Other Bariatric Surgery Considerations

According to Dr. Andrei Keidar and colleagues at Tel Aviv University, much needs to be learned about patient selection for surgery to enhance long-term success. They followed 443 obese patients who had VSG to see how much weight they lost and what improvements in health they experienced. After 1 year, participants had averaged a loss of 77% of their original weight. But in 5 years, many participants had only retained a weight loss of 56% of their original weight. Participants in the study had significantly reduced low-density lipoprotein (LDL) cholesterol levels in 1 year and 3 years, but little change by the fifth year [24].

Shikora et al. reported that many investigators attribute failures in bariatric surgery to patient noncompliance. After surgery, patients are advised to adhere to strict dietary guidelines but some patients ignore the restrictions, which leads to pouch dilatation, stomal enlargement, and staple disruption. A few patients have been reported to consume high-calorie drinks that cause inadequate weight loss [4].

Ethnicity may affect the success of bariatric surgery since some studies have reported better weight loss among non-Hispanic whites versus non-Hispanic blacks and Hispanics [25]. Weight loss and BMI reduction was similar among non-Hispanic whites and Hispanics compared with non-Hispanic blacks who had gastric bypass surgery. No significant ethnic difference was noted for AGB patients.

Gender is another potential factor that can influence weight loss after surgery. Bekheit et al. reported gastric banding to be less effective in males [26] but Perrone et al. concluded males had greater BMI loss than females post-VSG and RYGB surgeries [27].

Age appears to be less of a factor in patient selection for bariatric surgery although Abbas et al. indicated long-term effects need further studies. Their study indicated patients older than 60 were safe and effective candidates with low morbidity and mortality [28].

A good surgical result does not ensure a successful weight loss. Surgery is only one aspect in the management of obesity. Nutrition management pre- and postsurgery is needed to maximize weight loss, food avoidance, behavior change, improved physical activity, and compliance in nutrient supplementation.

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