Quality of Life After Laparoscopic Adjustable Gastric Banding Using the Baros and Moorehead-Ardelt Quality of Life Questionnaire II

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Abstract

Objectives:

The goal of weight reduction surgery is not only to decrease excess weight, but also to improve obesity related comorbidities and quality of life (QoL). Until now, few studies have utilized objective methods to evaluate all of these issues. Hereafter, using the newly developed Moorehead-Ardelt Quality of Life Questionnaire II (M-A QoLQ II) incorporated into the Bariatric Analysis and Reporting Outcome System (BAROS), we report our results for patients undergoing laparoscopic adjustable gastric banding (LAGB).

Methods:

M-A QoLQ II questionnaires were sent to patients undergoing LAGB at a single institution. Nonresponders were contacted by a second mailing and telephone calls. The respondents’ data were scored according to BAROS guidelines.

Results:

Data from 67 patients with a mean follow-up of 27 months (22–35) were analyzed. Mean age was 43.8 years (range, 21 to 68) with a mean preoperative body mass index (BMI) of 49.8 kg/m ² (range, 38.4 to 67.7). Mean postoperative BMI was 37.1 kg/m ² (range, 23.0 to 53.4) for a mean excess weight loss (EWL) of 53.2% (range, −7.5% to 108.6%). According to the BAROS scoring system, 8 patients (12%) were classified as failures, 13 patients (19%) had fair, 24 (36%) had good, 13 (19%) had very good, and 9 (13%) had excellent results. There was considerable improvement in patient's comorbidities, and positive scores for self-esteem, and activity level.

Conclusions:

The use of the M-A QoLQ II is an efficient method of assessing the success of bariatric surgery. Widespread use of the questionnaire would assist in standardizing reporting of results following bariatric surgery.

Our results suggest that LAGB may lead to excellent results with regards to resolution of comorbidities, improvement in QoL, and overall weight loss.

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Most cited references 18

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Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs.

My-Linh T. Nguyen, S Lee, Brent B Wolfe … (2001)

To compare outcomes, quality of life (QOL), and costs of laparoscopic and open gastric bypass (GBP). Laparoscopic GBP has been reported to be a safe and effective approach for the treatment of morbid obesity. The authors performed a prospective randomized trial to compare outcomes, QOL, and costs of laparoscopic GBP with those of open GBP. From May 1999 to March 2001, 155 patients with a body mass index (BMI) of 40 to 60 kg/m2 were randomly assigned to undergo laparoscopic (n = 79) or open (n = 76) GBP. The two groups were similar in age, sex ratio, mean BMI, and comorbidities. Main outcome measures included operative time, estimated blood loss, length of hospital stay, operative complications, percentage of excess body weight loss, and time to return to activities of daily living and work. Changes in QOL were assessed using the SF-36 Health Survey and the bariatric analysis of reporting outcome system (BAROS). Operative and hospital costs of the two operations were also compared. There were no deaths in either group. Mean operative time was longer for laparoscopic GBP than for open GBP, but operative blood loss was less. Two (2.5%) of the 79 patients in the laparoscopic group required conversion to laparotomy. Median length of hospital stay was shorter for laparoscopic GBP patients (3 vs 4 days). The rate of postoperative anastomotic leak was similar between groups. Wound-related complications such as infection (10.5 vs 1.3%) and incisional hernia (7.9 vs 0%) were more common after open GBP; late anastomotic stricture was less frequent after open GBP (2.6 vs 11.4%). Time to return to activities of daily living and work were shorter after laparoscopic GBP than after open GBP. Weight loss at 1 year was similar between groups. Preoperative SF-36 scores were similar between groups; however, at 1 month after surgery, laparoscopic patients had better physical conditioning, social functioning, general health, and less body pain than open GBP patients. At 6 months, the BAROS outcome was classified as good or better in 97% of laparoscopic GBP patients compared with 82% of open GBP patients. Operative costs were higher for laparoscopic GBP patients, but hospital costs were lower. Laparoscopic GBP is a safe and cost-effective alternative to open GBP. Despite a longer operative time, patients undergoing laparoscopic GBP benefited from less blood loss, a shorter hospital stay, and faster convalescence. Laparoscopic GBP patients had comparable weight loss at 1 year but a more rapid improvement in QOL than open GBP patients. The higher initial operative costs for laparoscopic GBP were adequately offset by the lower hospital costs.

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Gastrointestinal Surgery for Severe Obesity.

