Quality of life before and after laparoscopic sleeve gastrectomy. A prospective cohort study

doi:10.1016/j.soard.2014.04.024

Surgery for Obesity and Related Diseases

Volume 11, Issue 1, January–February 2015, Pages 70-76

https://doi.org/10.1016/j.soard.2014.04.024 Get rights and content

Abstract

Background

There is a lack of adequate prospective data on quality-of-life (QOL) and its predictors in patients undergoing laparoscopic sleeve gastrectomy (LSG). The aim of this study was to assess longitudinal changes in QOL after LSG with the use of the obesity-specific Moorehead-Ardelt II questionnaire (MAII) and to identify clinical parameters associated with QOL outcome.

Methods

Morbidly obese patients consecutively admitted for LSG, over a 30-month period, were prospectively studied. QOL was assessed using the validated Greek version of the MAII questionnaire and a visual analogueue scale (VAS), preoperatively and at 6, 12, and 24 months postoperatively. Anthropometric data and obesity-related co-morbidities were recorded.

Results

A total of 111 patients with a mean age 36.8±9.2 years were included. Mean preoperative body mass index (BMI) was 49.1±7.5 kg/m². Percentage excess BMI loss (%EBL) was 51.1±14.9, 64.2±17.9 and 66.4±18.0 at 6, 12, and 24 months, respectively. Postoperatively, all obesity-related co-morbidities were significantly improved. MAII score increased from −.40±1.30 preoperatively to 1.75±.83, 2.18±.80, and 1.95±.71 at 6, 12, and 24 months postoperatively (trend P<.001). Preoperative median (interquartile range) VAS was 3 (1) increasing to 9 (2), 10 (1), and 9 (1) at 6, 12, and 24 months postoperatively (P<.001). %EBL and reduction in obesity-related co-morbidities, especially resolution of diabetes and sleep apnea, correlated significantly with higher QOL during the course of the study.

Conclusion

LSG, a safe and effective bariatric operation, results in sustained weight loss and significant improvements in QOL. Both weight loss and amelioration of co-morbidities contribute to higher level of postsurgical QOL.

Section snippets

Methods

Morbidly obese patients, admitted for LSG in our Bariatric Unit, over a 30-month period, were consecutively enrolled. Patients who had undergone other bariatric intervention in the past were excluded. The validated Greek version of the MAII obesity-specific questionnaire [14] was offered to the patients, filled in, and collected on the day before operation. MAII questionnaire is a validated, disease-specific instrument that measures QOL in the morbidly obese population before and after surgery.

Results

A total of 118 patients were recruited of which 111 were included in the study (60 females, 51 males). Three patients were excluded due to a prior bariatric operation and 4 were lost in follow-up. The mean age of the patients was 36.8±9.2 years (range 20–56), and the mean BMI was 49.1±7.5 kg/m² (range 37.4–71.0). Perioperative mortality was 0%.

The percentage of excess BMI loss (%EBL) reached 51.1±14.9, 64.2±17.9, and 66.4±18.0 at 6, 12, and 24 months, respectively. At 24 months postoperatively,

Discussion

LSG has been established as a standalone bariatric operation [19], [20], [21], with proved efficacy on weight loss and co-morbidity resolution in the long term [19], [20], [21], [22], [23]. However, with the exception of a single study addressing QOL after LSG by using an obesity-specific QOL instrument [8], prospective QOL results are extremely scarce in the literature. Herein, we present the first prospective, QOL-oriented, cohort study regarding LSG, with the use of the obesity-specific MAII

Conclusion

LSG, a safe and effective procedure, results in a significant improvement in all aspects of QOL as measured by a disease-specific questionnaire. This improvement seems to be better maintained in female patients at the end of the 2^nd postoperative year. Higher QOL is associated with weight loss, but more importantly with the resolution of co-morbidities and especially type 2 diabetes and sleep apnea syndrome.

