Quality of life after gastric banding in morbidly obese Dutch patients: Long-term follow-up.

OBJECTIVE: Long-term effects of adjustable gastric banding (AGB) on quality of life (QoL) in a morbidly obese population were investigated in a cross-sectional study. Additionally, determinants of QoL after AGB were assessed. METHODS: All patients treated by AGB for morbid obesity in a Dutch hospital were invited to complete the RAND 36-Item Health Survey. Of 121 participating patients 59 met the criteria for long-term follow-up (>5 years): 4 male and 55 female, mean age 42.4 ± 9.7 years, mean body mass index (BMI) before surgery 44.9 ± 5.9 kg/m(2). Time since surgery was 74.7 months (range 60-107.6). The control group consisted of 28 presurgical patients. General and obesity-related parameters were assessed for correlation with QoL. RESULTS: Significant differences between the preoperative group and Dutch community norm (CN) values were found on five out of eight QoL subscales, in favor of CN. AGB induced significant weight loss in the postoperative group: 56.1% excess weight loss (%EWL). This group scored significantly better than the preoperative group on one out of eight subscales: physical functioning (P = 0.019). Additionally, scores on four out of eight subscales were still significantly impaired compared to CN. Postoperative BMI and %EWL influenced QoL after long-term follow-up, whereas weight regain had no negative impact. CONCLUSIONS: This study shows that after long-term follow-up subjects treated by gastric banding to induce weight loss have a slightly better QoL than those who did not undergo surgery yet. QoL remains impaired in comparison to the general population. After long-term follow-up BMI and weight loss do influence QoL whereas weight regain does not have any negative impact.

Gallstone formation after weight loss following gastric banding in morbidly obese Dutch patients.

BACKGROUND: Obesity is a risk factor for the development of gallstones. Rapid weight loss may be an even stronger risk factor. We retrospectively assessed the prevalence and risk factors of gallstone formation after adjustable gastric banding (AGB) in a Dutch population. METHODS: All patients who underwent AGB between Jan 1992 and Dec 2000 for morbid obesity were invited to take part in this study. Transabdominal ultrasonography of the gallbladder was performed in those patients without a prior history of cholecystectomy (Group A). Additionally, 45 morbidly obese patients underwent ultrasonography of the gallbladder before weight reduction surgery (Group B). RESULTS: 120 patients were enrolled in the study (Group A). Prior history of cholecystectomy was present in 21 patients: 16 before and 5 after AGB. Ultrasonography was performed in 98 patients: gallstones were present in 26 (26.5%). On multivariate analysis, neither preoperative weight, nor maximum weight loss, nor the interval between operation and the postoperative ultrasonography were determinants of the risk for developing gallstone disease. Prevalence of gallstones was significantly lower in the morbidly obese patients who had not yet undergone weight reduction surgery (Group B). CONCLUSIONS: Rapid weight loss induced by AGB, is an important risk factor for the development of gallstones. No additional determinants were found. Every morbidly obese patient undergoing bariatric surgery must be considered at risk for developing gallstone disease.

Clinical practice of nutritional support in Dutch intensive care units: a survey.

INTRODUCTION: Nutritional support in intensive care units (ICUs) has received increasing attention in the last few decades. We performed a national survey to establish the current practice with respect to nutritional support in Dutch ICUs. METHODS: A questionnaire was sent to all Dutch ICUs. The design of the study was a 1-day point prevalence study. RESULTS: The response rate of the ICUs was 51% (74/144). Eighty-eight percent of the questionnaires returned (65/74) were suitable for data analysis. The total number of patients present on the ICU on the given day was 354 and their mean age was 59.2+/-1.0 years. Sixty-nine percent of the patients (246) received nutritional support: enteral in 206 patients (58%), parenteral in 59 patients (17%), and a combination of the two in 19 patients (5%). The percentage of patients receiving nutritional support and the route of administration were dependent on the reason for admission to the ICU. Nutritional support was started after a mean of 1.3+/-0.1 days after admission to the ICU. One hundred and four patients (29%) received no nutritional support after a mean admission period of 1.6+/-0.1 days. For 193 patients (54%), the nutritional support met the nutritional requirements, for 145 patients (41%) it did not, and 17 respondents (5%) had no opinion. CONCLUSION: Nutritional support is provided to the majority of critically ill patients. Enteral feeding is more common than parenteral nutrition.