Improvement in health-related quality of life in first year after laparoscopic adjustable gastric banding

Abstract

Background: We analyzed the health-related quality of life (HRQOL) and its determinants in the first year after laparoscopic adjustable gastric banding (LAGB). The setting was 10 Italian public and private bariatric surgery centers. Methods: Data collected in an ongoing, prospective, 3-year multicenter Italian study on the changes in HRQOL after LAGB were used. HRQOL was investigated using the Medical Outcomes Study ShortForm 36 questionnaire. Hunger, satiety, and the self-perceived effects of LAGB were recorded. Results: A total of 334 patients were enrolled. The follow-up rate was 92.2%. The percentage of excess weight loss was 39.6% Ϯ 25.8%, with very few side effects or complications. Hunger in the morning (0 -10 scale) was 4.5 Ϯ 2.7 before surgery and 3.8 Ϯ 2.4 after 1 year (P Ͻ.001). Satiety after a meal (0 -10 scale) was 7.1 Ϯ 2.7 before surgery and 8.2 Ϯ 1.9 at 1 year (P Ͻ.001). The self-perceived effect of LAGB on caloric intake (0 -10 scale) was 8.4 Ϯ 1.9 after 1 year. The scores for the 8 Medical Outcomes Study Short-Form 36 subscales were significantly improved after surgery. The physical component summary score was 52.6 Ϯ 11.9 at baseline and 79.1 Ϯ 15.6 after 1 year (P Ͻ.001). The corresponding mental component summary scores were 52.2 Ϯ 12.3 and 76.5 Ϯ 17.2 (P Ͻ.001). Greater physical component summary improvement was independently associated with a low initial physical component summary (P Ͻ.001), high satiety (P ϭ .002), a high percentage of excess weight loss (P ϭ .013), and a high self-perceived effect of the LAGB (P ϭ .026). Greater mental component summary improvement was associated with a low initial mental component summary (P Ͻ.001), high satiety (P Ͻ.001), a low frequency of heartburn (P ϭ .004), and a high percentage of excess weight loss (P ϭ .012). Conclusions: Significant improvements in HRQOL were observed in the first year after LAGB. A poor baseline HRQOL, a high efficacy of the banding in eating control, and better weight loss might influence HRQOL changes. (Surg Obes Relat Dis 2012;8:260 -268.)

Psychosocial Issues After Bariatric Surgery

“…Patients with the most impaired levels of HRQOL at baseline experienced the greatest improvements in HRQOL. In addition, higher satiety after meals and a higher perceived effi cacy of the band were related to larger increases in physical and mental components of HRQOL [ 28 ]. These fi ndings suggest that patients with markedly impaired HRQOL prior to surgery may experience the largest improvements.…”

“…However, the data thus far do not support a relationship between these variables [ 29 ]. Furthermore, although bariatric surgeries can result in signifi cant food intolerance, nausea, and vomiting, studies indicate that gastrointestinal side effects are minimally related to HRQOL [ 28 ]. In an attempt to further clarify factors associated with HRQOL, Pilone and colleagues recently explored the impact of level of HRQOL prior to surgery, self-perceived effects of surgery, and hunger/satiety cues on HRQOL in 334 postoperative LAGB patients 1 year after surgery.…”

“…Here we provide a brief overview of changes in quality of life after surgery. Within the fi rst year after surgery, many bariatric surgery patients experience rapid improvements in health-related quality of life (HRQOL) [ 28 ]. For example, 1 year after LAGB, patients demonstrate important improvements within physical, psychosocial, and sexual functioning domains [ 29 ].…”

“…For example, 1 year after LAGB, patients demonstrate important improvements within physical, psychosocial, and sexual functioning domains [ 29 ]. Surprisingly, the most signifi cant gains have been documented in the fi rst few months postsurgery [ 28 ]. However, one recent study [ 30 ] suggests that these rapid improvements may not be consistent across the multiple domains of quality of life.…”

“…Several investigations have explored the role of degree of weight loss on HRQOL. Although a few studies have established a relationship between excess weight loss (EWL) and HRQOL [ 28 ], overall % EWL has not been shown to be predictive of HRQOL values [ 29 ]. In fact, despite differences in mean EWL, RYGB, and LAGB, patients have demonstrated comparable improvements in HRQOL.…”