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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Negative psychological sequelae have been reported after bariatric surgery. It is unclear which factors affect psychological function in the first postoperative years.
Evaluation of significant predictors of improved psychological function following bariatric surgery by analyzing data from the BODY-Q questionnaire.
Multicenter prospective cohort in 3 centers located in The Netherlands and Denmark.
The BODY-Q questionnaire was used to assess 6 domains of health-related quality of life. The domain of interest, psychological function, consists of 10 questions from which a converted score of 0 (low) to 100 (high) can be calculated. Linear mixed models were used to analyze which patient characteristics were most predictive of the psychological function score. Secondary outcomes of interest were cross-sectional scores of psychological function and the impact of weight loss, and the effect of major short-term complications on psychological function.
Data were analyzed from 836 patients who underwent bariatric surgery from 2015 to 2020. Patients with lower expectations concerning weight loss (<40% desired total weight loss), higher educational level, no history of psychiatric illness, and employment before bariatric surgery demonstrated the highest psychological function scores after bariatric surgery. At 1 and 2 years after bariatric surgery, more weight loss was associated with significantly higher psychological function scores. Experiencing a major short-term complication did not significantly impact psychological function.
Several relevant predictors of improved postoperative psychological function have been identified. This knowledge can be used to enhance patient education preoperatively and identify patients at risk for poor psychological functioning postoperatively.
Impact of gastrointestinal symptoms and psychological disturbances on patients’ quality of life after restrictive or malabsorptive bariatric surgery
2023, Gastroenterologia y Hepatologia
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These patients had the lowest %EBMIL and the highest prevalence of depression or anxiety compared with those undergoing malabsorptive procedures, which may explain the negative effect on QoL. In fact, percentage of weight loss has been shown to be significantly associated with QoL.21–23 Our study has several strengths and limitations.
The aim of this study was to evaluate and compare the presence and impact of Gastrointestinal (GI) symptoms, physical and psychological disturbances on patients’ QoL after sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD/DS).
A prospective, observational, cross-sectional, comparative study was carried-out. GI symptoms and patients’ QoL were evaluated by the SF-36 questionnaire and the GI quality of life index (GIQLI). Correlation between GI symptoms, psychological disturbances and QoL scores was analysed.
95 patients were included (mean age 50.5 years, range 22–70; 76 females). Presence of GI symptoms was a consistent finding in all patients, and postprandial fullness, abdominal distention and flatulence had a negative impact on patients’ QoL. Patients after SG showed a worsening of their initial psychological condition and the lowest QoL scores. Patients after RYGB showed the best GI symptoms-related QoL.
Both restrictive and malabsorptive bariatric surgical procedures are associated with GI symptoms negatively affecting patients’ QoL. Compared to SG and BPD/DS, patients after RYGB showed the best GI symptoms-related QoL, which can be used as additional information to help in the clinical decision making of the bariatric procedure to be performed.
El objetivo de este estudio fue evaluar y comparar la presencia e impacto de los síntomas gastrointestinales (GI), los cambios físicos y psicológicos en la calidad de vida (CV) de los pacientes sometidos a tubulación gástrica (TG), bypass gástrico en Y de Roux (BGYR) y derivación biliopancreática con cruce duodenal (DBP/CD).
Se realizó un estudio prospectivo, observacional, transversal y comparativo. Los síntomas gastrointestinales y la CV de los pacientes fueron evaluados mediante el cuestionario SF-36 y el índice gastrointestinal de calidad de vida (GIQLI). Se analizó la relación entre los síntomas gastrointestinales, los trastornos psicológicos y las puntuaciones de CV.
Se incluyeron 95 pacientes (edad media: 50,5 años, rango: 22-70; 76 mujeres). La presencia de síntomas gastrointestinales fue un hallazgo constante en todos los pacientes, y la pesadez posprandial, la distensión abdominal y la flatulencia tuvieron un impacto negativo en la CV de los pacientes. Los pacientes después de la TG mostraron un empeoramiento de su estado psicológico inicial y unas puntuaciones más bajas en la CV. Los pacientes después del BGYR presentaron la mejor CV relacionada con los síntomas gastrointestinales.
Los procedimientos de cirugía bariátrica tanto restrictivos como malabsortivos se asocian a síntomas GI que afectan negativamente la CV de los pacientes. En comparación con la TG y la DBP/CD, los pacientes tras el BGYR presentaron la mejor CV relacionada con los síntomas GI, lo que puede utilizarse como información adicional para ayudar en la toma de decisiones clínicas sobre el procedimiento bariátrico a realizar.
The effect of laparoscopic sleeve gastrectomy on quality of life: A prospective cohort study with 5-years follow-up
2018, Surgery for Obesity and Related Diseases
Citation Excerpt :
We have previously demonstrated that overall QoL was markedly low preoperatively and significantly increased at 6 and 12 months postoperatively compared with the baseline in both male and female morbidly obese patients. This was followed by a period of stabilization for the whole cohort at 24 months [12]. At the 5-year follow-up point, a statistically significant decrease in the overall QoL values, compared with the 2-year time point was noted affecting both sexes.
Obesity has a negative effect on quality of life (QoL). Bariatric surgery results in significant weight loss with improvement of QoL. Very few studies have evaluated QoL after sleeve gastrectomy (SG), especially with a long-term follow-up.
To assess long-term longitudinal changes of QoL of a laparoscopic SG cohort, with the obesity specific Moorehead-Ardelt II questionnaire (MAII) and to identify parameters associated with QoL outcome.
Bariatric Unit, University Hospital of Heraklion, Greece.
Morbidly obese patients admitted for laparoscopic SG over a 30-month period were prospectively studied. QoL was assessed using the Greek version of the MAII questionnaire and a visual analog scale preoperatively and at 6, 12, 24, and 60 months postoperatively. Anthropometric data and obesity-related co-morbidities were recorded.
