Outcomes on quality of life, weight loss, and comorbidities after Roux-en-Y gastric bypass

Impact of Body-contouring Surgery Post Bariatric Surgery on Patient Well-being, Quality of Life, and Body Image: Saudi Arabia-based Cross-sectional Study

Background

Body-contouring surgery is commonly performed to address functional and aesthetic issues that can arise following bariatric surgery. However, there is limited understanding of the psychological impact of this procedure on Saudi Arabian patients who have undergone bariatric surgery. This study aimed to explore the effects of body-contouring surgery on the psychological well-being, quality of life, and body image of individuals who have undergone bariatric surgery.

Methods

This cross-sectional study assessed the psychological impact of body-contouring surgery by measuring levels of depression and generalized anxiety disorder using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) scale, respectively.

Results

The study included a total of 227 participants, with 112 (49.3%) undergoing body-contouring surgery. Among the entire sample, 77.5% experienced excess skin folds following bariatric surgery. The prevalence of depression was 6% in the body-contouring group, lower than the 8% observed in the non-body-contouring group (P = 0.073). Notably, anxiety was significantly lower in the body-contouring group, with a prevalence of 4% compared with 6% in the non-body-contouring group (P = 0.006). Additionally, patients who had undergone body-contouring surgery reported higher scores for emotional well-being when compared with those who had not undergone body-contouring (P = 0.011).

Conclusions

The study suggests that body-contouring surgery improves the physical appearance of bariatric-surgery patients and reduces anxiety and depression, leading to improved psychological well-being. Further research, including larger and more diverse populations, such as multicenter studies at a regional or international level, is needed to validate these findings.

Postoperative 4-Year Outcomes in Septuagenarians Following Bariatric Surgery

BACKGROUND

Bariatric surgery is the most effective treatment for obesity; however, its utilization in older patients remains low. There is a dearth of literature on long-term effectiveness and safety of bariatric surgery in septuagenarian patients. The aim of this study was to compare the short- and long-term outcomes of bariatric surgery in this population.

METHODS

Patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) at our institution between 2011 and 2015 were included. Patients were divided into two age groups: < 70 and ≥ 70 years. Outcomes included postoperative hospital length of stay (LOS), 30-day complications, up to 4-year complications, 90-day mortality, comorbidity resolution, and 4-year weight loss (BMI change-ΔΒΜΙ). The groups were also compared using multivariable analyses adjusting for potential confounders (gender, preoperative BMI, and type of procedure).

RESULTS

Twenty-nine septuagenarians who underwent 21 LRYGB (72.4%) and 8 LSG (27.6%) were compared to 1016 patients aged < 70 years operated on during the same time period. Additionally, following the multivariable analyses, the septuagenarians had higher LOS (3 vs 2.3 days, p = 0.01), 4-year complications (38% vs 23%, p = 0.012), and less comorbidities' resolution but similar 4-year ΔBMI (- 8.6 vs - 10, p = 0.421), and 30-day complications (10% vs 6%, p = 0.316).

CONCLUSION

Bariatric surgery in carefully selected septuagenarians can be accomplished with acceptable safety and comparable postoperative weight loss at 4 years. Surgeons may consider broadening their selection criteria to include this patient subgroup but may allow the patients to reap its benefits if offered earlier in life.

Differences in Health-Related Quality of Life After Gastric Bypass Surgery: a Cross-Sectional Study

BACKGROUND

Gastric bypass (GBP) is a surgical method with good evidence of sustainable weight loss, reduced obesity-related comorbidities, and improved health-related quality of life (HRQoL). However, long-term data post-GBP is scarce on HRQoL related to other factors than weight loss, such as impact of socio-economic, age, and gender.

AIM

To investigate long-term HRQoL in GBP patients.

METHODS

The study was conducted as a cross-sectional study covering 3 to 9 years post-GBP measuring HRQoL using RAND-36. Association to weight loss, time since surgery, gender, educational level, occupation, and age was analyzed. The participants were included on the basis that they had received a GBP that was performed by Region Skåne, the southernmost administrative healthcare region in Sweden. Recruitment to the study was by mail invitation for an online survey.

