Laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for quality of life: a systematic review and meta-analysis

Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the mainstays of bariatric surgery in recent years. In addition, there has been an increased interest in the quality of life (QoL) of obese patients after surgery. This study examined the QoL of patients who had undergone either LSG or LRYGB. We retrieved the literature from PubMed, Web of Science, Embase, and the Cochrane Library database before November 2019. A total of 10 articles and 2327 obese patients were included in our meta-analysis. The QoL scoring tools included in the statistical analysis are the following: the gastrointestinal quality of life index, 36-items short-form health survey, bariatric analysis and reporting outcome system, and the Moorehead-Ardelt quality of life questionnaire II. Although the QoL score of the LRYGB group was higher than that of the LSG group in the bariatric analysis and reporting outcome system subgroup, statistical analysis showed no difference in the postoperative QoL of LSG and LRYGB. In our study, no difference was found in the QoL between LSG and LRYGB. Therefore, in terms of postoperative QoL, surgical methods should be selected on the basis of the patients’ condition and level of understanding of the surgeries.     

BAROS: An Effective System to Evaluate the Results of Patients after Bariatric Surgery

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

Measuring Outcomes following Bariatric Surgery: Weight Loss Parameters,Improvement in Co-morbid Conditions,Change in Quality of Life and Patient Satisfaction

Restrictive and particularly malabsorptive bariatric operations achieve significant sustained weight loss. Results from different operations have been difficult to compare.The aims of this review are: 1) to indicate the limitations of outcomes reported as weight-related parameters; 2) to document some of the patient characteristics that impact weight loss; 3) to assess the literature documenting improvement in obesity-related medical conditions; and 4) to review studies that quantitate changes in health-related quality of life (QoL). Weight-related parameters such as body mass index and % excess weight inconsistently correlate with body fat. Direct determination of body fat with bioelectric impedance may offer more reliable outcome parameters. Patient characteristics such as gender, age, weight, body mass index, ethnicity, race and socioeconomic status affect weight loss following bariatric operations. Improvements in co-morbid conditions are poorly documented in many studies. Standardized instruments that assess health-related QoL have shown differing values. SF-36 has given inconsistent results following bariatric operations. Both BAROS and IWQoL-Lite have demonstrated significant improvements after surgery. Bariatric surgeons have rarely used patient satisfaction as an outcome parameter. This review suggests that bariatric operations should be judged by change in fat mass or fat mass index, improvement in obesity-related medical conditions, change in health-related QoL as judged by standardized instruments, and level of patient satisfaction. In addition, surgeons should characterize their study population and report outcomes for sub-populations.     

Cognitive function and quality of life in bariatric surgery candidates

Background

Both poor quality of life (QoL) and cognitive impairment are common in persons with severe obesity. Work in other patient populations show that cognitive impairment is associated with poorer QoL, though this possibility has not been examined in bariatric surgery candidates.

Quality-of-Life Outcome After Laparoscopic Adjustable Gastric Banding for Morbid Obesity

Background: The definition of success and failure of a bariatric procedure should include weight loss as well as improvement of comorbidity and quality-of-life (QoL) assessment. QoL measures changes in physical, functional, mental, and social health in order to evaluate benefits of new programs and interventions. Material and Methods: From April 1995 until March 1999, 287 patients underwent laparoscopic adjustable silicone gastric banding (LASGB) at Northwest Hospital Frankfurt a.M. (Germany). In this study, 100 of 287 patients (preoperative mean BMI 48.3 kg/m²; mean age 35.2 years) with a follow-up >18 month were evaluated. All patients underwent anonymous questionnaire (26 questions with a maximum score of 60) about different aspects of QoL outcome after LSAGB. Results: In this study, 4 of 100 patients refused to give an answer to the QoL questions. Therefore 96 patients were evaluated. The QoL auto-evaluation of the patients shows that QoL generally improved after surgery in 92%. Using the scoring system, 44% of patients have excellent, 52% good, and only 4% bad results. The 4 patients who refused had to be classified as failure. General acceptance of LSAGB is wide, but gastrointestinal side effects are recognizable in more than 78% of operated patients. Successful weight loss is followed by an improvement of comorbidities. Conclusions: Safe, effective bariatric procedures increase the quality of life in morbidly obese patients markedly. Bariatric surgeons are committed to support and help their patients until they reach a new quality of life after obesity surgery.     