A total of 95 patients with mean age of 37.4 ± 9.2 years and body mass index of 48.3 ± 7.1 kg/m² completed the 5-year follow-up. Percentage excess body mass index loss was 51.7 ± 14.2, 64.8 ± 16.9, 67.4 ± 17.7, and 55.8 ± 25.5 at 6, 12, 24, and 60 months, respectively. All obesity-related co-morbidities improved significantly. MAII score increased from −.38 ± 1.3 preoperatively to 1.77 ± .8, 2.08 ± 0.8, 2.12 ± .7, and 1.67 ± 1.1 at the above time points, respectively (trend P < .001), and visual analog scale increased from 3.05 ± 1.6 to 9.11 ± 1.0, 9.2 ± 1.1, 9.03 ± 1.3, and 7.85 ± 2.4 (P < .001). Overall QoL scores at 6 and 24 months (P < .001), as well as patients' female sex, correlated significantly with higher QoL at the end of the study.
Laparoscopic SG is an effective bariatric operation, resulting in significant weight loss and improvements in QoL. Female sex and higher MAII score at 6 and 24 months predict better long-term QoL outcome.
Impact of obstructive sleep apnea on quality of life after laparoscopic Roux-en-Y gastric bypass
2018, Surgeon
Citation Excerpt :
Bariatric surgery (BS) is increasingly being performed to treat the rising epidemic of morbid obesity and has shown to provide a significant improvement of this QoL.1,2 This improvement has shown to be consequence to both a substantial percentage of weight loss and comorbidity improvement.3–6 One of the most prevalent comorbidities among morbidly obese subjects is obstructive sleep apnea (OSA).7
To examine the influence of obstructive sleep apnea (OSA) on the quality of life (QoL) in bariatric surgery.
All patients who underwent a laparoscopic Roux-and-Y gastric bypass (LRYGB), preoperative poly(somno)graphy and completed an Impact of Weight on QoL-Lite questionnaire before and after surgery were included.
A total of 276 patients were included. OSA was diagnosed in 150 (53.3%) patients. All subscale scores improved 15 months post-surgery (p < 0.01). Total score improved from 51.2 (SD 19.1) to 89.7 (SD 13.9). Lower postoperative scores were seen in OSA patients on subscales Public Distress (90.4 SD 18.8 versus 95.7 SD 10.2; p = 0.003) and Work (92.9 SD 15 versus 96.1 SD 9.7; p = 0.031). All postoperative subscale scores were negatively correlated with OSA severity (p < 0.01).
After LRYGB, QoL improved in both OSA and non-OSA patients. OSA patients, especially patients with severe OSA, have lower postoperative scores on subscales Public Distress and Work after LRYGB.
Pattern of changes in quality of life of obese patients after sleeve gastrectomy in Sulaimani provence –Kurdistan-Iraq, based on 4 years experience in two bariatric centers
2018, Annals of Medicine and Surgery
Citation Excerpt :
Before the operation only (N = 5, 12.5%) felt easiness in making postures comfortably such as crossing their legs, while (N = 1, 87.5%) and (N = 37, 92.5%) of them felt this ease after their operations in 6 and 12 months respectively. Obesity is widely known as a major health risk factor, and bariatric surgery has proved to be significantly effective and a safe procedure [8], results in sustainable and effective reduction in body weight [19,20], on a long-term basis [21], which provides meaningful weight loss and improvement in the quality of life [22], which is an effective alternative to the current standard procedures [23]. The ultimate goal of bariatric surgery is weight loss and the resolution of obesity-related comorbidities to improve psychosocial functioning and quality of life (QOL) in morbidly obese patients [24].
Obesity influences all aspects of the life of obese patients physically, psychologically, socially and monetarily, it is not only a disease but rather a beginning point of a group of ailments and inabilities, which gradually impacts and changes all aspects of their life.
The changes in the Quality of life in respect to the amount of access weight lost after sleeve gastrectomy.
A prospective longitudinal study evaluating 40 female patients who underwent laparoscopic sleeve gastrectomy within 4 years, starting from July 4th, 2012 up to July 5th, 2016.
More than three-quarter of the patients were not satisfied with their body before their operation, but six to twelve months after their weight loss; (N = 36, 90%) of them were satisfied with their new body image. Half of the patients were unhappy before their operation, but twelve months later (N = 31, 77.5%) of them became much happier. Regarding satisfaction with the body image, noticeable improvement occurred since (N = 36, 90%) of them were satisfied with their new body image. While, most of them have had low self-esteem and (N 27, 67.5%) of the patients had no self-esteem at all, 12 months after the operation (N = 35, 87.5%) felt great improvement in their self-esteem (p-value = .040). A significant decrease in appetite was noticed in (N = 39, 97.5%) of the patients after 12 months.
Significant changes in the parallel pattern to the extent of EWL were noticed in the quality of life of morbidly obese patients after laparoscopic sleeve gastrectomy.
Patient-reported quality of life after bariatric surgery: A single institution analysis
2017, Journal of Surgical Research
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This improvement in QoL is consistent with other studies that have investigated QoL changes for bariatric surgery patients. Charalampakis et al. reported that MAQoLII scores increased from −0.40 to +1.75 at 6 mo, +2.18 at 12 mo, and +1.95 at 24 mo in a Greek population.16 Zhang et al. found in a prospective Chinese study of 64 LRYGB and LSG patients that MAQoLII scores increased from 0.42 to 1.59 for LRYGB patients and 0.38 to 1.62 for LSG patients 1 y after surgery.18
Bariatric surgery is an effective weight loss and comorbidity treatment among severely obese patients. However, there are limited data describing its impact on patient-reported quality of life (QoL). We examined patient-reported QoL after bariatric surgery and analyzed variables associated with higher postoperative QoL.
Patient demographics, comorbidities, and weight loss data were obtained from our institutional database for patients who underwent bariatric surgery from January 2010 to December 2012. QoL scores were obtained during preoperative and postoperative visits (2, 6, 12, 24, 52, and 104 wk) from the Moorehead-Ardelt Quality of Life Questionnaire II. Multivariable logistic regression was performed to generate odds ratios for variables hypothesized a priori to be associated with higher postoperative QoL.
A total of 209 patients were included in the study. Patients lost an average of 59.1% (±19.0) of excess body weight 1 y after surgery. One-year postoperative QoL scores were available for 42% of patients. Mean QoL scores improved from 0.82 preoperatively to 1.66 1 y postoperatively (P = 0.004). Patients scored higher in all individual areas of Moorehead-Ardelt Quality of Life Questionnaire II: self-esteem (0.22 versus 0.36), physical activity (0.11 versus 0.31), social life (0.28 versus 0.36), work ability (0.07 versus 0.22), sexual functioning (0.04 versus 0.16), and approach to food (0.11 versus 0.26; all P values <0.05). On multivariable analysis, higher QoL was associated with private insurance/self-pay versus Medicare (odds ratio 4.20 [95% confidence interval 1.39-12.68]).
Bariatric surgery patients experienced significant improvement in QoL 1 y after surgery. Identifying modifiable predictors of high QoL after bariatric surgery requires additional investigation.

