Salman Bodla1, Richard Bodington1, Jennifer Abraham1, Hannah Adams1 and Shameen Jaunoo1,2*
1Warwickshire Surgical Research Group, Warwickshire. UK
2Oxford University Hospitals, Oxford. UK
Received: 12 January, 2016; Accepted: 23 February, 2016; Published: 25 February, 2016
Shameen Jaunoo, Warwickshire Surgical Research Group, Warwickshire. UK, E-mail:
Bodla S, Bodington R, Abraham J, Adams H, Jaunoo S (2016) Reciprocal Relationship between Compliance with Post-Op Follow-Up and Weight Loss after Bariatric Surgery. Arch Clin Gastroenterol 2(1): 004-006. 10.17352/2455-2283.000010
© 2016 Bodla S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Obesity is a large and growing health problem in the UK with high associated costs to the NHS. Bariatric surgery is proven as an effective treatment for obesity associated with long term weight loss and a reduction in obesity related comorbidities . The NICE guidance highlights the importance of follow-up post-surgery . The guidelines state that in order to be eligible for surgery the patient must commit to long term follow-up and that in order for a centre to offer bariatric surgery it must ensure that it can provide regular MDT post-op assessment and support for at least two years . This should be followed by lifelong follow-up at least annually in the community . NICE recommends that follow-up should include dietary, nutritional and physical activity assessment, advice and support along with individualized psychological support and information regarding access to peer support groups . NICE have created these guidelines due to their observation that practice differs across the country and that there is a real risk of harm if nutritional deficiencies are not identified and managed . The rationale behind the NICE, and therefore the British obesity and metabolic surgery society (BOMSS) guidelines are based upon a number of papers that demonstrate the importance of follow-up on the success of bariatric surgery. Studies have demonstrated a significantly improved percentage excess weight loss (%EWL) in laparoscopically adjusted gastric band (LAGB) patients who returned for follow-up more frequently in the first post op year when compared to those who returned less frequently [4,5]. Other studies have shown that laparoscopic gastric bypass patients who did not attend clinic without being prompted had significantly worse %EWL and similar results have been demonstrated with sleeve gastrostomy patients [1,6]. Follow-up improves outcome via general and specific interventions. The general interventions are those focused on by the NICE guidance as outlined earlier. LAGB patients require the specific intervention of adjustment of the gastric band in order to ensure sufficient constriction to lead to weight loss.
In this single-centre retrospective study we investigate the relationship between compliance with post-op follow-up appointments and the effect on excess weight loss in patients undergoing LAGB, gastric sleeve and Roux-en Y gastric bypass (RYGBP) operations.
Our data was gathered from bariatric out-patient clinic follow-up at the university Hospital of Coventry and Warwickshire (UHCW), Coventry, UK between 2009-2013, 164 post-bariatric surgery (BS) patients with similar initial BMI were included (70 LAGB, 70 sleeve gastrostomies and 24 Roux-en Y gastric by-passes (RYGBP)). Calculations of percentage excess weight lost (%EWL) were calculated based on a BMI of 25 and were recorded at intervals of 1-2 months, 3-4 months, 5-6 months, 8-9 months, and 10-12 months if attendance allowed. Data was analyzed using Microsoft Excel 2010.
One hundred and sixty four post-BS patients with similar initial BMI were included in our study (70 LAGB, 70 sleeve gastrostomies and 24 Roux-en Y gastric by-passes (RYGBP)). The average BMI of the LAGB group was 51.4, 52.5 for the gastric sleeve and 50.7 for the RYGBP group with no significant difference between the groups at baseline. 65.2% of patients were female and this proportion did not differ significantly between groups. Attendance at post-op appointments steadily declined with 83.75% patients attending at 1-2 (P=ns), 52.25% at 5-6 (P=0.011) and 61.25% at 10-12 months (P=0.002) (Figure 1). The number of appointments attended by LAGB, Sleeve and By-Pass patients did not differ significantly (Median 3-4; P=0.1-0.46). EWL Figures at 10-12 months were available for 36 LAGB (51.42%), 43 Sleeve (61.42%), and 16 (66.67%) RYGBP patients. LAGB patients with poor compliance (3 or less appointments) lost significantly less weight than those with 4 or more appointments (%EWL 15.9 vs. 33.7; P=0.01-0.004), while the same did not affect %EWL for Sleeve and By-Pass patients (P=0.26-0.72) (Figure 2). Interestingly, initial weight loss also affected subsequent attendance. Patients who managed to achieve >20% EWL at 1-2 months attended significantly less appointments compared to those with ≤20% EWL (P=0.0012) (Figure 3).
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