title: Long-term outcomes following laparoscopic adjustable gastric banding: postoperative psychological sequelae predict outcome at 5-year follow-up.
abstract: BACKGROUND
  NICE guidelines state that patients with psychological contra-indications should not be considered for bariatric surgery, including Laparoscopic Adjustable Gastric Banding (LAGB) surgery as treatment of morbid obesity, although no consistent correlation between psychiatric illness and long-term outcome in LAGB has been established. This is to our knowledge the first study to evaluate long-term outcomes in LAGB for a full range of DSM-IV defined psychiatric and eating disorders, and forms part of a research portfolio developed by the authors aimed at defining psychological predictors of bariatric surgery in the short-, medium- and long-term.
  
  
  METHODS
  Case notes of 37 subjects operated on between April 1997 and June 2000, who had undergone structured clinical interview during pre-surgical assessment to yield diagnoses of mental and eating disorders according to DSM-IV criteria were analyzed according to a set of operationally defined criteria. Statistical analysis was carried out to compare those with a poor outcome and those considered to have a good outcome in terms of psychiatric profile.
  
  
  RESULTS
  In this group of mainly female, Caucasian subjects, ranging in age from 27 to 60 years, one-third were diagnosed with a mental disorder according to DSM-IV criteria. The development of postoperative DSM-IV defined binge eating disorder (BED) or depression strongly predicted poor surgical outcome, but pre-surgical psychiatric factors alone did not.
  
  
  CONCLUSIONS
  Although pre-surgical psychiatric assessment alone cannot predict outcome, an absence of preoperative psychiatric illness should not reassure surgeons who should be mindful of postoperative psychiatric sequelae, particularly BED. The importance of providing an integrated biopsychosocial model of care in bariatric teams is highlighted.
authors: Department of Psychiatry, St. Georges Medical School, University of London, UK. sscholtz@sgul.ac.uk
authors: Samantha
authors: S
authors: Scholtz
authors: Louise
authors: L
authors: Bidlake
authors: John
authors: J
authors: Morgan
authors: Alberic
authors: A
authors: Fiennes
authors: Ashraf
authors: A
authors: El-Etar
authors: John Hubert
authors: JH
authors: Lacey
authors: Sara
authors: S
authors: McCluskey
mesh_terms: D000328:Adult; D001068:Feeding and Eating Disorders / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000379:methods* / Q000523:psychology*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D013997:Time Factors; D016896:Treatment Outcome