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Original articleQuality of life before and after laparoscopic sleeve gastrectomy. A prospective cohort study

Abstract

Background

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Conclusion

Disclosures

Surg Obes Relat Dis

Surg Obes Relat Dis

Surg Obes Relat Dis

Surg Obes Relat Dis

Surg Obes Relat Dis

Surg Obes Relat Dis

Am J Surg

Lancet

Cardiovascular disease risk factors and dietary habits of farmers from Crete 45 years after the first description of the Mediterranean diet

Eur J Cardiovasc Prev Rehabil

Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy

Obes Surg

Impact of overweight and obesity on health-related quality of life-a Swedish population study

Int J Obes Relat Metab Disord

The validation of the Moorehead–Ardelt Quality of Life Questionnaire II

Obes Surg

A comparison of Likert scale and visual analogue scales as response options in children׳s questionnaires

Acta Paediatr

Improvement in quality of life after laparoscopic sleeve gastrectomy

Obes Surg

The comparative effectiveness of sleeve gastrectomy, gastric bypass, and adjustable gastric banding procedures for the treatment of morbid obesity

Ann Surg

Effect of different bariatric operations on food tolerance and quality of eating

Obes Surg

Two-year results on morbidity, weight loss and quality of life of sleeve gastrectomy as first procedure, sleeve gastrectomy after failure of gastric banding and gastric banding

Obes Surg

Observations regarding ׳quality of life׳ and ׳comfort with food׳ after bariatric surgery: comparison between laparoscopic adjustable gastric banding and sleeve gastrectomy

Obes Surg

Original article
Quality of life before and after laparoscopic sleeve gastrectomy. A prospective cohort study