Hubbard, Hall (1991)

The National Institutes of Health Consensus Development Conference on Gastrointestinal Surgery for Severe Obesity brought together surgeons, gastroenterologists, endocrinologists, psychiatrists, nutritionists, and other health care professionals as well as the public to address the nonsurgical treatment options for severe obesity, the surgical treatments for severe obesity and the criteria for selection, the efficacy and risks of surgical treatments for severe obesity, and the need for future research on and epidemiological evaluation of these therapies. Following 2 days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel recommended that 1) patients seeking therapy for severe obesity for the first time should be considered for treatment in a nonsurgical program with integrated components of a dietary regimen, appropriate exercise, and behavioral modification and support, 2) gastric restrictive or bypass procedures could be considered for well-informed and motivated patients with acceptable operative risks, 3) patients who are candidates for surgical procedures should be selected carefully after evaluation by a multidisciplinary team with medical, surgical, psychiatric, and nutritional expertise, 4) the operation be performed by a surgeon substantially experienced with the appropriate procedures and working in a clinical setting with adequate support for all aspects of management and assessment, and 5) lifelong medical surveillance after surgical therapy is a necessity. The full text of the consensus panel's statement follows.

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Bariatric analysis and reporting outcome system (BAROS)

Horacio Oria, S Moorehead (1998)

The lack of standards for comparison of results was identified by the NIH Consensus Conference panelists as one of the key problems in evaluating reports in the surgical treatment of severe obesity. The analysis of outcomes after bariatric surgery should include weight loss, improvement in comorbidities related to obesity, and quality-of-life (QOL) assessment. Definitions of success and failure should be established and the presentation of results standardized. A survey among experienced bariatric surgeons was conducted to study the reporting of results. The concept of evaluating outcomes by using a scoring system was introduced in 1997 and has now been refined further. Psychologists with expertise in bariatrics were asked to recommend a disease-specific instrument to analyze QOL after surgery. The system defines five outcome groups (failure, fair, good, very good, and excellent), based on a scoring table that adds or subtracts points while evaluating three main areas: percentage of excess weight loss, changes in medical conditions, and QOL. To assess changes in QOL after treatment, this method incorporates a specifically designed patient questionnaire that addresses self-esteem and four daily activities. Complications and reoperative surgery deduct points, thus avoiding the controversy of considering reoperations as failures. The Bariatric Analysis and Reporting Outcome System (BAROS) analyzes outcomes in a simple, objective, unbiased, and evidence-based fashion. It can be adapted to evaluate other forms of medical intervention for the control of obesity. This method should be considered by international organizations for the adoption of standards for the outcome assessment of bariatric treatments, and for the comparison of results among surgical series. These standards could also be used to compare the long-term effects of surgery with nonoperative weight loss methods.

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Author and article information

Contributors

Jonathan A. Myers

James C. Clifford

Sharfi Sarker

Margaret Primeau

Gretchen L. Doninger

Vafa Shayani

Journal

Journal ID (nlm-ta): JSLS

Journal ID (iso-abbrev): JSLS

Journal ID (hwp): jsls

Journal ID (pmc): jsls

Journal ID (publisher-id): JSLS

Title: JSLS : Journal of the Society of Laparoendoscopic Surgeons

Publisher: Society of Laparoendoscopic Surgeons (Miami, FL )

ISSN (Print): 1086-8089

ISSN (Electronic): 1938-3797

Publication date (Print): Oct-Dec 2006

Publication date PMC-release: Oct-Dec 2006

Volume: 10

Issue: 4

Pages: 414-420

Affiliations

Rush University Medical Center, Department of Surgery, Chicago, Illinois, USA.

Loyola University Medical Center, Department of Surgery, Maywood, Illinois, USA.

Department of Psychiatry and Behavioral Neurosciences, Maywood, Illinois, USA.

Loyola University Medical Center, Department of Surgery, Maywood, Illinois, USA.

Author notes

Address reprint requests to: Vafa Shayani, MD, Loyola University Medical Center, Department of Surgery, 2160 South First Ave, Maywood, IL 60543, USA.

Article

PMC ID: 3015739

PubMed ID: 17575749

SO-VID: 08485667-1e35-4dbb-adae-afddedd88f8c

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.

Quality of Life After Laparoscopic Adjustable Gastric Banding Using the Baros and Moorehead-Ardelt Quality of Life Questionnaire II

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Abstract

Objectives:

Methods:

Results:

Conclusions:

Related collections

Asian Journal of Quality of Life (AjQoL)

Most cited references 18

Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs.

Gastrointestinal Surgery for Severe Obesity.

Bariatric analysis and reporting outcome system (BAROS)

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