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LSG vs banding

LSG betters banding for food tolerance and eating disorders

This is the first study to examine such issues in the Arabian Gulf region, and therefore believe that the outcomes will provide further insight for future research on bariatric surgery trends in the region

Laparoscopic sleeve gastrectomy (LSG) patients had superior outcomes in both food tolerance and eating disorder behaviours, compared with laparoscopic banding, according to researchers from Bahrain Defence Force Hospital, Riffa, Bahrain. However, despite these differences, the quality of life (QoL) did not significantly differ between the sleeve and gastric banding groups.

The paper, ‘Quality of life, food tolerance, and eating disorder behavior after laparoscopic gastric banding and sleeve gastrectomy - results from a middle eastern center of excellence’, published in BMC Obesity, sought to compare the QoL, food tolerance and behaviours of eating disorders related to LSG and gastric banding. The authors believe this is the first study to examine such issues in the Arabian Gulf region, and therefore believe that the outcomes will provide further insight for future research on bariatric surgery trends in the region.

In this retrospective study, all patients who had undergone laparoscopic gastric banding and sleeve gastrectomy at the Bahrain Defense Force Hospital between 2011 and 2014, who had at least one year of postoperative duration were invited to join the follow-up survey. All patients were assessed through face-to-face interviews with a dietitian.

Outcomes

In total, 84 bariatric patients (48 were LSG patients and 36 band patients) were asked to complete three questionnaires: the Medical Outcomes Study Short-Form Questionnaire (SF-36), the Quality of Alimentation questionnaire and the Eating Disorder Examination Questionnaire (version 6; EDE-Q).

The mean age of the patients was 35.8±10.1 years in the gastric sleeve group and 36.1±10.3 years in the gastric band group. The proportion of women was higher (58.3%) with no differences in age (p=0.681) or gender distribution (p>0.05) between the groups. The follow-up rate was 100% for banding and 92% for sleeve gastrectomy. The pre-operative BMI did not significantly differ between the groups (48.2±9.6 vs. 44.2±4.5, p=0.107). The mean BMI dropped from 48.2±9.6 to 30.9±6.2 after surgery in the sleeve group and from 44.2±4.4 to 34.9±6.8 in the band group. However, the post-operative BMI reduction was greater in the gastric sleeve group (31.0±6.2) than in the gastric band group (34.9 ± 6.8), p=0.012. The %EWL was significantly higher in the sleeve gastrectomy group (75.3±23.9) than the gastric band group (48.4±3.0), p=0.001.

The analysis of the SF-36 questionnaire responses revealed that post-operative QoL did not significantly differ between the groups. Although assessments of the pre-and postoperative HRQOL of the patients in the gastric sleeve group exhibited significant improvements in all of the items except for mental health domain, there was no pre-operative HRQOL data available for gastric banding patients.

The findings of the Quality of Alimentation questionnaire (Table 1), revealed that post-operative overall food tolerance and the evaluation of different food scores of the gastric sleeve group and gastric band group were significantly different (p=0.003 and p<0.001 respectively). The occurrence of vomiting was greater in the sleeve group compared to the band group (p<0.001) and the total score was significantly higher in the gastric sleeve group (p<0.001).

Table 1: Food tolerance measured using the Quality of Alimentation questionnaire. *P value of 0.05 was considered significant. Data are expressed as mean ± SD. The composite score ranged from 1 to 27. Score 27 for being the maximum for an excellent food tolerance, p value from Mann-Whitney U test

Mean global EDE-Q scores were significantly different between the groups (LSG 2.4±1.2 vs. 3.2±0.9 for banding; p=0.001). Patients in the band group showed a significantly greater number of eating disorder behaviour traits, compared with sleeve patients.

Furthermore, the researchers noted that QoL and weight loss were positively and significantly correlated (r=0.478, p=0.003) in the band group, but not significantly correlated in the sleeve group, but food tolerance and weight loss were not significantly correlated in either group. Post-operative behaviours of eating disorders were significantly and negatively correlated (r= −0.367, p=0.010) with weight loss in the gastric group.

The authors acknowledged that one limitation of their study is the lack of pre-operative data, as this would allow the study to suggest the possibility of the differences being due to the different kinds of surgery performed. The lack of pre-operative data makes it difficult to suggest that the differences in HRQOL results were due to the different types of surgery performed.

“Further studies are needed to compare sleeve gastrectomies with other bariatric surgeries to evaluate whether it is indeed a better procedure for obese patients,” the authors concluded. “Dysfunctional eating behaviours after laparoscopic gastric banding and sleeve gastrectomy appear to be associated with poorer weight loss and/or weight regain. The early diagnosis of such behaviours can help to prevent poor outcomes of the surgeries.”

To access this paper, please click here

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