Ten years post-surgery - benefits persist but worries remain
Patients experienced many sustained positive effects after metabolic and bariatric surgery (MBS) and were pleased they had surgery ten years after bariatric surgery, according to a study that explored patients’ experiences by researchers from Sweden. However, healthcare professionals should educate patients about increased sensitivity to alcohol after surgery, help them to have realistic expectations and inform them of possible problems that may persist or arise after surgery. The outcomes were featured in the paper, ‘Patients’ views of long-term results of bariatric surgery for super-obesity: sustained effects, but continuing struggles’, published in SOARD.
The study sought to explore and describe patients’ long-term experiences after bariatric surgery and was designed to capture their overall experiences a decade after surgery. It included 18 patients (10 RYGB, 8 biliopancreatic diversion with duodenal switch (BPD/DS), the majority were female (61%), the mean age was 48±6 years, preoperative mean BMI was 55.5±3.7 kg/m2 and current mean BMI was 40.2±7.4 kg/m2.
None of the patients expressed regret about having surgery, although two (1 GBP and 1 BPD/DS) talked extensively about complications, 12 (6 from both procedures) talked about gastrointestinal side effects, ranging from mild problems (eg, temporary constipation) to more disabling conditions (eg, often needing a bathroom in close proximity). The authors said that via the interviews, two broad themes, sustained effects and continued struggles, emerged.
Many patients imagined that had they not had the surgery, they would now be dead or severely ill (n=10). Undergoing MBS was described as a turning point, and many perceived it as a last resort. Eating behaviour, especially control over eating, was singled out as changing for the better post-surgery, described as taking smaller portions of food, making healthier food choices, allowing more time for eating, or developing new taste preferences. Dumping was still recurring for many participants, especially when they ate too fast or foods too high in sugar or fat (n=9).
More than half (n=10) revealed an increased sensitivity to alcohol and now drink less than before surgery and less than their non-operated partners and friends, and found socialising around alcohol to be difficult. Participants’ weights also continued to fluctuate over time, but many described having a new lower weight ‘set-point’ (n=9). Some patients acknowledged that they were far from normal weight according to a BMI definition, but are able to live a functional and satisfying life at their current weight.
Other key findings included:
Some patients described having envisioned more complications and adverse effects from the surgery and the lack of expected complications was seen as helpful in their adaptations to their new lives after surgery (n=6).
Most patients expressed satisfaction with their care from the hospital and the surgical clinic, and they acknowledged that being part of a study had given them access to continued follow-up beyond standard care (n=12). Others however, expressed a need for more psychosocial follow-up (n=5) or more dietetic advice (n=3) from the hospital.
Most participants described their yearly follow-up in primary healthcare as non-existent or suboptimal, which they attributed both to themselves and to primary care.
Participants often experienced a lack of knowledge about bariatric surgery in primary healthcare centres (n=9), which undermined their confidence in this care.
Aside from efforts from healthcare professionals, many participants talked about getting vital support from their partners and families. When the support worked well it was described as a resource or a necessity for coping with surgery.
“We need to provide more proficient long-term follow-up after MBS, tailored to meet patients’ needs both at the surgical clinic and in primary care. Healthcare providers must realise that some patients are reluctant to seek additional care after MBS because they are afraid of disappointing the clinicians,” the authors concluded. “Patients’ tendency to accuse themselves can be prevented by informing them about what kinds of struggles are expected after MBS and encouraging them to return for help when problems arise. To avoid reinforcing patients’ self-blame and to facilitate a trustful therapeutic relationship all patients must be met by healthcare professionals with a non-judgmental and caring attitude.”