RESULTS

Of the total population of 5310 persons receiving the questionnaire, 1339 of the 1372 responders fulfilled the inclusion criteria. Those with low educational level, unemployed, persons on sick leave or disability support, and those with less weight loss reported the lowest HRQoL. The longer time since surgery, the lower the HRQoL.

CONCLUSION

Less weight loss, longer time since GBP, lower educational level, and lower degree of employment all affect HRQoL negatively after GBP surgery.

Adherence to Mediterranean Diet or Physical Activity After Bariatric Surgery and Its Effects on Weight Loss, Quality of Life, and Food Tolerance

OBJECTIVE

To assess whether a healthy dietary pattern or physical activity after bariatric surgery mediates the effects of surgery on weight loss, the quality of life, or food tolerance.

METHODS

A prospective observational study conducted in the context of a randomized controlled trial. We assessed the extent to which increasing or decreasing adherence to the Mediterranean diet (MedDiet)-assessed by MEDAS (Mediterranean Diet Adherence Screener)-and of increasing or decreasing physical activity (PA)-assessed with the Short Questionnaire of International PA (IPAQ-Short Q)-after bariatric surgery affected changes in weight, body mass index (BMI), quality of life (Moorehead-Arlet Questionnaire), and food tolerance (Suter test). Assessments were recorded at baseline and quarterly up to 12 months of surgery.

RESULTS

Seventy-eight morbidly obese participants undergoing bariatric surgery were assessed up to 1 year after surgery. Those individuals who increased adherence to MedDiet showed a significantly higher mean of total weight loss percentage than those who decreased or maintained their adherence during follow-up: 37.6% (35.5-39.8) versus 34.1% (31.8-36.5) (p = 0.036). No significant differences were observed in changes in weight or BMI comparing individuals who increased their PA versus those who maintained or decreased PA, nor in quality of life or food tolerance between those individuals who increased versus those who decreased adherence to MedDiet or PA during the follow-up.

CONCLUSIONS

After bariatric surgery, morbidly obese subjects present greater weight loss if they adhere to the MedDiet. PA after surgery is not associated with the magnitude of weight loss nor the quality of life and tolerance to diet.

REPERCUSSÕES DA CIRURGIA BARIÁTRICA SOBRE PARÂMETROS METABÓLICOS. EXPERIÊNCIA DE 15 ANOS EM HOSPITAL DE MACEIÓ - BRASIL

RESUMO - RACIONAL: A obesidade é caracterizada pelo acúmulo excessivo de gordura corporal prejudicial à saúde e nos últimos anos tem crescido significativamente na maioria dos países. A cirurgia bariátrica deverá ser recomendada para pacientes obesos que não obtiveram êxito no tratamento clínico e após análise da equipe multiprofissional. Objetivo: comparar os resultados metabólicos, perda ponderal e parâmetros associados à obesidade no pré e pós-operatório dos pacientes submetidos à cirurgia bariátrica. Métodos: estudo retrospectivo, descritivo, transversal, de abordagem quantitativa através da consulta a prontuários. Os dados foram coletados no período de maio a setembro de 2020, de indivíduos submetidos à cirurgia bariátrica no período de 15 anos (2003 a 2018). Foi realizada análise estatística comparativa e descritiva das variáveis antropométricas, metabólicas, bioquímicas e morbidades associadas. Resultados: a maioria era do sexo feminino (68,50%). Em ambos os sexos a maior prevalência se encontravam na faixa etária de 30 a 39 anos e mais da metade tinha obesidade grau III. A técnica cirúrgica utilizada foi o gastroplastia em Y de Roux. Após 4 meses houve uma redução significativa do perfil lipídico, dos parâmetros antropométricos e enzimas hepáticas em ambos os sexos, os quais permaneceram em declínio no final do primeiro ano, com melhora acentuada da síndrome metabólica. Conclusões: O impacto positivo determinado pela gastroplastia na perda de peso, na redução do IMC e perfil lipídico é bastante relevante já após quatro meses, e se mantém após um ano da realização do procedimento, demonstrando benefícios na redução dos fatores de risco da síndrome metabólica.

