Bariatric analysis and reporting outcome system (BAROS) applied to laparoscopic gastric banding patients

Relationship of personality characteristics and eating attitude with the success of bariatric surgery

Background: Obesity is a chronic disease that causes several medical and psychiatric complications. There are plenty of pharmacological and non-pharmacological therapies for obesity treatment. Bariatric surgery is one of the most efficient nonpharmacological treatment for morbid obesity; however, several psychological factors affect the success of bariatric surgery. This study aims to evaluate personality characteristics and eating attitude relationship with the success of bariatric surgery. Methods: This study was carried out on 75 patients with obesity who were candidates of bariatric surgery in the obesity clinic of Rasoul-e-Akram Hospital in Tehran. The patients were asked to fill the TCI and EAT-26 questionnaires before and after the surgery. Statistical analyses were performed using the SPSS-23 applying T-test, Mann-Whitney tests and Pearson and Spearman's correlation coefficient. The significance level was set at 0.05. Results: Seventy-five patients, including 13 men and 62 women, were assessed through this study. The mean of the BMI of the participants was 44.7 prior to the surgery and 30 after the operation. Personality characteristics and eating attitudes had no significant relationship with the success of bariatric surgery. Conclusion: Although the eating attitude and personal characteristics of the bariatric surgery candidates before the surgery was not related to the outcome of the surgery, they should be considered in post-operational psychological assessments.

Quality of life and bariatric surgery: a systematic review of short- and long-term results and comparison with community norms

Currently the effects of bariatric surgery are generally expressed in excess weight loss or comorbidity reduction. Therefore the aim of this review was to provide insight in the available prospective evidence regarding the short and long-term effects of bariatric surgery on Quality of Life (QoL) and a comparison with community norms. A systematic multi-database search was conducted for 'QoL' and 'Bariatric surgery'. Only prospective studies with QoL before and after bariatric surgery were included. The 'Quality Assessment Tool for Before-After Studies with No Control Group' was used to assess the methodological quality. Thirty-six studies met the inclusion criteria. Most studies were assessed to be of 'fair' to 'good' methodological quality. Ten different questionnaires were used to measure QoL. Follow-up ranged from 6 months to 10 years, sample sizes from 26 to 1276 and follow-up rates from 45 to 100%. A significant increase in QoL after bariatric surgery was found in all studies (P⩽0.05), however, mostly these outcomes stay below community norms. Only outcomes of the IWQoL, SF-36 and OWQoL show QoL outcomes that exceed community norms. The QoL is increased after bariatric surgery on both the short and long term. However, due to the heterogeneity of the studies and the generality of the questionnaires is it hard to make a distinction between different surgeries and difficult to see a relation with medical profit. Therefore, tailoring QoL measurements to the bariatric population is recommended as the focus of future studies.

Comparative study of five different surgical techniques for the treatment of morbid obesity using BAROS

Background

The obesity is an universal disease of epidemic proportions and in a growing prevalence. It is one of the main public health problems and it will be inexorably the largest problem of the developing world. The morbid obesity is associated to serious diseases, reducing the life perspective, increasing the morbility and mortality. Several strategies of losing weight were proposed; however, the bariatric surgeries are today the most effective treatment for this disease. The BAROS is the most simple, practical and efficient method to evaluate the results in the bariatric surgeries.

Aim

To compare five surgical techniques for the treatment of morbid obesity using BAROS.

Method

The sample is constituted of 102 patients submitted to Fobi-Capella (23 patients), Scopinaro (21 patients), duodenal switch (20 patients), vertical banded gastroplasty of Mason (15 patients) and the adjustable gastric band (23 patients), evaluated 12 months after the surgeries using BAROS.

Results

The analysis of the final result of BAROS for the classification demonstrated that good, very good and excellent results were obtained in 100% of the patients in the group of duodenal switch; 91,3% in Fobi-Capella; 85,7% in Scopinaro; 60% in Mason; and 56,5% in adjustable gastric band. The final result of BAROS for the total score demonstrated that the group of duodenal switch obtained 6,3 points; the Fobi-Capella 5,1 points; the Scopinaro 4,8 points; the Mason 3,0 points; and the adjustable gastric band 2,9 points (p<0,0001).

