title: Patients with psychiatric comorbidity can safely undergo bariatric surgery with equivalent success.
abstract: BACKGROUND
  Patients with psychiatric disorder were reported to have a poor outcome in bariatric surgery. Few studies have examined the outcome of laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) in patients with psychiatric history. We aimed to compare excess weight loss (%EWL) in patients with and without psychiatric comorbidities who underwent LSG or LAGB.
  
  
  METHODS
  Patients undergoing LSG or LAGB were identified from our prospective database. A multidisciplinary team evaluated all patients preoperatively, including a psychological evaluation. Patients with the diagnosis of depression, anxiety, bipolar disorder, and schizophrenia were included in the psychiatric comorbidity group (PSY). Others were included in group NON-PSY. All patients were first screened to be psychologically stable to undergo surgery. Initial BMI and %EWL at 3, 6, and 12 months postoperatively were compared.
  
  
  RESULTS
  A total of 590 patients (81.4 % women), with a median BMI of 43.8 kg/m(2) (range 30-99) who underwent LSG (n = 222) or LAGB (n = 368) from January 2006 to June 2013, were identified. Psychiatric comorbidities that were well controlled at the time of surgery were found in 188 patients (31.9%). Diagnostic criteria for depression were met in 154 patients (26.1%), 75 patients suffered from anxiety (12.7%), 9 from bipolar disorder, and 4 from schizophrenia (0.7%). Initial BMI was not different between the two groups. No significant difference in %EWL between the groups was found during follow-up (44.13 vs. 43.37%EWL, respectively, at 1 year; p = 0.76). When LSG and LAGB patients were analyzed as subsets, again no difference in %EWL at 1 year was found for PSY vs. NON-PSY (LSG: 51.56 vs. 54.86%EWL; LAGB: 38.48 vs. 38.45%EWL, all p = ns). In multivariate analysis, the differences from unadjusted analysis persisted.
  
  
  CONCLUSIONS
  These findings demonstrate that a similar %EWL can be achieved in patients undergoing LSG or LAGB despite the presence of well-controlled psychiatric comorbidity.
authors.affiliation: Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA. hfuchs@ucsd.edu.|Department of Surgery, University of Cologne, Cologne, Germany. hfuchs@ucsd.edu.
authors.forename: Hans F
authors.initials: HF
authors.lastname: Fuchs
authors.affiliation: Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Laughter
authors.affiliation: Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA.
authors.forename: Cristina R
authors.initials: CR
authors.lastname: Harnsberger
authors.affiliation: Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Broderick
authors.affiliation: Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Berducci
authors.affiliation: Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: DuCoin
authors.affiliation: Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Langert
authors.affiliation: Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA.
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Sandler
authors.affiliation: Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA.
authors.forename: Garth R
authors.initials: GR
authors.lastname: Jacobsen
authors.affiliation: Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
authors.forename: William
authors.initials: W
authors.lastname: Perry
authors.affiliation: Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA.
authors.forename: Santiago
authors.initials: S
authors.lastname: Horgan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery*; D012189:Retrospective Studies; D015431:Weight Loss; D055815:Young Adult
keywords: Abdominal; Bariatric; Clinical papers; G-I; Gut; Obesity; Research; Trials
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