psychosomatic condition. The more weight patients lost, the more their quality of life improved, as evaluated by the BAROS (P<0.001). Conclusions: The bariatric surgery most satisfactorily improved the patients' psychosomatic condition, as well as their quality of life, during the first 2 years after VBG.     

Health-related quality of life in morbidly obese patients: effect of gastric bypass surgery

Background: The effect of gastric bypass on the health-related quality of life (HRQoL) of morbidly obese patients was investigated in a cross-sectional study. Methods: A postoperative group of 78 patients on average 13.8 years after gastric bypass was compared with a preoperative control group of 110 patients. The SF-36 was used to assess HRQoL. In preoperative patients, the SF-36 was self-administered, while in the postoperative group, telephone interviews were conducted. In the postoperative sample, multiple stepwise linear regression analyses were carried out to examine putative predictors of the physical (PCS) and the mental (MCS) composite scores of the SF-36. Results: Significant differences between the preand postoperative group were found for all subscales except Mental Health, in favor of the postoperative group. On average 13.8 years after gastric bypass, most of the sub-scales were similar to the US norm values. However, the Bodily Pain and the overall Physical Composite scale (PCS) scores were lower (more impaired) in the postoperative group compared with the US norms. Female patients, patients who were hospitalized since the surgery, and those who had lost less weight had more impaired values on the PCS and patients who reported binge-eating disorder (BED) at follow-up had more impaired values on the Mental Composite Scale (MCS) of the SF-36. Conclusion: HRQoL was significantly better in postoperative gastric bypass patients in comparison to a sample of preoperative patients. However, HRQoL, specifically the physical domain of the SF-36, was more impaired in long-term follow-up patients compared with US norm values. The reoccurrence of BED after surgery negatively influenced the mental domain of the SF-36.