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Background: Patient-reported outcomes and perceptions are critical to the overall efficacy and acceptability of a surgical procedure. Outcomes, such as patient satisfaction and perceived success of the surgery and adverse symptoms, have not been described in detail following bariatric surgery. The associations and predictors of patient satisfaction have not been defined. This study aimed to examine long-term outcomes and perceptions after laparoscopic adjustable gastric banding (LAGB). Methods: We conducted a prospective study of outcomes, satiety and adverse upper gastrointestinal symptoms, as well as quality of life and subjective patient satisfaction in LAGB patients. Data were collected at 3 years (T1) and 8 years post-operatively (T2). Results: One-hundred and sixty patients completed follow-up at T1 and T2. The average age was 44.0 ± 11.2 years. At T2, the total body weight loss was 17.8 ± 11.9 %. Satisfaction decreased significantly between time points (8.6 ± 1.8 vs 7.2 ± 2.9, p < 0.01), and quality of life reduced slightly across all domains. Hunger scores remained low (3.8 ± 1.8 vs 3.9 ± 1.8, p = 0.61). The dysphagia score did not change significantly ( p = 0.54). There was minimal change in frequency of regurgitation, although there was significant increase in patient assessment of how bothered they were by regurgitation. Multivariate analysis identified increased awareness of regurgitation as a principal driver of reduced satisfaction. Conclusions: Weight loss, satiety and adverse symptoms demonstrated only slight changes between 3 and 8 years post-operatively. Despite this, overall satisfaction and perception of success of the procedure reduced markedly. This appeared mediated by reduced tolerance of adverse symptoms. These data inform follow-up practises aimed at optimizing outcomes. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to identify the efficacy and safety of combining laparoscopic adjustable gastric banding with repair of large para-oesophageal hernias. Background: Para-oesophageal hernias are more common in the obese with higher recurrence rates following repair. The effect and safety of combining para-oesophageal hernia repair with laparoscopic adjustable gastric banding is unknown. Methods: One-hundred fourteen consecutive patients undergoing primary laparoscopic adjustable gastric banding with concurrent repair of a large para-oesophageal hernia were prospectively identified and matched to a control group undergoing primary laparoscopic adjustable gastric banding only. Weight loss and complication data were retrieved from a prospectively maintained database, and a standardised bariatric outcome questionnaire was used to assess post-operative symptoms, satisfaction with surgery and satiety scores. Results: At a mean follow up of 4.9 ± 2.1 years, total weight loss was 16.4 ± 9.9 % in the hernia repair group and 17.6 ± 12.6 % in the control group ( p = 0.949), with 17 vs. 11 % loss to follow up rates ( p = 0.246). No statistically significant difference in revisional surgery rate and symptomatic recurrence of hiatal hernia was documented in four patients in the hernia repair group (3.5 %). No statistically significant difference in mean reflux (9.9 vs. 10.3, p = 0.821), dysphagia (20.7 vs. 20.1, p = 0.630) or satiety scores was identified. Conclusions: Concurrent repair of large para-oesophageal hiatal hernia and laparoscopic adjustable gastric banding placement is safe and effective both in terms of symptom control and weight loss over the intermediate term. In obese patients with large hiatal hernias, consideration should be given to combining repair of the hernia with a bariatric procedure. [ABSTRACT FROM AUTHOR]

Background/Objectives: Diabetes and obesity are common and serious health challenges for indigenous people worldwide. The feasibility of achieving substantial weight loss, leading to remission of diabetes, was evaluated in a regional indigenous Australian community. Subjects/Methods: A prospective cohort study of 30 obese indigenous adults from the Rumbalara Aboriginal Co-operative in Central Victoria was performed. Inclusion criteria included aboriginality, BMI > 30 kg/m and diabetes diagnosed within the last 10 years. Weight loss was achieved using laparoscopic adjustable gastric banding (LAGB). Participants were treated in their community and followed for 2 years. Outcomes were compared with those of non-indigenous Australians from an earlier randomized controlled trial (RCT) using a similar protocol. Results: 30 participants (26 females, mean age 44.6 years; mean BMI 44.3) had LAGB at the regional hospital. Twenty-six participants completed diabetes assessment at 2 years follow-up. They showed diabetes remission (fasting blood glucose < 7.0 mmol/L and haemoglobin A1c (HbA1c) < 6.2 % while off all therapy except metformin) in 20 of the 26 and a mean weight loss (SD) of 26.0 (14) kilograms. Based on intention-to-treat, remission rate was 66 %. Quality of life improved. There was one early event and 12 late adverse events. The outcomes for weight loss and diabetes remission were not different from the LAGB group of the RCT. Conclusions: For obese indigenous people with diabetes, a regionalized model of care centred on the LAGB is an effective approach to a serious health problem. The model proved feasible and acceptable to the indigenous people. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN 12609000319279). [ABSTRACT FROM AUTHOR]