Conclusion

The duodenal switch is the best technique for the surgical treatment of the morbid obesity, in the following 12 months post-surgical clinical procedures, according to BAROS.

Sleep study, respiratory mechanics, chemosensitive response and quality of life in morbidly obese patients undergoing bariatric surgery: a prospective, randomized, controlled trial

BACKGROUND

Obesity is a major public health problem in both developed and developing countries alike and leads to a series of changes in respiratory physiology. There is a strong correlation between obesity and cardiopulmonary sleep disorders. Weight loss among such patients leads to a reduction in these alterations in respiratory physiology, but clinical treatment is not effective for a long period of time. Thus, bariatric surgery is a viable option.

METHODS/DESIGN

The present study involves patients with morbid obesity (BMI of 40 kg/m2 or 35 kg/m2 to 39.9 kg/m2 with comorbidities), candidates for bariatric surgery, screened at the Santa Casa de Misericórdia Hospital in the city of Sao Paulo (Brazil). The inclusion criteria are grade III morbid obesity, an indication for bariatric surgery, agreement to participate in the study and a signed term of informed consent. The exclusion criteria are BMI above 55 kg/m2, clinically significant or unstable mental health concerns, an unrealistic postoperative target weight and/or unrealistic expectations of surgical treatment. Bariatric surgery candidates who meet the inclusion criteria will be referred to Santa Casa de Misericórdia Hospital and will be reviewed again 30, 90 and 360 days following surgery. Data collection will involve patient records, personal data collection, objective assessment of HR, BP, neck circumference, chest and abdomen, collection and analysis of clinical preoperative findings, polysomnography, pulmonary function test and a questionnaire on sleepiness.

DISCUSSION

This paper describes a randomised controlled trial of morbidly obese patients. Polysomnography, respiratory mechanics, chemosensitive response and quality of life will be assessed in patients undergoing or not undergoing bariatric surgery.

TRIAL REGISTRATION

The protocol for this study is registered with the Brazilian Registry of Clinical Trials - ReBEC (RBR-9k9hhv).

Content identification of the IWQOL-Lite with the International Classification of Functioning, Disability and Health

INTRODUCTION

The identification of the content of a measure could ensure that the most appropriate measure is chosen to meet a particular objective. Mapping the Impact of Weight on Quality Of Life (IWQOL-Lite) to the International Classification of Functioning, Disability and Health (ICF) will improve the understanding of its structure and aid in the interpretation of the results.

METHODS

A mapping exercise was performed by 21 raters using the Delphi technique to identify the ICF codes that best describe the content of the items of the IWQOL-Lite. Both French and English versions were linked to validate the French translation. The results were validated on a sample of 122 participants and were also compared to the mapping performed by another group.

RESULTS

Most of the content of the IWQOL-Lite was identified. All five components of the ICF were represented in the IWQOL-Lite. The mapping differed across languages. The results of the mapping were similar to those obtained by another group.

CONCLUSIONS

The content of the IWQOL-Lite is compatible with the ICF. The measure has good content validity. The content could be improved by the addition and the specification of some terms. The French translation of some items should be revised.

BAROS results in 700 patients after laparoscopic Roux-en-Y gastric bypass with subset analysis of age, gender, and initial body mass index

BACKGROUND

The Bariatric Analysis and Reporting Outcome System (BAROS) uses a point scale (maximal score of 9) to evaluate weight loss, complications, improvement in medical conditions, and quality of life among postoperative bariatric patients. The BAROS was originally developed to address the need for a standardized method of reporting open gastric bypass outcomes and has been shown to be both valid and reliable. BAROS scores >7 are considered "excellent." Our objective was to assess the overall BAROS scores in patients undergoing laparoscopic Roux-en-Y gastric bypass at each postoperative follow-up interval and to examine the effect of age and gender on BAROS scores.