The Association Between Preoperative Symptoms of Obesity in Knee and Hip Joints and the Change in Quality of Life After Laparoscopic Roux-en-Y Gastric Bypass

Background

Weight loss after bariatric surgery is shown to reduce knee and hip pain in the majority of the severely obese. Studies indicate that with a reduction in musculoskeletal symptoms, quality of life (QoL) will improve. The group of severely obese with knee and hip symptoms might therefore have potential for a large improvement in QoL after a bariatric surgery. This study aimed therefore to assess the association between the degree of knee and hip symptoms before a laparoscopic Roux-en-Y gastric bypass (LRYGB) and the improvement of QoL, 1 year after the surgery, in severely obese.

Methods

This study is a historical cohort study based on data collected consecutively at the private hospital Mølholm, Denmark. Before LRYGB surgery, 4548 severely obese completed a questionnaire on knee and hip symptoms of obesity and QoL. One year after surgery, 2862 (62.9 %) of the participants answered the same questionnaire again.

Results

Participants with moderate or severe knee or hip symptoms, before the surgery, experienced a statistically significantly larger improvement of their QoL, compared to participants without symptoms before the surgery. Furthermore, an association between the reduction of knee and hip symptoms and the improvement in QoL was found.

Conclusions

Severely obese with moderate or severe preoperative knee and hip symptoms experienced a larger improvement of their QoL after a LRYGB compared to participants without symptoms before the operation.

     

Improvement in quality of life after bariatric surgery: sleeve versus bypass

Background

Obesity is steadily growing to be the largest threat to human health in this century, not only increasing prevalence of obesity-related co-morbidity but also impairing health-related quality of life (QoL). Bariatric surgery has shown to improve co-morbidity as well as QoL.

Influence of Bariatric Surgery on the Use and Pharmacokinetics of Some Major Drug Classes

The purpose of this review is to evaluate the influence of bariatric surgery on the use and pharmacokinetics of some frequently used drugs. A PubMed literature search was conducted. Literature was included on influence of bariatric surgery on pharmacoepidemiology and pharmacokinetics. Drug classes to be searched for were antidepressants, antidiabetics, statins, antihypertensive agents, corticosteroids, oral contraceptives, and thyroid drugs. A reduction in the use of medication by patients after bariatric surgery has been reported for various drug classes. Very few studies have been published on the influence of bariatric surgery on the pharmacokinetics of drugs. After bariatric surgery, theoretically, reduced drug absorption may occur. Correct dosing and choosing the right dosage form for drugs used by patients after bariatric surgery are necessary for optimal pharmacotherapy. Therefore, more clinical studies are needed on the influence of bariatric surgery on the pharmacokinetics of major drugs.     

Bariatric Surgery and the Central Nervous System

Bariatric procedures are now known to have an effect on hunger as well as on metabolism. The role of central nervous pathways in causing these effects after bariatric surgery is now being elucidated. A brief overview of these pathways has been presented for the sake of bariatric surgeons. A PubMed search was made using various search phrases to retrieve all original articles concerning the effect of bariatric surgery on the neural pathways. The mechanisms regulating the food intake and energy expenditure can be broadly divided into homeostatic and hedonic systems. The effect of bariatric surgery on the homeostatic system in animal models is not clear. A decrease in preference for sweet taste and high calorie foods has been demonstrated in animal models. The effect of bariatric surgery on the hedonic system in humans has been consistent with decreased activation of the hedonic system being demonstrated by functional MRI and decreased preference for intake of high energy foods also being observed post-surgery. The effect of bariatric surgery on dopamine signaling, which is involved in the hedonic system, is however not clear. Functional MRI studies have also demonstrated increased activation of the hypothalamus after surgery. Various studies utilizing questionnaires have demonstrated increased satiety and decreased hunger after bariatric surgery.     

