The role of brief strategic therapy on the outcome of gastric banding.

BACKGROUND: The success of bariatric surgery can be measured in different ways and depends on many factors. The aim of this study was to assess if preoperative Brief Strategic Therapy (BST), a specific psychological support, can positively influence the results (weight loss, improvement in health status and quality of life, QOL) in the short- and long-term. METHODS: 500 patients who underwent laparoscopic adjustable gastric banding from 1996 to 1999 were evaluated both objectively (weight loss, health status) and subjectively (improvement in QOL and self-perception). We compared these results with those of a group of 145 patients treated with preoperative BST (6 sessions average). Patients were divided into 3 groups according to the percent of excess weight loss (< 40%, 40-60%, > 60%). The Moorehead-Ardelt QOL Questionnaire scoring was used. Individual interviews were conducted to understand emotional feelings and to evaluate the actual changes in the QOL and eating habits. RESULTS: Patients treated preoperatively with BST had 46% excess weight loss (EWL) at 1 year which was significantlly different from patients non-treated (40% EWL). In the following years, treated patients showed better results, although not statistically significant. QOL improved objectively and subjectively CONCLUSION: Preoperative BST gives a satisfactory result. In addition, good compliance preoperatively corrected eating habits that has been maintained through the years and is a good predictor of long-term success.

Outcome predictors in morbidly obese recipients of an adjustable gastric band.

BACKGROUND: The authors investigated the outcome predictors in obese patients who underwent laparoscopic adjustable banding with the Lap-Band. METHODS: The 3-year excess weight loss (EWL) and rate of band-related complications (pouch dilatation and port leakage) were analyzed in 260 morbidly obese patients, according to several possible predictive characteristics. Success rate (EWL > 50%), failure rate (EWL < 20%) and weight regain rate (regain of > 10% EWL between 1 and 3 yrs) were considered. RESULTS: The Lap-Band produced a 43.0 +/- 22.3% EWL, corresponding to a BMI reduction from 46.6 +/- 7.0 to 36.8 +/- 6.6 kg/m2. Success rate was 35.7%, failure rate was 14.1% and weight regain rate was 20.7%. Pouch dilatation occurred in 32 patients (12.3%), band erosion in 2 (0.8%), port leakage in 74 (28.5%), and port twisting in 2 (0.8%). Major band-related surgery was requested in 11 patients (4.2%) and minor port-related surgery in 62 patients (23.9%). Significant success predictors were found to be age < 40 years and BMI < 50 kg/m2. Significant failure predictors were found to be male sex and non-sweet eating behavior. Significant weight regain predictors were found to be BMI < 50 kg/m2 and the occurrence of a port leakage. Port leakage was significantly more frequent in women and in patients with BMI < 50 kg/m2. The prevalence of pouch dilatation was threefold higher in women than in men. CONCLUSIONS: Lap-Band was associated with a good outcome and with a low rate of severe complications. The outcome was more influenced by physiological and technical reasons than by psychological or behavioural factors.