METHODS

A total of 700 patients who had undergone LRYGB were asked to complete a BAROS questionnaire at their postoperative visits. The BAROS scores were recorded in a prospective database. The patients were stratified by their initial age and body mass index. The statistical analysis included analysis of variance. P <.05 was considered significant.

RESULTS

The mean BAROS score peaked at 7.29 at the 18-month appointment. More than one half of the patients presenting for follow-up visits at 12, 18, 24, and 36 months had BAROS scores in the "excellent" range. Age stratification (20-29, 30-39, 40-49, and ≥ 50 years) resulted in significant differences at 3, 6, 9, 12, and 18 months postoperatively. When stratified by the initial body mass index, differences were seen at 3 weeks and 3, 6, 9, and 12 months postoperatively.

CONCLUSION

Patients with a lower initial body mass index had greater BAROS scores at many of the follow-up intervals. Laparoscopic Roux-en-Y gastric bypass effectively improved the overall health and quality of life of patients.

Cross-validation of the Taiwan version of the Moorehead-Ardelt Quality of Life Questionnaire II with WHOQOL and SF-36

Background

Obesity has become a major worldwide public health issue. There is a need for tools to measure patient-reported outcomes. The Moorehead–Ardelt Quality of Life Questionnaire II (MA II) contains six items. The objective of this study was to translate the MA II into Chinese and validate it in patients with morbid obesity.

Methods

The MA II was translated into Chinese and back-translated into English by two language specialists to create the Taiwan version, which was validated by correlations with two other generic questionnaires of health-related quality of life (HRQOL), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and World Health Organization Quality of Life (WHOQOL)-BREF Taiwan version. The convergent validity was accomplished by a series of Spearman rank correlations. Reliability of the MA II Taiwan version was determined by internal consistency obtained by Cronbach’s alpha coefficient and test–retest reliability obtained by intraclass correlation coefficient.

Results

One hundred subjects with morbid obesity were enrolled to test the MA II Taiwan version convergent validity and internal consistency. Test–retest studies (2 weeks apart) were applied to 30 morbidly obese patients. Satisfactory internal consistency was demonstrated by a Cronbach’s alpha coefficient of 0.79. Good test–retest reliability was shown by intraclass correlations ranging from 0.73 to 0.91. The total sum of MA II scores was significantly correlated with all four domains of the WHOQOL-BREF and two major components of SF-36 (all correlations, p < 0.01; range, 0.44–0.64). All six MA II items showed significant correlations with each other (r = 0.34–0.69, p < 0.01), and the total sum of MA II scores was negatively correlated with body mass index (r = −0.31, p < 0.01), indicating a one-dimensional questionnaire of HRQOL.

Conclusions

The MA II Taiwan version is an obesity-specific questionnaire for QOL evaluation with satisfactory reliability and validity. It has the advantages of extensive evaluation for HRQOL, cross-cultural application, rapid completion, high response rates, and an advanced scoring system.

Prospective evaluation and 7-year follow-up of Swedish adjustable gastric banding in adults with extreme obesity

BACKGROUND

Swedish adjustable gastric banding (SAGB) is a widespread laparoscopic procedure in bariatric surgery. Few long-term data is available.

AIM

To determine long-term outcome after SAGB in 196 patients studied prospectively.

PATIENTS AND METHODS

196 patients, 40 men, and 156 women have been operated from 1996 to 2005. Age was 38 +/- 1 (mean +/- sem) years. Mean follow-up was 63 +/- 2 months.

RESULTS

Hospital morbidity was 3% (0.5% early reoperation); mortality was 0. Late complications were band migration (1%), leakage (5%), slipping (4%), or pouch dilatation (8%). Minor reoperations (tube replacement, port-related, and hernias) were needed in 7.5%. Cumulative major reoperation rate reached 32%. Eighteen percent had a band replacement; 14% had removal of band anatomy. Late mortality was 0.5%. Exactly 7 years after SAGB, BMI decreased from 45 +/- 1 kg/m2 to 33 +/- 1 kg/m2, and excess weight loss (EWL) was 61 +/- 4%. Sixty-eight percent of the patients reached > or = 50% EWL.

