Psychological changes in morbidly obese patients after sleeve gastrectomy.

BACKGROUND: The aim of this study is to observe the psychological changes at one year postop in a group of patients undergoing laparoscopic vertical sleeve gastrectomy (GVL) and multidisciplinary follow- up. METHODS: A total of 46 patients with a BMI-35 or higher, who were selected for GVL, completed psychological testing. After GVL surgery, patients received psychological, nutritional, and medical attention during 12 months, and they retook the same tests. RESULTS: Psychological tests showed an improvement on almost all scales tested, except perfectionism. The most significant change was in the benchmark for Eating Disorders with an improvement of 89% for bulimia (P<.01), and 55% for body dissatisfaction (P<.01) and ineffectiveness (P<.01). In quality of life there was an improvement of 57% in the change in health status (P<.01). CONCLUSION: During our study, a protocol involving GVL and multidisciplinary follow-ups seems proved to be an effective intervention for improving bulimic symptoms and quality of living. The results of these psychological changes are similar to Roux-en-Y Gastric bypass but different to vertical banded gastroplasty or adjustable gastric band, according to previous studies. However, long-term studies are necessary to confirm this trend.

Predictive model of failure of outpatient laparoscopic cholecystectomy.

INTRODUCTION: The aim of our study was to review our experience and to determine a predictive model of factors for unanticipated admissions after ambulatory laparoscopic cholecystectomy (LC). MATERIALS AND METHODS: Between January 1999 and June 2003, 410 consecutive LCs were performed as outpatient procedures. We performed univariate analysis and logistic regression models of preoperative and intraoperative variables. The scoring system developed allowed calculating the ambulatorization probability of LC in each patient. Validation and calibration of the model were realized by means of Hosmer-Lemeshow test. RESULTS: Three hundred sixty-three patients were strictly ambulatory (86.8%). Forty-two patients required overnight admission (10.2%), most of them because of social factors, and 5 patients were admitted. Predictive factors related to overnight stay or admission were: age of patient over 65 years [P=0.021; odds ratio (OR)=2.225; 95% confidence interval (CI), 1.130-4.381], operation duration superior to 60 minutes (P=0.046; OR=2.403; 95% CI, 1.106-5.685), and "dissection difficulty" intraoperative score superior to 6 (P=0.034; OR=3.063; 95% CI, 1.086-8.649). The right classification index of the predictive system was 91.7%, reaching a sensibility of 99.7% and specificity of 31.9%. CONCLUSIONS: Outpatient LC is safe and feasible. Age of the patient, operation duration, and complexity of surgical dissection during LC are independent factors influencing ambulatorization rate.