Adaptability and compliance of the obese patient to restrictive gastric surgery in the short term.
BACKGROUND
Low compliance, as well as recurrent vomiting, are often pointed out as the main causes of both postoperative technical complications and poor weight loss.


METHODS
50 patients were examined. All underwent preoperative psychological assessment through an intensive clinical interview. Between October 1999 and January 2000, all the patients underwent vertical banded gastroplasty (VBG). Excess Weight Loss (EWL) was followed, and the number of vomiting episodes was recorded at 1, 3 and 6 months after surgery.


RESULTS
3 different groups of patients could be distinguished: 1) those with no vomiting and good weight loss; 2) those with sporadic vomiting and fairly good weight loss; and 3) those with frequent vomiting and poorer weight loss. However, this last group of patients was not homogeneous and should be divided into 2 subgroups: 1) patients who lose weight, while vomiting; 2) patients who do not lose weight, while vomiting.


CONCLUSIONS
The experience of vomiting is a crucial cross-roads. The influence of psychosocial factors was noticed in all patients. The absence of psychosocial stressors, together with realistic expectations and a strong motivation to change, should be considered as reliable and replicable predictors of success. However, even those patients with accentuated psychological difficulties were able to succeed in coping with them, and achieved a good weight outcome, with good effects on the psychic side. Therefore, the evidence of psychological disorders cannot be taken as an absolute criterion of selection/exclusion of candidates for the operation. Accurate presurgical education and postoperative psychological support are likely to increase the patient's compliance and the percentage of successful cases.
Pessina
A
A
Department of Surgery, Prof. E. Morelli Clinic Institute, Pavia, Italy.
Andreoli
M
M
Vassallo
C
C
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects / Q000523:psychology*; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D009042:Motivation; D020380:Needs Assessment; D010349:Patient Compliance / Q000523:psychology*; D010353:Patient Education as Topic; D018579:Patient Selection; D011237:Predictive Value of Tests; D012307:Risk Factors; D012944:Social Support; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control / Q000523:psychology*; D015431:Weight Loss