Quality of Life One Year After Bariatric Surgery: the Moderator Role of Spirituality

BACKGROUND

This study aimed to assess quality of life in obese patients 1 year after bariatric surgery taking into consideration the influence of socio-demographic, clinical, and psychological variables.

METHODS

A sample of 90 patients undergoing bariatric surgery was assessed in two moments: before surgery and 1 year after surgery.

RESULTS

Social support, problem-focused coping strategies, and quality of life increased after surgery, while eating disorder behaviour and impulsiveness decreased. The presence of eating disorder behaviour predicted worse physical and mental quality of life and higher satisfaction with social support predicted better physical and mental quality of life. In addition, higher impulsiveness predicted worse mental quality of life. Spirituality moderated the relationship between impulsiveness and mental/physical quality of life.

CONCLUSIONS

Interventions should focus on promoting social support and coping strategies particularly spirituality since it played an important role in quality of life.

Factibilidade da gastrectomia vertical aberta no Sistema Único de Saúde

RESUMO Objetivo: analisar as características clínicas e epidemiológicas, as complicações pós-operatórias e a perda de peso em pacientes submetidos à gastrectomia vertical por via convencional, em uma instituição de saúde do Sistema Único de Saúde (SUS). Métodos: estudo transversal, longitudinal, retrospectivo realizado a partir da coleta de dados de prontuários para análise de variáveis em pacientes submetidos à gastrectomia vertical aberta, no SUS, no período de julho de 2013 a janeiro de 2017. Resultados: foram analisados 296 pacientes operados no período do estudo, dos quais 54% eram do sexo masculino; a média de idade foi de 39,9 anos ±11,4; o índice de massa corporal (IMC) médio no pré-operatório foi de 43,5kg/m² e no pós-operatório, de 30,3kg/m²; a perda de excesso de peso foi de 73,6%; 83,24% apresentaram uma perda de excesso de peso maior do que 50%; o IMC pré-operatório foi maior no grupo com perda de peso menor do que 50%. Observou-se uma taxa de complicações precoces com necessidade de internamento de 5,4% e um índice de mortalidade de 1%. Conclusão: a gastrectomia vertical aberta é uma técnica segura e eficaz para a perda de peso e que pode ser mais realizada no SUS. Dentre as variáveis avaliadas, o IMC prévio foi a única relacionada com o sucesso pós-operatório.

Perceived oral health in patients after bariatric surgery using oral health-related quality of life measures

Obesity is an increasing problem of the 21st century. A frequent intervention is bariatric surgery. The impact of bariatric surgery on oral health is largely unknown. The aim of the present case-control study was to survey the perceived oral health amongst individuals that had undergone bariatric surgery and compare the measures with two cohorts consisting of healthy individuals with respectively at or below versus above a body mass index score of 30. Study volunteers were recruited from interest group on the Internet. The study participants completed online a validated oral health-related quality of life scale, that is, OHIP-S. The three cohorts consisted of individuals that had undergone bariatric surgery (OS, n = 77) and the healthy obese (ONS, n = 45) and nonobese individuals (HNS, n = 71). Nonparametric Kruskal-Wallis rank sum tests were used to estimate likelihood of nondifference amongst the three cohorts. Individuals that had undergone bariatric surgery reported significant more oral health problems than the study participants in with the two other cohorts. Their perception of oral health-related quality of life was higher or similar to the obese study participants and lower than for nonobese study participants. Perceived oral health problems appear to be more frequent amongst individuals that have undergone bariatric surgery in comparison with healthy obese and nonobese individuals. Bariatric surgery may be consider a risk marker for impaired oral health.

