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      QUALITY OF LIFE AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY USİNG BAROS SYSTEM Translated title: QUALIDADE DE VIDA APÓS GASTRECTOMIA VERTICAL LAPAROSCÓPICA USANDO O SISTEMA BAROS

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          ABSTRACT

          Background:

          Laparoscopic sleeve gastrectomy (LSG) is currently the most frequently performed bariatric procedure in Turkey. 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).

          Aim:

          To evaluate the impact of LSG on patient quality of life, weight loss, and comorbidities associated with morbid obesity according to the updated BAROS criteria.

          Methods:

          Eleven hundred thirty-eight adult patients were undergone to LSG by our bariatric surgery team between January 2013 and January 2016. A questionnaire (The Bariatric Analysis and Reporting Outcome System - BAROS) was published on social media. The data on postoperative complications were collected from hospital database.

          Results:

          Number of respondants was 562 (49.4%). Six of 1138 patients(0.5%) had leakage. All patients who had leakage were respondants. The overall complication rate was 7.7%. After a mean period of 7.4±5.3 months(1-30), mean excess weight loss was 71.3±27.1% (10.2-155.4). The respondants reported 772 comorbidities. Of these, 162 (30%) were improved, and 420 (54.4%) were resolved. The mean scores for QoL were significantly increased after LSG (range, p<0.05 to <0.001). Of the 562 patients, 26 (4.6%) were classified as failures; 86 (15.3%) fair; 196 (34.9%) good; 144 (25.6%) very good, and 110 (19.6%) excellent results according to the updated BAROS scoring system.

          Conclusion:

          LSG is a highly effective bariatric procedure in the manner of weight control, improvement in comorbidities and increasing of QoL in short- and mid-term.

          RESUMO

          Racional:

          A gastrectomia vertical laparoscópica (LSG) é atualmente o procedimento bariátrico mais frequentemente realizado na Turquia. O objetivo da operação de redução de peso não é apenas diminuir o excesso de peso, mas também melhorar as comorbidades e a qualidade de vida relacionadas à obesidade (QoL).

          Objetivo:

          Avaliar o impacto do LSG na qualidade de vida dos pacientes, perda de peso e comorbidades associadas à obesidade mórbida de acordo com os critérios BAROS atualizados.

          Métodos:

          Estudo não-randomizado de intervenção comportamental e de saúde pública. Um total de 1138 pacientes adultos foram submetidos a LSG entre janeiro de 2013 e janeiro de 2016. Um questionário (The Bariatric Analysis and Reporting Outcome System - BAROS foi utilizado. Os dados sobre complicações pós-operatórias foram coletados do banco de dados hospitalar.

          Resultados:

          Responderam ao questionário 562 (49,4%) pacientes. Seis de 1138 pacientes (0,5%) tiveram deiscência e todos estes responderam a pesquisa. A taxa geral de complicações foi de 7,7%. Após período médio de 7,4±5,3 meses (1-30), a perda média de excesso de peso foi de 71,3±27,1% (10,2-155,4). Os questionados relataram 772 comorbidades. Destes, 162 (30,0%) foram melhorados e 420 (54,4%) foram resolvidos.Os escores médios de QoL foram significativamente aumentados após LSG (p<0,05 a <0,001). Dentre os resultados dos 562 pacientes, 26 (4,6%) foram classificadas como falhas; 86 (15,3%) regular; 196 (34,9%) bom;144 (25,6%) muito bom; e 110 (19,6%) excelente de acordo com para o sistema de pontuação BAROS atualizado.

          Conclusão:

          O LSG é procedimento bariátrico altamente efetivo para controle de peso, melhora nas comorbidades e aumento da QoL em curto e meio prazos.

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          Most cited references15

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          Weight loss, weight regain, and conversions to Roux-en-Y gastric bypass: 10-year results of laparoscopic sleeve gastrectomy.

          With promising short-term results, laparoscopic sleeve gastrectomy (SG) has become the second most frequently performed bariatric procedure worldwide. Aside from a growing number of reports covering up to 10 years of follow-up, only limited data have been published so far on long-term results.
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            Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss.