CONCLUSION

In 14% of the patients, the band anatomy had to be removed. Seven years of intact band anatomy leads to a successful EWL of 61 +/- 4% and to EWL of > or = 50% in 68%. However, cumulative major reoperation rate of 32% in 7 years makes it mandatory to offer and discuss other bariatric procedures to the respective patients.

[Comparison of quality of life in morbidly obese patients and healthy volunteers. A prospective study using the GIQLI questionnaire]

BACKGROUND

Morbid obesity decreases the quality of life. The aims of surgical and medical treatment are weight loss, reduction of co-morbidity, and improved quality of life.

AIMS

To compare the quality of life between obese patients (BMI: 40 or>35+comorbidity) and healthy volunteers using the GIQLI (Gastrointestinal Quality of Life) questionnaire.

PATIENTS

Between January 2001 and December 2002, 127 morbidly obese patients (109 female, 18 male) with a mean age of 40.1 years were surgically treated with laparoscopic gastric banding. Quality of life, as measured by the GIQLI questionnaire, was systematically evaluated pre-operatively. During the same period, a control group of 125 healthy volunteers of comparable age, gender, and prior surgical history were evaluated using the same questionnaire.

RESULT

The two groups, while comparable in age and gender, were significantly different in terms of weight (123 vs. 66 kg), BMI (44.3 vs. 22.2) (p<0.001), co-morbidity factors (p=0.001), and professional activity (p=0.02). The mean global GICLI score was 122 for healthy individuals and 95 for morbidly obese patients. (p=0.001), and the differences were most marked in the super obese. These differences particularly involved social dysfunction, physical status, and emotional symptoms but were not significantly different for gastrointestinal symptoms.

CONCLUSION

The quality of life in morbidly obese and super obese patients is significantly diminished from that of a control population. There was good correlation between the degree of obesity (BMI) and the alteration of the GIQLI global and subscales scores. Quality of life should be systematically evaluated before and after both medical and surgical therapy.

Weight loss and quality of life after bariatric surgery: a study of 200 patients after vertical gastroplasty or adjustable gastric banding

BACKGROUND AND OBJECTIVES

Long term evaluation of bariatric surgery must include quality of life measurement.

METHODS

Quality of life (QoL) was evaluated using the original Moorehead-Ardelt questionnaire for 200 patients operated for massive obesity in a single centre between 1994 and 2003. QoL and physical data were obtained by retrospective mail questionnaire. Surgical procedures were vertical-banded gastroplasty according to Mason (VBGM) and adjustable gastric banding (AGB) in 61 and 39% of patients, respectively. The aim of the study was to assess the nutritional outcome and QoL according to the procedure.

RESULTS

Overall, the body mass index (BMI) decreased from 50+/-8 kg/m(2) before surgery to 35.2+/-7.5 kg/m(2) at the time of the questionnaire. The percentage of weight loss was 28.8+/-12.2%. In the group treated with VBGM, the mean initial weight (P=0.003) and the percentage of weight loss (P<0.001) were significantly higher, and the QoL was better (P=0.003) than in the group treated with AGB. On the basis of the time spent since surgery, a regular weight loss was observed during the first 5 years, whereas weight subsequently increased over the five following years. Similarly, the total QoL score gradually improved during the first 5 years and worsened thereafter. However, it remained better than before surgery. A linear regression analysis showed a positive correlation between the percentage of weight loss and the QoL score (P<0.001).

CONCLUSIONS

This study suggests that the bariatric surgery, particularly the VBGM technique, improved the QoL of obese patients, at least in the first 5 years following surgery.

Quality of life and alteration in comorbidity following laparoscopic adjustable gastric banding

OBJECTIVES

Obesity is an increasing problem in the UK and bariatric surgery is likely to increase in volume in the future. While substantial weight loss is the primary outcome following bariatric surgery, the effect on obesity-related morbidity, mortality and quality of life (QOL) is equally important. This study reports on weight loss, QOL, and health outcomes following laparoscopic adjustable gastric banding (LAGB) in a low volume bariatric centre (<20 cases/year) and presents the first assessment of factors relating to the QOL which has been produced from a UK based surgical practice.