Effect of age on quality of life after gastric bypass: data from the Scandinavian Obesity Surgery Registry

BackgroundWhether patients aged 60 years or older should be recommended bariatric surgery is still controversial.ObjectiveTo assess the effect of age on health-related quality of life (QoL) over time after gastric bypass.SettingData from the Swedish national registry for bariatric surgery.MethodsData of 57,215 patients undergoing gastric bypass were retrieved from the Scandinavian Obesity Surgery Register with a follow-up rate at 1,2, and 5 years at 89%, 69%, and 59%, respectively. Patients were divided into 5-years age intervals. Odds ratios for the relative mean changes in QoL were compared by logistic regression.ResultsPreoperatively, patients aged 60 years or older scored better on mental aspects (Mental Component Summary score, MCS) of RAND-36 (Short Form Health Survey (higher values better)) as well as OP (Obesity related Problem scale (lower values better)) better than the entire cohort of patients (MCS: mean [95% CI], 46.2 [45.5–46.9] versus 43.5 [43.4–43.7], respectively; OP: mean [95% CI], 55.3 [54.0–56.6] versus 64.1 [63.9–64.4], respectively), whereas the Physical Component Summary (PCS) scores of patients aged 60 years or older were lower (mean [95% CI], 32.3 [31.7–32.8] for the ≥60-yr cohort versus 36.4 [36.2-36.5] for the entire cohort; P < .001 for all). In all age groups, MCS was improved at 1 and 2 years but decreased to baseline at 5 years. The postoperative improvements in PCS and OP were sustained in all age groups. Although the relative increases for PCS and OP in patients aged ≥60 years were somewhat lower compared with the entire cohort at 5 years, the values were well above baseline levels (mean [95% CI], 41.0 [40.0–42.0] versus 32.3 [31.7–32.8] and 22.2 [20.3–24.0] versus 55.3 [54.0–56.6], respectively; P < .001).ConclusionMental QoL is transiently improved after bariatric surgery without marked differences between age groups. However, patients aged ≥60 years report pronounced and sustained improvements in physical and obesity-specific QoL 5 years postoperatively. These observations support previous studies that older patients should not be denied bariatric surgery from a risk-benefit perspective, solely based on age.     

Excess skin after weight loss following bariatric surgery: focus on the abdomen

BackgroundThe majority of postbariatric patients experience major problems from excess skin, with most desiring abdominoplasty.ObjectivesTo present visual assessments and objective measurements of excess abdominal skin; analyze relationships between patient-reported outcomes, objective measurements of excess skin, and visual assessments; and discuss criteria for reconstructive abdominal surgery in public healthcare.SettingAn academic hospital in Sweden.MethodsThis is a secondary analysis of a prospective, longitudinal study that included 200 obese patients undergoing bariatric surgery, with 147 of these patients participating in follow-up 18-months postsurgery. Patients rated their symptoms related to excess skin and quality of life (QoL) according to the Sahlgrenska Excess Skin Questionnaire and EuroQol-5 D before and after bariatric surgery. Abdominal ptosis was measured at different anatomic locations.ResultsWaist circumference and ptosis were significantly reduced at all anatomic locations after weight loss, and abdominal ptosis was significantly larger laterally than at the midline (P < .001). The majority of patients had a ptosis ≥3 cm following bariatric surgery and had significantly more symptoms related to excess skin relative to those reported preoperation (P < .05). Additionally, the number of patients experiencing discomfort from excess skin increased along with increased ptosis size, but the correlation between ptosis size and QoL was low. Reconstructive abdominal surgery was requested by 70% of patients, all having significantly larger ptosis and significantly more symptoms than those not desiring surgery.ConclusionCriteria for abdominal reconstruction should be based on both patient-reported symptoms and objective measures to ensure more patient-centered care than is possible only using objective measurements.     