Repercussões da cirurgia bariátrica na qualidade de vida, no perfil bioquímico e na pressão arterial de pacientes com obesidade mórbida

RESUMO A indicação da cirurgia bariátrica (CB) para perda de peso e redução de comorbidades associadas à obesidade é crescente. O objetivo do presente estudo foi analisar as repercussões da CB na qualidade de vida (QV), no perfil bioquímico e na pressão arterial (PA) de indivíduos obesos mórbidos em três momentos distintos: um mês antes, três meses depois e seis meses após a CB. Participaram da pesquisa 42 indivíduos com obesidade mórbida do programa de CB de um hospital da cidade de Juiz de Fora - MG, os quais foram aleatoriamente divididos em grupo intervenção (GI, n=21) e grupo controle (GC, n=21). O GI sofreu intervenção cirúrgica e o GC foi orientado a manter os afazeres diários usuais durante todo período do estudo, além de receberem acompanhamento nutricional. Foram avaliados a QV, o perfil bioquímico e a PA através do instrumento SF-36, do exame laboratorial de sangue obtido no prontuário dos pacientes e do esfigmomanômetro e estetoscópio, respectivamente. Os resultados demonstraram redução nas variáveis bioquímicas High-density lipoproteins (HDL), Low-density lipoproteins (LDL), Very Low-Density Lipoprotein (VLDL), colesterol, triglicerídeos, hemoglobina glicada, glicose, pressão arterial sistólica e pressão arterial diastólica no GI, após 6 meses de cirurgia. Houve melhora significativa nas variáveis relacionadas à QV, exceto nos aspectos emocionais. Conclui-se que a CB pode repercutir positivamente na maioria dos domínios da QV, na melhora do perfil bioquímico e na PA de pacientes obesos mórbidos após 3 e 6 meses de CB.

Evaluation of quality of life, weight loss and comorbidities of patients undergoing bariatric surgery

OBJECTIVE

to assess the efficacy of weight loss, the evolution of comorbidities, the quality of life and the BAROS protocol (Bariatric Analysis and Reporting Outcome System) in the postoperative period of patients undergoing bariatric surgery.

METHODS

we conducted a cross-sectional, quantitative study with 95% true strength (P=0.05), with 103 patients submitted to SLEEVE Vertical Gastrectomy (40) and Roux-en-Y Gastric Bypass (63), from four months after surgery. We carried out the research at the Ambulatory of General Surgery of the Clinics Hospital of the Federal University of Pernambuco, using the BAROS protocol.

RESULTS

the majority of the patients were female (89.3%). The mean age was 44.23 years. The mean percentage loss of excess weight was 69.35%. The mean postoperative follow-up time was 41.87 months (±37.35). The comorbidities with the highest percentage of resolution were sleep apnea (90.2%), diabetes (80.7%) and hypertension (70.8%). The most frequent complications were hair loss (79.6%), nutritional deficiency (37.9%) and anemia (35%). The BAROS protocol demonstrated that patients positively evaluated quality of life in 93.2% of the cases. The Moorehead-Ardelt questionnaire showed that quality of life "improved" or "improved greatly" for 94.1% of patients.

CONCLUSION

bariatric surgery has been shown to be an effective procedure in the treatment of morbid obesity and in the control of comorbidities. Quality of life analysis was evaluated positively through the BAROS protocol.

Patient-reported quality of life after bariatric surgery: a single institution analysis

BACKGROUND

Bariatric surgery is an effective weight loss and comorbidity treatment among severely obese patients. However, there are limited data describing its impact on patient-reported quality of life (QoL). We examined patient-reported QoL after bariatric surgery and analyzed variables associated with higher postoperative QoL.

METHODS

Patient demographics, comorbidities, and weight loss data were obtained from our institutional database for patients who underwent bariatric surgery from January 2010 to December 2012. QoL scores were obtained during preoperative and postoperative visits (2, 6, 12, 24, 52, and 104 wk) from the Moorehead-Ardelt Quality of Life Questionnaire II. Multivariable logistic regression was performed to generate odds ratios for variables hypothesized a priori to be associated with higher postoperative QoL.