STUDY DESIGN

Questionnaire based study of patients who had LAGB. Each patients' initial body mass index (BMI), QOL, and comorbidities were recorded. Change in these parameters was measured including excess weight loss, and output from both the Moorehead-Ardelt QOL questionnaire, and the Bariatric Analysis and Reporting Outcome System (BAROS).

RESULTS

Eighty-one patients (14 males, 67 females) answered the questionnaire. More than 50% excess weight loss was recorded in 52/81 patients (64%). Sixty-four patients (79%) reported improvement in their QOL including self-esteem, physical activity, social involvement, and ability to work. Seventy-one patients had initial obesity related comorbidity. In 61 of these patients (86%) their comorbidities resolved or improved. Minor port site related complications were recorded in nine patients while two patients had removal of the band because of infection.

CONCLUSION

LAGB is a safe method of bariatric surgery. It can achieve satisfactory weight loss with significant improvement in QOL and comorbidity.

Quality of Life in Morbidly Obese Patients after Surgical Weight Loss

BACKGROUND

Laparoscopic adjustable gastric banding (LAGB) is seen as a safe surgical procedure in individuals with morbid obesity, with satisfactory weight loss and significant postoperative improvement in quality of life (QoL). The present study investigates the predictive value of various parameters such as age, gender, weight loss, and preoperative psychiatric disorders with regard to QoL after LAGB.

METHODS

300 obesity surgery patients were sent questionnaires to assess a variety of personal parameters. QoL was assessed using the Ardelt-Moorehead Quality of Life Questionnaire. Questionnaires were completed by 140 (63%) female patients and 36 (45%) male patients.

RESULTS

Average weight loss in both sexes was 14.7 kg/m2; however, not all patients successfully lost weight. No difference was seen in satisfaction with weight loss among the age groups. Some correlations were seen between the amount of weight loss and QoL scores in females, but not in males. Greater weight loss showed a statistically significant positive correlation to self-esteem, physical activity, social relationships, sexuality, and eating pattern. Obese females with no preoperative psychiatric diagnosis had better self-esteem, more physical activity, and more satisfying social and sexual relationships than those with psychiatric diagnoses at follow-up.

CONCLUSION

A majority of morbidly obese patients show psychological and interpersonal improvement after surgery. However, some obese patients, particularly those having a preoperative psychiatric or personality disorder, need more individual strategies for psychosocial intervention than do obese individuals with no psychiatric disorder.

Quality of life after laparoscopic gastric banding: Prospective study (152 cases) with a follow-up of 2 years

To evaluate influence of laparoscopic gastric banding (LGB) on quality of life (QOL) in patients with morbid obesity. Laparoscopic adjustable gastric banding is a popular bariatric operation in Europe. The objectives of surgical therapy in patients with morbid obesity are reduction of body weight, and a positive influence on the obesity-related comorbidity as well the concomitant psychologic and social restrictions of these patients. In a prospective clinical trial, development of the individual patient QOL was analyzed, after LGB in patients with morbid obesity. From October 1999 to January 2001, 152 patients [119 women, 33 men, mean age 38.4 y (range 24 to 62), mean body mass index 44.3 (range 38 to 63)] underwent evaluation for LGB according the following protocol: history of obesity; concise counseling of patients and relative on nonsurgical treatment alternatives, risk of surgery, psychologic testing, questionnaire for eating habits, necessity of lifestyle change after surgery; medical evaluation including endocrinologic and nutritionist work-up, upper GI endoscopy, evaluation of QOL using the Gastro Intestinal Quality of Life Index (GIQLI). Decision for surgery was a multidisciplinary consensus. This group was follow-up at least 2 years, focusing on weight loss and QOL. Mean operative time was 82 minutes; mean hospital stay was 2.3 days and the mean follow-up period was 34 months. The BMI dropped from 44.3 to 29.6 kg/m and all comorbid conditions improved markedly: diabetes melitus resolved in 71% of the patients, hypertension in 33%, and sleep apnea in 90%. However, 26 patients (17%) had late complications requiring reoperation. Preoperative global GIQLI score was 95 (range 56 to 140), significant different of the healthy volunteers score (120) (70 to 140) P < 0.001. Correlated with weight loss (percentage loss of overweight and BMI), the global score of the group increased to 100 at 3 months, 104 at 6, 111 at 1 year to reach 119 at 2 years which is no significant different of healthy patients. Analyzing the subscale, physical condition, emotional status, and social integration increased significantly (P < 0.001) from preoperative to end of follow-up. Digestive symptoms were not modified. In case of failure of the procedure (10.5%) global Giqli score is not modified. Patients who have required successful revisional surgery for late complications (6.5%) have an excellent QOL outcome that are not different from the whole group. Together with a satisfactory reduction of the excess overweight, laparoscopic gastric banding may lead in a carefully selected population of patients with morbid obesity to a significant improvement of patient QOL, in at least 2 years follow-up.

