A Qualitative Longitudinal Exploration of the Lived Experience of Laparoscopic Adjustable Gastric Banding Surgery

Abstract

Objectives: In the United Kingdom, laparoscopic adjustable gastric banding (LAGB) surgery is an option for obese individuals who meet the National Institute for Health and Clinical Excellence criteria. Despite the many benefits of LAGB, there is a paucity of literature exploring the long-term impact on individuals. The present study explored how people make sense of the experience of being banded from pre-to five years post-surgery. Design:A prospective longitudinal qualitative study utilising interpretative phenomenological analysis.Methods: Semi-structured interviews were undertaken pre-banding, at six months, then annually up to five years post-banding with seven individuals.Results: Pre-banding participants described the stigma associated with being overweight and unwelcome in society, the need for support, preparations for being banded, and their expectations of successful weight loss with a concomitant return to normality. Post-banding revealed the inadequacy of participants' previous preparation for real life with the band. That, plus some support-related problems, meant at five years post-banding participants still had concerns about whether their eating issues had been addressed, and all were still dependent on the band to control their food intake. Conclusions:Five years post-banding and changed eating behaviours are still not habitual, the weight loss has not been to the extent originally predicted, and their stated aim (the return to normality with the knowledge of how to manage their weight with the band), remains in the future. Improved preparation and support are clear needs for this patient population to achieve a normal life free from stigma, others' revulsion and pity.

Patient motivations and expectations prior to bariatric surgery: A qualitative systematic review

“…Despite these expectations, some participants also demonstrated awareness that excess skin might be a side effect of surgery; however, none deemed this to be an overly extensive or distressing issue to the extent that it would deter them from undergoing surgery …”

“…Participants also reported difficulties moving, performing daily tasks, and experiencing physical pain that they sought to get rid of or reduce. Participants had trouble walking and moving, climbing stairs, lifting, bending, and taking part in exercise and sports they had previously enjoyed . As a result, they described numerous restrictions in daily life, including difficulties managing housework and domestic chores, attending to personal hygiene, and physical difficulties associated with parenting young children such as being able to lift and play .…”

“…Difficulty finding suitable and appealing clothing was reported by a number of participants, who expressed expectations that surgery would create physical changes that would facilitate their ability to fit into clothes, and look more slim and beautiful:

“I'm so excited about this bariatric treatment because I'm going to get into that dress, and I will get into it.” [Female, UK]

…”

“…Participants also conducted their own extensive research and attended information meetings and groups to become informed about the procedures, risks, and outcomes. Through this learning process, they became more “comfortable” with the option of surgery and felt they had become properly informed . For many, the decision to have surgery was further facilitated through hearing about others' successful weight loss from surgery .…”

“…Through this learning process, they became more “comfortable” with the option of surgery and felt they had become properly informed . For many, the decision to have surgery was further facilitated through hearing about others' successful weight loss from surgery . In these cases, perceiving the “amazing” results others had achieved influenced their own motivation …”