Background: This study aimed to test the hypothesis that the amount of weight lost on a mandatory 2-week pre-operative very-low-calorie diet (VLCD) would predict the longer-term outcomes of laparoscopic adjustable gastric banding (LAGB). Methods: All patients treated with a primary LAGB from 21 October 2008 until 30 June 2010, who were prescribed a 2-week pre-operative VLCD, have been included in the study. Patient age, weight, BMI and excess weight (defined as weight above a BMI of 25) were extracted on the day of first visit, day of surgery and at the post-operative visits at 3, 12 and 24 months. From these data, percent excess weight loss (EWL) was calculated and compared at all time points. Results: The weight loss achieved on a mandatory 2-week pre-operative diet did not predict weight outcomes at 2 years ( r = −0.008; p = 0.931). Using multivariate analysis, the best predictor of 24-month percent EWL was percent EWL at 3 months post operation (sr = 0.34; p = 0.003). Conclusions: Results from a pre-operative diet should not be used to predict the ultimate outcome of bariatric surgery. The weight loss at 3 months following LAGB was a strong predictor of longer-term outcomes. There may be potential for improving longer-term results with LAGB by better supporting patients who are not achieving good weight loss at this early time point. [ABSTRACT FROM AUTHOR]

Background: Follow-up is critical to the success of laparoscopic adjustable gastric banding (LAGB). Few data guide this and expected norms of satiety, adverse symptoms, and outcomes have not been defined. Methods: Consecutive patients, who underwent LAGB, were evaluated using a newly developed instrument that assessed satiety, adverse upper gastrointestinal (dysphagia, reflux, and epigastric pain), and outcomes (overall satisfaction, weight loss, and quality of life (SF-36)). Results: Three hundred twenty-three of 408 patients responded (80%; mean age 44.4 ± 11.8 years, 56 males). Excess weight loss was 52%. Satiety was greater at breakfast compared to lunch (5.3 ± 1.9 vs. 4.1 ± 1.7, p < 0.005) or dinner (3.8 ± 1.8, p < 0.005). The satisfaction score was 8.3 ± 2.1 out of 10, and 91% would have the surgery again. Quality of life was less than community norms, except in physical functioning (83.4 ± 20.5 vs. 84.7 ± 22.0, p = 0.25) and bodily pain (78.4 ± 15.2 vs. 75.9 ± 25.3, p = 0.004). Inability to consume certain foods was cited as the biggest problem by 66% of respondents. The dysphagia score was 19.9 ± 8.7; softer foods were tolerated, although difficulty was noted with firmer foods. The reflux score was 8.7 ± 9.8 and regurgitation occurred a mean of once per week. Weight loss and the mental component score were the only predictors of overall satisfaction ( r = 0.46, p = 0.01). Conclusions: Patients are highly satisfied with the outcome of LAGB and achieve substantial weight after 3 years. Expected ranges of satiety, adverse symptoms, and outcomes have been defined. The most troublesome symptom is the inability to consume certain foods. Weight loss predicted overall satisfaction, regardless of adverse symptoms. [ABSTRACT FROM AUTHOR]

The article discusses a study which compared the outcomes of gastric banding and lifestyle intervention programs on adolescent obesity. The study included 50 adolescents from Melbourne, Victoria, who are aged 14 to 18 and with a body mass index (BMI) that is higher than 35. It found that study subjects in the gastric banding group experienced no adverse events and reported quality of life improvements. Study authors concluded that gastric banding results in greater weight loss compared to lifestyle intervention. They also noted the health and quality of life benefits of gastric banding.

High levels of readiness to change (RTC) are considered critical to the long-term success of weight management programs including bariatric surgery. However, there are no data to support this assertion. We hypothesize that RTC level will not influence weight outcomes following surgery. In 227 consecutive patients undergoing adjustable gastric banding surgery, we recorded reasons for seeking surgery, and RTC measured with the University of Rhode Island Change Assessment. Scores were blinded until study completion. The primary outcome measure was percentage of excess BMI loss at 2 years (%EBMIL-2); others included compliance and surgical complications. Of 227 subjects, 204 (90%) had weight measurement at 2 years. There was no significant correlation between RTC score and %EBMIL-2 (r = 0.047, P = 0.5). Using the median split for RTC score the lowest 102 subjects mean %EBMIL-2 was 52.9 ± 26.9% and the highest 52.2 ± 28.3%, P = 0.869. There was no weight loss difference between highest and lowest quartiles, or a nonlinear relationship between weight loss and RTC score. There was no significant relationship between RCT score and compliance, or likelihood of complications. Those motivated by appearance were more likely to be younger women who lost more weight at 2 years. Poor attendance at follow-up visits was associated with less weight loss, especially in men. Measures of RTC did not predict weight loss, compliance, or surgical complications. Caution is advised when using assessments of RTC to predict outcomes of bariatric surgery.Obesity (2009) 17 4, 698–705. doi:10.1038/oby.2008.609 [ABSTRACT FROM AUTHOR]

This article reports on a clinical trial to determine if gastric banding surgery could be effective therapy for the treatment of type 2 diabetes. Obesity and type 2 diabetes are both on the rise in the U.S. and other developed countries. The conditions are linked and weight control may be the most important factor in reducing the incidence of diabetes. This study wanted to see if surgically induced weight loss offered better blood sugar control and less need for medications than the more traditional approaches of diet and exercise. The study found that patients given the surgical option were more likely to achieve remission of their diabetes. The authors caution that a larger study needs to confirm their findings.

The author reflects on the current ethics review process in Australia in 2016. Topics discussed include multisite quality and safety initiatives, national Bariatric Surgery Registry (BSR), and clinical quality registries (CQRs). Also being discussed is the human research ethics committee (HREC) of the nation.