Laparoscopic surgical concepts of morbid obesity

BACKGROUND

According to the WHO, obesity and obesity with associated morbidity constitute a chronic, multi-factorial condition requiring treatment. Conservative treatment has been shown in long-term studies to be ineffective in morbid obesity. Surgical treatments break down into restrictive, malabsorptive, combined restrictive and malabsorptive or motility-reducing procedures.

METHOD AND RESULTS

Laparoscopic implantation of an adjustable gastric band is an efficient restrictive measure for treating the majority of patients with this condition. The adjustable gastric band enables weight loss and food intake to be adapted to the individual patient's need. Of these patients, 80-90% can expect to lose 55-70% of their excess weight. Vertical banded gastroplasty is losing ground among the restrictive options. Preliminary experiences are encouraging, but the long-term results are disappointing when assessed by the standard criteria. Gastric bypass is gaining ground in Europe and is a standard procedure in the USA. This operation is estimated to give a 70-80% loss in excess weight, and provides a better quality of life than do restrictive procedures. The biliopancreatic diversion with duodenal switch combines a sleeve gastrectomy with a duodeno-ileal switch to achieve maximum weight loss. Consistent excess weight loss of between 70% and 80% is achieved, with acceptable decreased long-term nutritional complications. The laparoscopic approach to this procedure has successfully created a surgical technique with optimum benefit and minimal morbidity, especially in the super-obese patient. Intra-gastric stimulation is the least invasive surgical procedure at present. However, the excess weight loss is lowest with this method, at only 32% in the first 2 years after the operation.

CONCLUSION

Provided that safety recommendations are observed, laparoscopic operations for obesity have a fairly low risk. The mortality rate in centres with experienced staff is less than 0.3%. The death rate due to untreated morbid obesity is significantly higher than in a comparable group of patients after surgery.

Overview of obesity

The purpose of this article is to provide a succinct overview of obesity. It will be useful to highlight some of the epidemiological issues associated with this disease. Obesity is intertwined between public health issues, increased risk of morbidity and mortality, rising health care costs and expensive treatment options, social stigma, and internal psychological challenges--clearly no easy answers as to how to treat this health dilemma. Even with all of the challenges, bariatric surgery certainly offers a viable option for patients to get their health back, and more important, their lives back.

Lap-band failures: conversion to gastric bypass and their preliminary outcomes

BACKGROUND

The LAP-BAND is designed to be an adjustable laparoscopically placed gastric restriction device for the treatment of severe obesity. The purpose of this study was to assess the outcome in patients who had failed to effectively lose weight with this device and were converted to a gastric bypass.

METHODS

A retrospective chart review was performed of all LAP-BANDS placed in patients at our institution from March 1996 to June 1998.

