Advertisement

Surgical Endoscopy

, Volume 30, Issue 1, pp 251–258 | Cite as

Patients with psychiatric comorbidity can safely undergo bariatric surgery with equivalent success

  • Hans F. FuchsEmail author
  • Vanessa Laughter
  • Cristina R. Harnsberger
  • Ryan C. Broderick
  • Martin Berducci
  • Christopher DuCoin
  • Joshua Langert
  • Bryan J. Sandler
  • Garth R. Jacobsen
  • William Perry
  • Santiago Horgan
Article

Abstract

Introduction

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/m2 (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.

Conclusion

These findings demonstrate that a similar %EWL can be achieved in patients undergoing LSG or LAGB despite the presence of well-controlled psychiatric comorbidity.

Keywords

Bariatric Abdominal Clinical papers Trials Research Obesity Gut G-I 

Notes

Disclosures

Drs. Fuchs, Laughter, Harnsberger, Broderick, Berducci, DuCoin, Langert, Jacobsen, Sandler, Perry, and Horgan have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Flegal KM, Carroll MD, Ogden CL, Curtin LR (2010) Prevalence and trends in obesity among US adults, 1999–2008. JAMA 303(3):235–241PubMedCrossRefGoogle Scholar
  2. 2.
    Moyer VA (2012) US Preventive Services Task Force. Screening for and management of obesity in adults: US Preventive Services Task Force recommendation statement. Ann Intern Med 157(5):373–378PubMedGoogle Scholar
  3. 3.
    Look AHEAD Research Group, Wing RR, Bolin P, Brancati FL, Bray GA, Clark JM, Coday M, Crow RS, Curtis JM, Egan CM, Espeland MA, Evans M, Foreyt JP, Ghazarian S, Gregg EW, Harrison B, Hazuda HP, Hill JO, Horton ES, Hubbard VS, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Kitabchi AE, Knowler WC, Lewis CE, Maschak-Carey BJ, Montez MG, Murillo A, Nathan DM, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Reboussin D, Regensteiner JG, Rickman AD, Ryan DH, Safford M, Wadden TA, Wagenknecht LE, West DS, Williamson DF, Yanovski SZ (2013) Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 369(2):145–154CrossRefGoogle Scholar
  4. 4.
    Picot J, Jones J, Colquitt JL, Gospodarevskaya E, Loveman E, Baxter L, Clegg AJ (2009) The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess 13(41):1–190, 215–357, iii–ivGoogle Scholar
  5. 5.
    Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292(14):1724–1737PubMedCrossRefGoogle Scholar
  6. 6.
    American Society for Metabolic and Bariatric Surgery. Bariatric Procedures estimates. http://asmbs.org/2014/03/estimate-of-bariatric-surgery-numbers. Accessed 5 July 2014
  7. 7.
    Regan JP, Inabnet WB, Gagner M, Pomp A (2003) Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg 13(6):861–864PubMedCrossRefGoogle Scholar
  8. 8.
    Belachew M, Legrand M, Vincent V, Lismonde M, Le Docte N, Deschamps V (1998) Laparoscopic adjustable gastric banding. World J Surg 22(9):955–963PubMedCrossRefGoogle Scholar
  9. 9.
    Galvani C, Gorodner M, Moser F, Baptista M, Chretien C, Berger R, Horgan S (2006) Laparoscopic adjustable gastric band versus laparoscopic Roux-en-Y gastric bypass: ends justify the means? Surg Endosc 20(6):934–941PubMedCrossRefGoogle Scholar
  10. 10.
    Horgan S, Holterman MJ, Jacobsen GR, Browne AF, Berger RA, Moser F, Holterman AX (2005) Laparoscopic adjustable gastric banding for the treatment of adolescent morbid obesity in the United States: a safe alternative to gastric bypass. J Pediatr Surg 40(1):86–90; discussion 90-1Google Scholar
  11. 11.
    Aarts EO, Dogan K, Koehestanie P, Aufenacker TJ, Janssen IM, Berends FJ (2014) Long-term results after laparoscopic adjustable gastric banding: a mean fourteen year follow-up study. Surg Obes Relat Dis 10(4):633–640PubMedCrossRefGoogle Scholar
  12. 12.
    Kalarchian MA, Marcus MD, Levine MD, Soulakova JN, Courcoulas AP, Wisinski MS (2008) Relationship of psychiatric disorders to 6-month outcomes after gastric bypass. Surg Obes Relat Dis 4(4):544–549PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Powers PS, Rosemurgy A, Boyd F, Perez A (1997) Outcome of gastric restriction procedures: weight, psychiatric diagnoses, and satisfaction. Obes Surg 7(6):471–477PubMedCrossRefGoogle Scholar
  14. 14.
    Dubovsky SL, Haddenhorst A, Murphy J, Liechty RD, Coyle DA (1985–1986) A preliminary study of the relationship between preoperative depression and weight loss following surgery for morbid obesity. Int J Psychiatry Med 15(2):185–196Google Scholar
  15. 15.
    Semanscin-Doerr DA, Windover A, Ashton K, Heinberg LJ (2010) Mood disorders in laparoscopic sleeve gastrectomy patients: does it affect early weight loss? Surg Obes Relat Dis 6(2):191–196PubMedCrossRefGoogle Scholar
  16. 16.