RESULTS

A total of 209 patients were included in the study. Patients lost an average of 59.1% (±19.0) of excess body weight 1 y after surgery. One-year postoperative QoL scores were available for 42% of patients. Mean QoL scores improved from 0.82 preoperatively to 1.66 1 y postoperatively (P = 0.004). Patients scored higher in all individual areas of Moorehead-Ardelt Quality of Life Questionnaire II: self-esteem (0.22 versus 0.36), physical activity (0.11 versus 0.31), social life (0.28 versus 0.36), work ability (0.07 versus 0.22), sexual functioning (0.04 versus 0.16), and approach to food (0.11 versus 0.26; all P values <0.05). On multivariable analysis, higher QoL was associated with private insurance/self-pay versus Medicare (odds ratio 4.20 [95% confidence interval 1.39-12.68]).

CONCLUSIONS

Bariatric surgery patients experienced significant improvement in QoL 1 y after surgery. Identifying modifiable predictors of high QoL after bariatric surgery requires additional investigation.

Comparing quality of life outcomes between Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass using the RAND36 questionnaire

BACKGROUND

Obesity surgery is an effective treatment to improve the health of patients. There is a lack of data regarding weight loss surgery outcomes and effects on Quality of Life (QoL). This study aims to compare changes in QoL following either Laparoscopic Sleeve Gastrectomy (LSG) or Laparoscopic Roux-en-Y Gastric Bypass (LRYGB).

METHODS

SF36 questionnaires were mailed to all LSG and LRYGB patients who underwent surgery in 2013. Demographic data was obtained from hospital records. Statistical analysis was undertaken using Stats direct.

RESULTS

158 patients were sent postal questionnaires. 60 were returned (38%). 41 were women, 16 LSG, 44 LRYGB, mean age 52 years, mean BMI pre-surgery 41.0. Both procedures yielded similar weight loss over 2 year follow up (p = 0.01), and similar improvements in obesity related co-morbidities. These procedures yielded significant improvements in all QoL scales and domains other than the emotional role limitations scale following sleeve gastrectomy.

CONCLUSION

Bariatric surgery has been shown to improve a patient's QoL. More research is needed to explain the reasons why there was a difference between Sleeve and Bypass procedures in emotional changes to patients.

Comparison of the efficacy of standard bariatric surgical procedures on Saudi population using the bariatric analysis and reporting outcome system

OBJECTIVES

To  compare the efficacy of various standard bariatric surgical procedures using the Bariatric Analysis and Reporting Outcome System (BAROS). Methods: This is a prospective, descriptive analytical study conducted in 2 medical institutions in Saudi Arabia. A total of 270 patients who had different bariatric surgery during the period between March 2010 and December 2012 were included. The data was analyzed and scored against 3 outcomes, excess weight loss, cure or improvement of comorbidities, and quality of life changes. Results: All patients who had different bariatric procedures were included in our study. Seventy-nine (29.3%) underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP), 159 (58.9%) had laparoscopic sleeve gastrectomy (LSG), and 32 (11.9%) had laparoscopic adjustable gastric banding (LAGB). Complete remission of at least one comorbidity was reported in 36% of LRYGBP, 51% in LSG, and 42% in LAGB. While all other patients have improved comorbidities. The BAROS score was good or higher in 78.5% of LRYGBP, 83.6% for the LSG, and 84.4% of LAGB patients. The average excess weight loss was 67.9% in LRYGBP, 75.8% in LSG, and 81.7% LAGB patients. Conclusion: Bariatric surgery provides a substantial reduction in excess weight, improvement and cure of comorbidities, and improvement in quality of life. Standard bariatric procedures have different degrees of outcomes that can be beneficial in selecting appropriate procedure for appropriate indications and patients.

Preoperative multidisciplinary program for bariatric surgery: a proposal for the Brazilian Public Health System