Weight loss and quality of life after bariatric surgery: a 2-year longitudinal study

BackgroundBariatric surgery is currently recognized as being an effective technique for weight loss and the improvement of patients’ postoperative well-being.ObjectivesThe objective of the study was to measure changes in quality of life (QoL) and body mass index (BMI) according to patients’ sex and 2 types of surgical procedures.SettingLongitudinal cohort study using an online platform from a private hospital in West France.MethodsTwo hundred six patients (38 men and 168 women) undergoing one-anastomosis gastric bypass or sleeve gastrectomy surgery provided online information concerning their QoL and weight both before the operation and then every 3 months over a postoperative period of 24 months.ResultsBMI clinically decreased on average by 19.6% in the first 3 months and up to 39.2% 24 months after surgery. Slight differences between men and women appeared as from 18 months after the operation, with men experiencing increased BMI between 18 and 24 months, contrary to women whose BMI remained unchanged during the same period. QoL also improved significantly. The average level of women’s quality of life increased between 3 and 15 months after surgery, then decreased between 15 and 24 months. As for men, no change was observed in their improved QoL between 3 and 24 months after the operation.ConclusionsThis study highlights the importance of optimizing patients’ monitoring, notably around 15 to 18 months after bariatric surgery. This period can be identified as a first “critical” period during which weight regain (especially for men) and diminished self-perceived quality of life (especially for women) appear.     

Technique of resection of esophageal adenocarcinoma after Roux-en-Y gastric bypass and literature review of esophagogastric tumors after bariatric procedures

BackgroundThe number of bariatric procedures has continued to increase worldwide. However, experience with tumors arising in the esophagus or stomach after gastric bypass is lacking. We report our technique for curative resection of esophageal adenocarcinoma in a patient who had undergone previous gastric bypass and review the reported data on esophagogastric tumors after bariatric surgery.MethodsWe have described the operative details of esophagectomy after gastric bypass and reviewed the published data regarding type of bariatric surgery, gender predilection, presentation, symptom duration, cancer stage, and prognosis of patients with esophagogastric tumors occurring after bariatric surgery.ResultsOnly 22 esophagogastric tumors have been reported so far after bariatric surgery. The majority of them are locally advanced or metastatic at presentation.ConclusionEsophagogastric tumors after bariatric surgery are uncommon. This operative technique pays particular attention to the altered anatomy, dissection of the gastric pouch, and preservation of the blood supply to the excluded stomach. This technique can also be applied to manage tumors arising in the gastric pouch after previous gastric bypass. Close collaboration with the bariatric surgeon during surgery is essential to achieve a successful oncologic outcome in this subset of patients.     

BARIATRIC SURGERY IN AUSTRALIA: WHO,WHY AND HOW?

A review of published reports was conducted to identify gaps in the research regarding bariatric surgery. Much of the research that has been conducted is clinical outcome based; however, little research has been conducted in many key areas. Data on the demographics of the bariatric surgery group are patchy at best. The role of best practice and evidence-based medicine in bariatric surgery seems to be poorly understood, and equity issues and the role of clinical pathways in bariatric surgery need to be clarified. Significant gaps were identified in the published reports regarding pathways to bariatric surgery and multidisciplinary team use. Additionally, much of the published report and research data were from US studies, as few Australian studies have been conducted. Further research and policy and practice developments in bariatric surgery are needed, especially with regard to the Australian context.     

Decreased serum betaine concentrations in patients after bariatric surgery

Bariatric surgery significantly reduces the risk of cardiovascular diseases but has no effects on hyperhomocysteinemia, the risk factor for atherogenesis. We hypothesize that the decrease in serum betaine (involved in homocysteine metabolism) concentrations, after bariatric surgery, impairs conversion of homocysteine to methionine, leading to hyperhomocysteinemia. If this is true, it may be desirable to supply patients after bariatric surgery with betaine. Serum betaine and homocysteine concentrations were measured by liquid chromatography/mass spectrometry, in 16 obese patients, before and 6 months after bariatric surgery. Ten healthy individuals with normal body mass index served as controls. Serum betaine concentrations decreased to the values lower than in controls after bariatric surgery, whereas serum homocysteine concentrations remained elevated. In patients supplemented with B₁₂ and folate, no effect of bariatric surgery on serum concentrations of vitamins involved in homocysteine metabolism was observed. These results suggest that betaine deficit could be responsible for maintenance of hyperhomocysteinemia after bariatric surgery. We postulate that supplementation with betaine could be of therapeutic value for the treatment of hyperhomocysteinemia after bariatric surgery.     

