title: Long-term follow-up after gastric surgery for morbid obesity: preoperative weight loss improves the long-term control of morbid obesity after vertical banded gastroplasty.
abstract: BACKGROUND
  Gastric restrictive surgery in a large non-university teaching hospital has been combined with preoperative weight loss by diet. The aims of preoperative dieting were to test patient motivation, to reduce perioperative morbidity, to accustom patients to the restriction of food intake after surgery, and to increase total weight loss. This study was performed to investigate the long-term results of this approach.
  
  
  METHODS
  200 morbidly obese persons were operated on between 1978 and 1986 after they had lost more than 50% of their excess weight by diet. 100 Roux-en-Y gastric bypasses (RYGB) and, after 1983, 100 vertical banded gastroplasties (VBG) were performed. Data from medical records and data concerning present weight, complaints, food intolerance, nutritional deficiencies, and medical follow-up visits were obtained by questionnaire.
  
  
  RESULTS
  The lowest body weight was obtained 1 year after operation with an average excess weight loss (EWL) of 78% after RYGB and 75% after VBG. Body weight gradually increased, and 7 years after surgery the average EWL was 67% after RYGB and 63% after VBG. Ten patients had died (three postoperatively after RYGB). Preoperative dieting did not decrease perioperative morbidity and mortality in comparison with other reports.
  
  
  CONCLUSIONS
  After combined preoperative dieting and VBG, weight loss is greater than after surgery alone. No additional weight loss after preoperative dieting was observed in RYGB patients. Most patients who underwent bariatric surgery still experience nutritional, physical, and cosmetic problems 7 years after surgery.
authors.affiliation: Department of Internal Medicine, Ruwaard van Putten Ziekenhuis, Spijkenisse, The Netherlands.
authors.forename: E J
authors.initials: EJ
authors.lastname: van de Weijgert
authors.forename: C H
authors.initials: CH
authors.lastname: Ruseler
authors.forename: J W
authors.initials: JW
authors.lastname: Elte
mesh_terms: D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D018752:Diet, Fat-Restricted; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000178:diet therapy* / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss