Friday, November 23, 2007

Is it really important to do the follow-up visits after bariatric surgery?

After weight loss surgery (let's say gastric bypass or Lap Band), the majority of patients will initially lose some of their excess weight very well. In fact, they may do so well that they take for granted their weight loss trend, and some become less and less compliant with their follow-ups. Does it make a difference? Should patients do their follow-ups with their bariatric surgery programs, in addition to the usual check-ups with their own family doctors? We always felt that patients benefit tremendously from being committed to their long-term follow-ups. Is there any evidecne that long-term follow-ups make any difference? A study is published in the Nov-Dec 2007 issue of the journal "Surgery for Obesity and Related Diseases" titled "Impact of routine and long-term follow-up on weight loss after laparoscopic gastric bypass". It is another addition to a mounting evidence. The authors, (Gould JC, Beverstein G, Reinhardt S, Garren MJ) from the University of Wisconsin School of Medicine, Madison, Wisconsin, looked into the data of patients with 3-4 years of follow-up data after laparoscopic gastric bypass. The patients were divided into 3 groups:

Group 1 patients: had attended every scheduled postoperative appointment
Group 2 patients had attended every appointment for 1 year, then were lost to follow-up
Group 3 patients had been lost to follow-up before 1 year.

Although the excess weight loss (EWL) did not differ at 1 year of follow-up, a significant difference in the EWL was observed at 3-4 years (74% for Group 1; 61% for Group 2; 56% for Group 3). The authors found that the most common explanation for missed follow-up appointments was a lack of insurance coverage. They concluded that on-going, multidisciplinary care is likely a critical component in maintaining the benefit after surgery.

Source Article:
Gould JC, Beverstein G, Reinhardt S, Garren MJ. Impact of routine and long-term follow-up on weight loss after laparoscopic gastric bypass. Surg Obes Relat Dis. 2007 Nov-Dec;3(6):627-30. PMID: 17950045 (Abstract)

Other References:

Shen R, Dugay G, Rajaram K, Cabrera I, Siegel N, Ren CJ. Impact of patient follow-up on weight loss after bariatric surgery. Obes Surg. 2004 Apr;14(4):514-9. PMID: 15130229 (Abstract)

Harper J, Madan AK, Ternovits CA, Tichansky DS. What happens to patients who do not follow-up after bariatric surgery? Am Surg. 2007 Feb;73(2):181-4. PMID: 17305299 (Abstract)

"Surgery for Obesity and Related Diseases" (SOARD) is the official journal of the American Society for Metabolic and Bariatric Surgery (ASMBS) and the Brazilian Society for Bariatric Surgery (SBCBM - Sociedade Brasileira de Cirurgia Bariátrica e Metabólica).

Obesity surgery" is the official journal of several international societies including, among many others, the International Federation for the Surgery of Obesity (IFSO) , the Obesity Surgery Society of Australia and New Zealand and the French Society for Obesity Surgery (Société Française de Chirurgie de l'Obésité)