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

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

肥胖症的外科治疗

肥胖及其并发疾病已成为全球主要健康问题。对于严重肥胖的患者而言,手术治疗是长期有效的。在减轻体重的同时,患者原有的肥胖相关疾病也得到了缓解和控制,远期病死率大大降低。大量临床资料已经证明了减肥手术的安全性及有效性。减肥手术为解决肥胖问题及其并发疾病打开了一扇新窗口。     

Health-related quality of life following vertical banded gastroplasty

Background  Morbid obesity is associated with increased risks of morbidity and mortality as well as poor quality of life (QoL). Therefore, the goal of bariatric surgery should not only be reducing weight and treatment of comorbid conditions, but also improving QoL. Moreover, enhanced QoL may motivate patients to adhere to adequate health behavior in order to maintain the surgically established weight loss. Methods  We evaluated early postoperative health-related quality of life (HRQoL) over time. Preoperatively as well as 6, 12, and 24 months after vertical banded gastroplasty (VBG), 107 patients were psychologically assessed using a semistructured interview and the RAND 36-item Health Survey (RAND-36). Results  Over time, we found significant changes in weight: 2 years after surgery, excess weight loss (EWL) was 58.4%. HRQoL showed significant improvements over time, especially in the physical domains. Two years after surgery, 74% of patients were satisfied with the results of the operation and 94.1% would opt for surgery again. Conclusions  VBG not only leads to considerable weight loss, but also to significant improvements in HRQoL. However, some of the initially reported improvements lessened over time and not all patients appeared to profit in the same way.     

Six-year bariatric surgery outcomes: the predictive and incremental validity of presurgical psychological testing

BackgroundResearch identifying preoperative psychosocial predictors of bariatric surgery outcomes has yielded inconsistent results with minimal examination of longer-term outcomes. Utilizing a broadband measure of personality and psychopathology during the preoperative evaluation helps to identify preoperative risk factors for suboptimal bariatric surgery outcomes.ObjectiveExamine predictors of outcome and the incremental contribution of presurgical psychological testing to various long-term bariatric surgery outcomes.SettingAcademic medical center.MethodA total of 168 postoperative patients (average of 6 postoperative years) consented to participate in the outcome study. Participants were weighed by the trained research/clinical staff and completed a battery of self-report questionnaires, including measures assessing eating attitudes and behaviors and weight-related quality-of-life (QoL). Patients had completed the Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF) as part of the institution’s routine preoperative psychosocial evaluation. Weight loss was calculated as percent total weight loss (%TWL) and percent weight regain (%WR) was calculated as a percentage of maximum weight loss. Other preoperative data were obtained from a review of each patient’s electronic medical record (EMR). From the initial sample, 145 patients were retained for analyses in the present study.ResultsPreoperative problematic eating variables predicted long-term postoperative problematic eating behaviors and body image concerns. Scores on preoperative MMPI-2-RF scales measuring Demoralization, Dysfunctional Negative Emotions, Antisocial Behaviors, and Hypomanic Activation were consistent incremental predictors of 6-year outcomes, accounting for an additional 3%–24% of the variability in postoperative eating behaviors and QoL.ConclusionsThe preoperative psychological evaluation can be used to identify predictors of long-term bariatric surgery outcomes. Identification of these risk factors provides important targets for pre- and postoperative clinical interventions to maximize surgical outcomes.     

肥胖症的外科治疗

肥胖及其并发疾病已成为全球主要健康问题.对于严重肥胖的患者而言,手术治疗是长期有效的.在减轻体重的同时,患者原有的肥胖相关疾病也得到了缓解和控制,远期病死率大大降低.大量临床资料已经证明了减肥手术的安全性及有效性.减肥手术为解决肥胖问题及其并发疾病打开了一扇新窗口.