ABSTRACT BACKGROUND Bariatric surgery has become the gold standard treatment for morbid obesity, but access to surgery remains difficult and low compliance to postoperative follow-up is common. To improve outcomes, enable access and optimize follow-up, we developed a multidisciplinary preoperative approach for bariatric surgery. OBJECTIVE To determine the impact of this program in the outcomes of bariatric surgery in the Brazilian public health system. METHODS A prospective evaluation of the individuals who underwent a preoperative multidisciplinary program for bariatric surgery and comparison of their surgical outcomes with those observed in the prospectively collected historical database of the individuals who underwent surgery before the beginning of the program. RESULTS There were 176 individuals who underwent the multidisciplinary program and 226 who did not. Individuals who underwent the program had significantly lower occurrence of the following variables: hospital stay; wound dehiscence; wound infection; pulmonary complications; anastomotic leaks; pulmonary thromboembolism; sepsis; incisional hernias; eventrations; reoperations; and mortality. Both loss of follow-up and weight loss failure were also significantly lower in the program group. CONCLUSION The adoption of a comprehensive preoperative multidisciplinary approach led to significant improvements in the postoperative outcomes and also in the compliance to the postoperative follow-up. It represents a reproducible and potentially beneficial approach within the context of the Brazilian public health system.

Validation of a new method for the endoscopic measurement of post-bariatric gastric outlet using a standard guidewire: an observer agreement study

Background and aims

Between 10 and 20% of all patients undergoing bariatric surgery procedures regain weight secondary to a gastrojejunostomy enlargement. The aim of this study was to validate the interobserver agreement while measuring gastric outlet diameters using a new standard guidewire.

Methods

We selected thirty-five videos of consecutive endoscopic procedures on patients undergoing esophagogastroduodenoscopy after a Roux-en-Y gastric bypass procedure. All videos were evaluated by four raters: two expert endoscopists and two trainees. We excluded videos having a slipped Fobi ring or a strictured gastric outlet. Anastomosis diameter was measured using a novel device with standardized markings on a guidewire (Hydra jagwire, Boston Scientific, Natick. MA) as well as the current gold standard defined as a calibrated endoscopic measuring instrument (Olympus America, Center Valley, PA).

Results

We obtained 272 measurements of the gastric outlet. Overall agreement measured through intra-class correlation coefficients for the gold standard was 0.84 (p < 0.01) and 0.83 (p < 0.01) for the new guidewire. Agreement among experts was 0.699 (p < 0.01), while among trainees it was 0.822 (p < 0.01).

Conclusion

The new guidewire demonstrated a high degree of observer reliability, also presenting similar results between expert endoscopists and trainees.

Glucagon-like peptide 1 in the pathophysiology and pharmacotherapy of clinical obesity

Though the pathophysiology of clinical obesity is undoubtedly multifaceted, several lines of clinical evidence implicate an important functional role for glucagon-like peptide 1 (GLP-1) signalling. Clinical studies assessing GLP-1 responses in normal weight and obese subjects suggest that weight gain may induce functional deficits in GLP-1 signalling that facilitates maintenance of the obesity phenotype. In addition, genetic studies implicate a possible role for altered GLP-1 signalling as a risk factor towards the development of obesity. As reductions in functional GLP-1 signalling seem to play a role in clinical obesity, the pharmacological replenishment seems a promising target for the medical management of obesity in clinical practice. GLP-1 analogue liraglutide at a high dose (3 mg/d) has shown promising results in achieving and maintaining greater weight loss in obese individuals compared to placebo control, and currently licensed anti-obesity medications. Generally well tolerated, provided that longer-term data in clinical practice supports the currently available evidence of superior short- and long-term weight loss efficacy, GLP-1 analogues provide promise towards achieving the successful, sustainable medical management of obesity that remains as yet, an unmet clinical need.

ENDOSCOPIC SLEEVE GASTROPLASTY - MINIMALLY INVASIVE THERAPY FOR PRIMARY OBESITY TREATMENT

Background

Less invasive and complex procedures have been developed to treat obesity. The successful use of Endoscopic Sleeve Gastroplasty using OverStitch(r) (Apollo Endosurgery, Austin, Texas, USA) has been reported in the literature.

Aim

Present technical details of the procedure and its surgical/ endoscopic preliminary outcome.

Method

The device was used to perform plications along the greater curvature of the stomach, creating a tubulization similar to a sleeve gastrectomy.

Result

A male patient with a BMI of 35.17 kg/m2 underwent the procedure, with successful achievement of four plications, and preservation of gastric fundus. The procedure was successfully performed in 50 minutes, time without bleeding or other complications. The patient presented mild abdominal pain and good acceptance of liquid diet.