            This retrospective study evaluated long-term weight loss, resolution of comorbidities, quality of life (QoL), and food tolerance after laparoscopic sleeve gastrectomy (LSG). Between January 2003 and July 2008, 102 patients underwent LSG as a sole bariatric operation. A retrospective review of a prospectively collected database was performed. Demographics, complications, and percentage of excess weight loss (%EWL) were determined. Quality of life was measured using Medical Outcomes Survey Short Form 36 (SF-36) and Bariatric Analysis and Reporting Outcome System (BAROS) questionnaires, which were sent to all patients. The food tolerance score (FTS) was determined and compared with that of nonobese subjects. A total of 83 patients (81.4%) were eligible for follow-up evaluation. Their mean initial body mass index (BMI) was 39.3 kg/m(2). No major complications occurred. At a median follow-up point of 49 months (range, 17-80 months), the mean %EWL was 72.3% ± 29.3%. For the 23 patients who reached the 6-year follow-up point, the mean %EWL was 55.9% ± 25.55%. The mean BAROS score was 6.5 ± 2.1, and a "good" to "excellent" score was observed for 75 patients (90.4%). In the comparison of patients with a %EWL greater than 50% and those with a %EWL of 50% or less, the SF-36 scores were statistically different only for "physical functioning" and "general health perception." The mean FTS was 23.8, and 95.2% of the patients described their food tolerance as acceptable to excellent. Laparoscopic sleeve gastrectomy is a safe and effective bariatric procedure, although a tendency for weight regain is noted after 5 years of follow-up evaluation. Resolution of comorbidity is comparable with that reported in the literature. The LSG procedure results in good to excellent health-related QoL. Food tolerance is lower for patients after LSG than for nonobese patients who had no surgery, but 95.2% described food tolerance as acceptable to excellent.
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              Updated Bariatric Analysis and Reporting Outcome System (BAROS).

              The Bariatric Analysis and Reporting Outcome System (BAROS) evaluates the results of obesity treatments by analyzing 3 domains: weight loss, changes in co-morbidities, and quality of life. Up to 3 points are allowed for each, and points are deducted for complications and reoperations. The final score classifies the results in 5 outcome groups, providing an objective definition of success or failure. This report describes refinements to the original instrument. The system has been used in many countries since the late 1990s. Feedback from its users and additional research prompted some changes. The quality of life questionnaire was tested in clinical practice in United States and Austria, which led to improvements. It was later compared with other instruments for validity and reliability using a group of 110 gastric bypass patients. The updated BAROS includes the percentage of excess body mass index loss, new criteria for the diagnosis of diabetes, and clarifies the concept of its "improvement." The wording and drawings in the quality-of-life questionnaire were modified. A sixth question, analyzing eating behavior, was added, and the scoring key was changed to a 10-point Likert scale, creating the Moorehead-Ardelt Quality of Life Questionnaire II. The new instrument correlated significantly with the Medical Outcomes Study Short Form 36-item Health Survey, the Beck Depression Inventory II, and the Stunkard and Messick Eating Inventory. The BAROS is very useful for evaluating and reporting the results of obesity treatments. It can be used to measure the outcomes of > or =1 operations and to compare the results among different surgeons, regardless of their location. If this is corroborated by generalized use of the system, the BAROS can contribute to a uniform assessment of outcomes.
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                Author and article information

                Journal
                Arq Bras Cir Dig
                Arq Bras Cir Dig
                abcd
                Arquivos Brasileiros de Cirurgia Digestiva : ABCD
                Colégio Brasileiro de Cirurgia Digestiva
                0102-6720
                2317-6326
                16 August 2018
                2018
                : 31
                : 3
                : e1385
                Affiliations
                [1 ]Department of Surgery, Firat University Medical Faculty
                [2 ]Department of Surgery, Turkish Ministry of Health Medical Sciences University, Elazig Training and Research Hospital, Elazig, Turkey.
                Author notes
                Correspondence: Mehmet Buğra Bozan E-mail: bbozan@ 123456yahoo.com

                Conflict of interest: none

                Article
                00302
                10.1590/0102-672020180001e1385
                6097161
                30133677
                f1f78dcf-b7e4-4dde-80a6-9ff748a5a8e5

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 17 April 2018
                : 14 June 2018
                Page count
                Figures: 8, Tables: 4, Equations: 0, References: 16, Pages: 1
                Categories
                Original Article

                obesity,sleeve gastrectomy,quality of life,bariatric surgery,obesidade,gastrectomia vertical,qualidade de vida,cirurgia bariátrica

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