    Kalarchian MA, Marcus MD, Levine MD, Courcoulas AP, Pilkonis PA, Ringham RM, Soulakova JN, Weissfeld LA, Rofey DL (2007) Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status. Am J Psychiatry 164(2):328–334; quiz 374Google Scholar
  17. 17.
    Guisado JA, Vaz FJ, López-Ibor JJ Jr, Rubio MA (2001) Eating behavior in morbidly obese patients undergoing gastric surgery: differences between obese people with and without psychiatric disorders. Obes Surg 11(5):576–580PubMedCrossRefGoogle Scholar
  18. 18.
    Barrash J, Rodriguez EM, Scott DH, Mason EE, Sines JO (1987) The utility of MMPI subtypes for the prediction of weight loss after bariatric surgery. Minnesota Multiphasic Personality Inventory. Int J Obes 11(2):115–128PubMedGoogle Scholar
  19. 19.
    Montgomery SA, Asberg M (1979) A new depression scale designed to be sensitive to change. Br J Psychiatry 134(4):382–389PubMedCrossRefGoogle Scholar
  20. 20.
    Radloff LS (1977) The CES-D scale: a self report depression scale for research in the general population. Appl Psychol Measure 1:385–401CrossRefGoogle Scholar
  21. 21.
    Broderick RC, Fuchs HF, Harnsberger CR, Sandler BJ, Jacobsen GR (2014) Comparison of bariatric restrictive operations: laparoscopic sleeve gastrectomy and laparoscopic gastric greater curvature plication. Surg Technol Int 25:82–89PubMedGoogle Scholar
  22. 22.
    Henry C (2002) Lithium side-effects and predictors of hypothyroidism in patients with bipolar disorder: sex differences. J Psychiatry Neurosci 27(2):104–107PubMedPubMedCentralGoogle Scholar
  23. 23.
    Honig A, Arts B, Ponds R, Riedel W (1999) Lithium induced cognitive side-effects in bipolar disorder: a qualitative analysis and implications for a daily practice. Int Clin Psychopharmacol 14:167–171PubMedGoogle Scholar
  24. 24.
    Galioto R, Gunstad J, Heinberg LJ, Spitznagel MB (2013) Adherence and weight loss outcomes in bariatric surgery: does cognitive function play a role? Obes Surg 23(10):1703–1710PubMedCrossRefGoogle Scholar
  25. 25.
    Hasnain M, Vieweg WV (2013) Weight considerations in psychotropic drug prescribing and switching. Postgrad Med 125(5):117–129PubMedCrossRefGoogle Scholar
  26. 26.
    Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost all antipsychotics result in weight gain: a meta-analysis. PLoS ONE 9(4):e94112PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J (2008) American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Surg Obes Relat Dis 4(5 Suppl):S109–S184PubMedCrossRefGoogle Scholar
  28. 28.
    Valley V (1984) Preoperative psychologic assessment in determining outcome from gastric stapling for morbid obesity. Can J Surg 27(2):129–130PubMedGoogle Scholar
  29. 29.
    Hamoui N, Kingsbury S, Anthone GJ, Crookes PF (2004) Surgical treatment of morbid obesity in schizophrenic patients. Obes Surg 14(3):349–352PubMedCrossRefGoogle Scholar
  30. 30.
    Burchett MA, McKenna DT, Selzer DJ, Choi JH, Mattar SG (2015) Laparoscopic sleeve gastrectomy is safe and effective in elderly patients: a comparative analysis. Obes Surg 25(2):222–228PubMedCrossRefGoogle Scholar
  31. 31.
    Gullick AA, Graham LA, Richman J, Kakade M, Stahl R, Grams J (2014) Association of race and socioeconomic status with outcomes following laparoscopic Roux-en-Y Gastric Bypass. Obes Surg. 2014 Oct 11 [Epub ahead of print]Google Scholar
  32. 32.
    Bayham BE, Bellanger DE, Hargroder AG, Johnson WD, Greenway FL (2012) Racial differences in weight loss, payment method, and complications following Roux-en-Y gastric bypass and sleeve gastrectomy. Adv Ther 29(11):970–978PubMedCrossRefGoogle Scholar
  33. 33.
    Lelwica M, Hoglund E, McNallie J (2009) Spreading the religion of thinness from California to Calcutta: a critical feminist postcolonial analysis. JFSR 25(1):19–41Google Scholar
  34. 34.
    Lahti M, Tiihonen J, Wildgust H, Beary M, Hodgson R, Kajantie E, Osmond C, Räikkönen K, Eriksson J (2012) Cardiovascular morbidity, mortality and pharmacotherapy in patients with schizophrenia. Psychol Med 42(11):2275–2285PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Hans F. Fuchs
    • 1
    • 2
    Email author
  • Vanessa Laughter
    • 3
  • Cristina R. Harnsberger
    • 1
  • Ryan C. Broderick
    • 1
  • Martin Berducci
    • 1
  • Christopher DuCoin
    • 1
  • Joshua Langert
    • 1
  • Bryan J. Sandler
    • 1
  • Garth R. Jacobsen
    • 1
  • William Perry
    • 3
  • Santiago Horgan
    • 1
  1. 1.Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of SurgeryUniversity of California, San DiegoLa JollaUSA
  2. 2.Department of SurgeryUniversity of CologneCologneGermany
  3. 3.Department of PsychiatryUniversity of California, San DiegoLa JollaUSA

Personalised recommendations