Conclusions

The endoscopic gastroplasty procedure was safe, with acceptable technical viability, short in duration and without early complications.

[The profile of patients undergoing bariatric surgery in the Brazilian Unified National Health System: a systematic review]

Nearly one million Brazilians were morbidly obese in 2013. Bariatric surgery is an option for sustained weight loss, and the Brazilian Unified National Health System (SUS) had provided 50,000 such procedures as of 2014. The SUS database does not provide anthropometric and comorbidity data on these patients, so the aim of the current study was to perform a systematic review to assess the profile of SUS patients that underwent bariatric surgery from 1998 to 2014. The MEDLINE, LILACS, SciELO, and Scopus databases were searched, and the methodological quality of the included articles was assessed. Of the 1,591 identified studies, 39 were selected, 95% of which were observational. Patients had a mean age of 41.4 years and mean body mass index of 48.6kg/m2; 21% were males, 61% hypertensive, 22% diabetics, and 31% presented sleep apnea. When compared to international study samples, SUS patients showed similar a anthropometric profile and comorbidities but higher prevalence of hypertension. The studies' low methodological quality suggests caution in interpreting the results.

Assessment of bariatric surgery results

The objective was to evaluate the results of bariatric surgery in patients in the late postoperative period using the Bariatric Analysis and Reporting Outcome System (BAROS). This cross-sectional study was conducted from November 2011 to June 2012 at a hospital in the state of Ceará, Brazil. Data were collected from 92 patients using the BAROS protocol, which analyzes weight loss, improved comorbidities, complications, reoperations and Quality of Life (QoL). Data were analysed using the chi-squared test, Fischer's exact test and the Mann-Whitney test. There was a reduction in the Body Mass Index (47.2 ± 6.8 kg/m2 in the pre-operatory and 31.3 ± 5.0 kg/m2 after surgery, p< 0.001). The comorbidity with the highest resolution was arterial hypertension (p<0.001), and QV improved in 94.6% of patients. The main complications were hair loss, incisional hernia and cholelithiasis. The surgery provided satisfactory weight loss and improvements in the comorbidities associated to a better QL. Use of the BAROS protocol allows nurses to plan interventions and maintain the good results.

BARIATRIC SURGERY IN THE ELDERLY: RESULTS OF A MEAN FOLLOW-UP OF FIVE YEARS

BACKGROUND

Surgical treatment of obesity in the elderly, particularly over 65, remains controversial; it is explained by the increased surgical risk or the lack of data demonstrating its long-term benefit. Few studies have evaluated the clinical effects of bariatric surgery in this population.

AIM

To evaluate the results of surgical treatment of obesity in patients over 60 years, followed for an average period of five years.

METHOD

This was a retrospective study evaluating 46 patients, 60 years or older, who underwent surgical treatment of obesity, by conventional gastric bypass technique (laparotomy). The average age was 64 years (60-71), mean BMI of 49.6 kg/m2 (38-66), mean follow-up of 5.9 years; 91% of patients were hypertensive, 56% diabetics and 39% had dyslipidemia.

RESULTS

The incidence of complications (major and minor) in patients under 65 years was 26% and over 65 years 37% (p=0.002). There were no deaths in the group with less than 65 years and there were two deaths (12.5%) over 65 years. The average loss of overweight over 65 years or less was 72% vs 68% (p=0.56). There was total control of the diabetes mellitus in 77% and partial in 23%, with no difference between groups. There was improvement in arterial hypertension in 56% of patients, also no difference between groups. The average LDL levels did not differ between the pre and postoperative (106 mg/dl to 102 mg/dl), an increase of HDL (56 mg/dl to 68 mg/dL) and reduced triglyceride levels (136 mg/dl to 109 mg/dl). There was no statistical difference in the variation of the cholesterol fractions and triglycerides between the groups. Two patients in the group with less than 65 years died in late follow-up, of brain tumor and pneumonia, three and five years after bariatric surgery, respectively.

CONCLUSIONS

Surgical morbidity and mortality were higher in patients over 65 years, and this group had the same benefits observed in patients lower 65 years for weight loss and comorbidities control.