Conversion of a failed VBG to a RYGB is more effective than a reVBG, because conversion to RYGB provides satisfactory weight loss without requiring further revisional surgery.

This RCT demonstrates that, despite the initial better weight loss in the VBG group, based on complication rates and clinical outcome, LAGB is preferred. It had a shorter LOS and less postoperative morbidity.

BACKGROUND: Bioelectrical-impedance spectroscopy (BIS) is a very attractive method for body composition measurements in a clinical setting. However, validation studies often yield different results. This can partly be explained by the different approaches used to transform measured resistance values into body compartments. OBJECTIVE: The aim of this study was to compare the linear regression (LR) method with the Hanai Mixture theory (HM). Secondly, the effect of degree of overweight on the accuracy of BIS was analysed. DESIGN: In 90 people (10 M, 80 F; body mass index (BMI) 23 ± 62 kgam 2 ) total body water (TBW) and extracellular water (ECW) were measured by deuterium and NaBr dilution methods, respectively, and by BIS. Resistance values of ECW (R ECW ) and TBW (R TBW ) were used for volume calculations. Data of half the group were used for LR based on L 2 aR (L length, R resistance) to predict TBW and ECW and to calculate the constants used in the HM (k ECW ), k p ). Prediction equations and constants were cross-validated in Group 2. RESULTS: Bland and Altman analysis showed that the LR method underestimated TBW by 1.1 l (P`0.005) and ECW by 1.1 l (P`0.005). The HM approach underestimated ECW by 0.8 l (P`0.005). The correlations with the dilution methods and the SEEs for TBW and ECW were comparable for the two approaches. The prediction error of BIS for TBW and ECW correlated with BMI. The constant k ECW , and the speci®c resistivities of the ECW and intracellular water (ICW) p ECW and p ICW were also correlated with BMI. CONCLUSIONS: The mixture approach is slightly more accurate than linear regression, but not sensitive enough for clinical use. The constants used in the HM model are not constants in a population with a wide variation in degree of overweight. The physical causes of the correlation between BMI and constants used in the model should be studied further in order to optimize the mixture model.

Because treatment of morbid obesity with VBG results in QALYs gained and less costs, there is no doubt that this procedure should be introduced or continued from a societal point of view.

The effect of surgically induced weight loss on the quality of life of morbidly obese patients was investigated in a controlled cross-sectional study. A postoperative group of 62 patients was compared with a control group of 20 preoperative patients. The Nottingham Health Profile part I (NHP-I) and part II (NHP-II) and a visual analogue scale were used for quality of life assessment. Significant differences were found on the NHP-II (P < 0.0001), the visual analogue scale (P < 0.001), and on the domains of mobility (P < 0.0001), energy (P < 0.001), and emotional reaction (P < 0.001) on the NHP-I in favor of the postoperative group. Better quality of life outcome was related to larger weight loss and shorter length of postoperative follow-up. No correlation was found between quality of life outcome and the type of surgical procedure or surgical complications. The unemployment rate was 53% for the overall postoperative group and 64% for the female postoperative group compared with 80% (P < 0.05) and 84% (NS) in the overall and female control groups, respectively. Overweight as the reason for unemployment was more frequent in the control group. The results of this study show that quality of life is better after surgically induced weight loss and is not related to the type of surgical procedure nor to surgical complications. Postoperative quality of life tends to decrease with time.