RESULTS

36 LAP-BANDS were placed. To date, 18 of 36 (50%) have been removed. Fourteen of 18 were simultaneously converted to a gastric bypass. Indications for conversion included: failed weight loss (5), failed weight loss with esophageal dilatation (5), failed weight loss with leaking band (2), and symptomatic esophageal dilatation (1). Median time to conversion after LAP-BAND placement was 38.2 months. Median follow-up after conversion to gastric bypass was 8.3 months. Nineteen percent excess weight loss occurred after LAP-BAND placement. Forty-three percent excess weight loss occurred after conversion to gastric bypass (P =.025).

CONCLUSIONS

In our experience, the LAP-BAND is associated with a high frequency of inadequate weight loss. Conversion to gastric bypass in this subset of patients is technically challenging but results in superior weight loss in a shorter time period.

[Evaluation of laparoscopic bariatric surgery using the BAROS score]

AIM OF THE STUDY

Mid-term assessment of laparoscopic adjustable silicon gastric banding (Lap-Band) by a specific score.

PATIENTS AND METHODS

One hundred consecutive patients received by mail 12 to 54 months after laparoscopic adjustable gastric banding a questionnaire including the Bariatric Analysis and Reporting Outcome System (BAROS) which is the only specific and validated instrument for measuring the quality of life after bariatric surgery. This score includes five categories of results (failure, fair, good, very good, excellent). It uses three major fields: the quality of life, excess weight loss, and medical comorbidities evaluation.

RESULTS

Seventy three patients answered back with a mean follow up of 24.6 +/- 10 months. Forty six (2/3) had lost more than 50% of their weight excess. Sixty six experienced an improvement of their medical conditions following surgery. Final results were good or excellent for 60 patients (82% of those who answered back). Failure was reported in 7 patients (2 "sweet eaters" and 2 pouch dilatations) which needed a surgical treatment.

CONCLUSION

This evaluation based on the BAROS confirms its validation in France and the good mid-term results of bariatric surgery based on the Lap-Band.

Quality of life and obesity

Interest in the quality of life of patients with different diseases continues to grow. Recent years have witnessed a dramatic rise in the prevalence of obesity worldwide, stimulating interest in the health and quality of life consequences of this phenomenon. The body of research on the quality of life of obese individuals has grown to a point that a review of this literature is warranted. Numerous studies have demonstrated that obese persons experience significant impairments in quality of life as a result of their obesity, with greater impairments associated with greater degrees of obesity. Weight loss has been shown to improve quality of life in obese persons undergoing a variety of treatments. Further research is needed to clarify whether quality of life differs among subsets of obese persons. Until recently, there has been little standardization of quality of life measures in obesity. The SF-36 has been used in a number of studies of obese persons. Several obesity-specific instruments have also been developed and have shown great promise. The quality of life of obese individuals is an important issue that should be included in weight management treatment and research.

Quality of life following laparoscopic gastric banding in patients with morbid obesity

In a prospective study of 188 patients with morbid obesity, the time-dependent changes in the quality of life of individual patients were analyzed following laparoscopic gastric banding (LGB). These 188 patients (148 females and 40 males; age 19 to 59 years; body mass index 33 to 72 kg/m(2)) underwent evaluation of the LGB according to a strict protocol that included psychological testing using standardized instruments, detailed medical evaluation, upper gastrointestinal function studies, and evaluation of quality of life using the Gastrointestinal Quality of Life Index (GIQLI). Following this evaluation, 73 patients (57 females and 16 males; age 37 years [range 19 to 59 years]; body mass index 48 kg/m(2) [range 37 to 72 kg/m(2)]) underwent LGB and were followed up for 2 years focusing on weight loss, postoperative morbidity, weight-related comorbidity, and quality of life. The results demonstrate that LGB is well able to allow for a significant loss of excess weight and a significant improvement in patients' quality of life, both after a rather short period of time after surgery and at a continuous rate throughout the follow-up. The price for this success that was found in approximately 90% of patients is a complication rate of 38%; 85% of these patients, almost one third of all patients, must undergo some type of revision surgery. However, once the complications are resolved, these patients achieve the same level of weight loss and improvement in quality of life as patients with an uncomplicated postoperative course.