Initiation and maintenance of weight loss after laparoscopic adjustable gastric banding: The role of outcome expectation and satisfaction with the psychosocial outcome

Item does not contain fulltextA premise of this study was that different psychological processes would predict the initiation and maintenance of weight loss after surgery for morbid obesity. Our aim was to examine whether more favorable preoperative expectations of psychosocial outcomes predict weight loss in the first year after laparoscopic adjustable gastric banding (LAGB) and whether postoperative satisfaction with these outcomes predicts weight maintenance in the second year after the operation. Six months before and 1 year after surgery, the "Obesity Psychosocial State Questionnaire" was filled out by 91 patients (77 female, 14 male, mean age 45 +/- 9 years, mean preoperative body mass index 47 +/- 6 kg/m(2)). We evaluated the preoperative outcome expectations and the postoperative satisfaction for the seven domains of psychosocial and physical functioning of this questionnaire, as well as the correlations between these scores and both weight loss and weight maintenance. Patients showed high satisfaction with psychosocial outcomes after LAGB in all seven domains (p < 0.001), even though the improvement was less than expected in five of the domains (p a parts per thousand currency signaEuro parts per thousand 0.01). While weight loss 1 year after the operation was related to satisfaction with psychosocial outcomes (p a parts per thousand currency signaEuro parts per thousand 0.05), preoperative expectations were not related to weight loss in the first year after surgery, and satisfaction with the outcomes was not related to weight maintenance in the second year after surgery. Our study suggests that surgically induced effects of weight loss and weight maintenance are achieved independently of the patient's preoperative expectations of and postoperative satisfaction with the psychosocial outcomes

Preoperative Characteristics of Patients with Presumed Pancreatic Cancer but Ultimately Benign Disease:A Multicenter Series of 344 Pancreatoduodenectomies

Preoperative differentiation between malignant and benign pancreatic tumors can be difficult. Consequently, a proportion of patients undergoing pancreatoduodenectomy for suspected malignancy will ultimately have benign disease. The aim of this study was to compare preoperative clinical and diagnostic characteristics of patients with unexpected benign disease after pancreatoduodenectomy with those of patients with confirmed (pre)malignant disease. We performed a multicenter retrospective cohort study in 1,629 consecutive patients undergoing pancreatoduodenectomy for suspected malignancy between 2003 and 2010 in 11 Dutch centers. Preoperative characteristics were compared in a benign:malignant ratio of 1:3. Malignant cases were selected from the entire cohort by using a random number list. A multivariable logistic regression prediction model was constructed to predict benign disease. Of 107 patients (6.6 %) with unexpected benign disease after pancreatoduodenectomy, 86 fulfilled the inclusion criteria and were compared with 258 patients with (pre)malignant disease. Patients with benign disease presented more often with pain (56 vs. 38 %; P = 0.004), but less frequently with jaundice (60 vs. 80 %; P <0.01), a pancreatic mass (13 vs. 54 %, P <0.001), or a double duct sign on computed tomography (21 vs. 47 %; P <0.001). In a prediction model using these parameters, only 19 % of patients with benign disease were correctly predicted, and 1.4 % of patients with malignant disease were missed. Nearly 7 % of patients undergoing pancreatoduodenectomy for suspected malignancy were ultimately diagnosed with benign disease. Although some preoperative clinical and imaging characteristics might indicate absence of malignancy, their discriminatory value is insufficient for clinical use