Banding gastrique par laparoscopie : traitement moderne de l'obésité morbide ? [Laparoscopic gastric banding : Modern therapy for morbid obesity?]

Il est démontré que les formes actuelles de traitement conservateur de l'obésité morbide n'ont pas d'effet à long terme, et que seul le traitement chirurgical est efficace. Nous rapportons dans cet article notre expérience du banding gastrique effectué par laparoscopie chez 172 malades. 5,2% d'entre eux ont développé des complications opératoires majeures, et un malade est décédé (0,6%). Le poids perdu après 12-24 mois correspond à plus de 50% de l'excès pondéral initial chez 55-71% des malades. Des complitalions tardives sont survenues dans 12,7% des cas et sont, pour plus de la maitié, attribuables à une technique opératoire imparfaite au début de notre expérience. Elles ont diminué avec l'amélioration de celle-ci. Le banding gastrique par laparoscopie est peu agressif, ne modifie pas l'anatomie, ne comporte pas de suture ou d'agrafage digestif. Nous le considérons comme la technique de choix actuellement chez la plupart des malades atteints d'obésité morbide

Effects of laparoscopic gastric banding on body composition, metabolic profile and nutritional status of obese women: 12-months follow-up.

BACKGROUND: Obesity is frequently associated with metabolic and cardiovascular co-morbidities and high mortality rates. Besides, because of the increasingly recognized fact that conservative therapy for morbid obesity is associated with an almost 90-95% failure rate in the long term, and probably because of the development of laparoscopic surgery,the demand for bariatric surgery is increasing rapidly.The significant weight loss observed during the first 6-12 months after gastric banding is related to the severe food restriction, related hypercatabolism, and has a potential risk of mineral and vitamin deficiencies.The aim of this study was to evaluate the effects of gastric banding on total body composition, metabolic profile and nutritional status. METHODS: 31 women were studied with median age 36 years (range 25-52), body weight 118.6 kg (range 98-156), BMI 43.6 kg/m(2) (range 36-56 kg/m(2)), percentage of excess body weight (%EW) of 107% (range 72- 166%), waist 115 cm (range 98-132) and hip 138 cm (range 119-155). Total body composition was measured before, 6 and 12 months after laparoscopic gastric banding, using dual-energy x-ray absorptiometry. Metabolic and nutritional profile were evaluated before and 1, 3, 6, 9 and 12 months postoperatively. RESULTS: There was a 23.3% reduction of total body weight and 36.8% reduction of body fat. Unfortunately we also observed a reduction of Fat Free Mass (FFM) of 9.6%. In addition, the major determinants of weight loss were the initial body weight and abdominal distribution of fat mass. Reduction of FFM was positively correlated with the rapidity of weight loss. A significant improvement of glucidic profile was observed, with disappearance of impaired fasting glucose, and normalization of the values of triglycerides in all patients. The prevalence of the metabolic syndrome decreased from 89% in preoperative conditions to 15% 1 year after gastric banding. No major nutritional deficiencies was found following gastric banding. CONCLUSIONS: This prospective study suggests that the first 6 months postoperatively are crucial for weight loss and changes in body composition. Furthermore, the significant reduction of body weight is accompanied by an important improvement of biological abnormalities

Rising role of obesity surgery caused by increase of morbid obesity, failure of conventional treatments and unrealistic expectations: trends from 1997 to 2001.

BACKGROUND: The authors analyzed the trends in anthropometric and behavioral characteristics among patients seeking weight loss and the trends in choice of treatments, between 1997 and 2001 in an outpatient obesity clinic. PATIENTS AND METHODS: 138 and 128 consecutive patients attending the out-patient obesity clinic at University Hospital of Lausanne were screened in 1997 and in 2001 respectively. Eating habits, body composition and treatment used were assessed. RESULTS: Median BMI was 35 kg/m2 in 1997 and 38 kg/m2 in 2001 (P <0.001) and waist circumference was 99 cm and 111 cm respectively (P <0.001). This increase in the average body weight involved especially patients <30 years old (P <0.01). Morbid obesity increased by 16% (P <0.01), and prevalence of abdominal obesity by 13% (P < 0.05). The median desired weight loss increased significantly from 25% to 29% (P <0.05). 64% of the patients in 1997 and 83% in 2001 (P <0.01) hoped for a weight loss of 20% of their baseline weight. Motivation to lose weight for esthetic reasons was found in 81% of the women and 55% of the men in 1997 (P <0.01), while in 2001 the percentage was 89 and 43 respectively (P <0.001). CONCLUSION: In spite of the increasing access to weight loss programs, we found that the patients are more severely obese, especially those <30 years old, and have more unrealistic expectations of weight loss. This may explain the doubling of the patients treated by surgery

Impact of preoperative teaching on surgical option of patients qualifying for bariatric surgery.

BACKGROUND: During the last 5 years, the performance of bariatric operations has doubled via our outpatient obesity clinic. Currently, 52% of the patients presenting for weight loss are interested in bariatric surgery. Gastric banding and Roux-en-Y gastric bypass are the two laparoscopic procedures proposed. The aim of this study was to evaluate the impact of preoperative teaching on the patients' surgical option. METHODS: All the candidates for bariatric surgery were submitted to preoperative teaching and those between February 2001 and December 2002 are the subject of this study. The teaching consisted of 3 weekly interactive 2-hour sessions. During the first session, the patients were asked about the type of operation that they had in mind: gastric banding, gastric bypass, or not yet decided. The same questions were repeated at the end of the third session, with an additional possible answer: no surgery. RESULTS: 297 consecutive patients with a BMI >35 kg/m(2) with at least one severe co-morbidity, were submitted to preoperative teaching. 80% of the patients were women. Median age was 41 years. Before teaching, 68 patients (23%) were uncertain, 100 (34%) favored gastric banding, and 129 (43%) wanted a gastric bypass. After education, only 3 patients (1%) remained uncertain, 45 (15%) changed their surgical option, and 27 (9%) declined surgery. The proportion of patients opting for gastric banding decreased from 34% to 20%, whereas those electing bypass increased from 43% to 70%. CONCLUSIONS: Preoperative training provides an informed and better patient selection for bariatric surgery. It helps the patients understand the various surgical options, and makes their decision easier