Abstract
Background
Disordered bowel habits might influence quality of life after bariatric surgery. Different types of bariatric operations—gastric banding (AGB), Roux-en-Y gastric bypass (RYGB), or biliopancreatic diversion (BPD)—might alter bowel habits as a consequence of the surgical procedure used. Whether change in bowel habits affects quality of life after AGB, RYGB, or BPD differently is unknown.
Methods
The study group contained 290 severely obese patients undergoing bariatric surgery between August 1996 and September 2004 [BPD: n = 103, 64.1% women, age 43 ± 1 years (mean ± SEM), BMI 53.9 ± 0.9 kg/m2, weight 153.4 ± 2.9 kg; Roux-en-Y gastric bypass: n = 126, 73.0% women, age 43 ± 1 years, BMI 44.2 ± 0.3 kg/m2, weight 123.8 ± 1.5 kg; adjustable gastric banding (AGB): n = 61, 57.4% women, age 44 ± 1 years, BMI 49.9 ± 0.5 kg/m2, weight 146.1 ± 2.0 kg). Changes in bowel habits, flatulence, flatus odor, and effects on social life were estimated at least 4 months after surgery using a self-administered questionnaire.
Results
Fecal consistency changed significantly after surgery. Loose stools and diarrhea were more frequent after BPD and RYGB (P < 0.001) but more so after BPD than after either RYGB or AGB (P < 0.002). Constipation was more likely after AGB (P = 0.03). In addition, malodorous flatus affecting social life was more frequent after BPD than after either RYGB or AGB (P < 0.003). Furthermore, flatus frequency increased after BPD and RYGB, and patients were more bothered by their malodorous flatus than after AGB (all P < 0.001). Flatus severity score was highest in BPD, intermediate in RYGB, and lowest in AGB patients (all P < 0.001), a difference that was not influenced by frequency of metabolic syndrome before and after surgery. Moreover, observation period after surgery had no influence on overall results of bowel habits. Subsore quality of life bariatric analysis and reporting outcome system (BAROS) scores were largely similar between all three groups. However, flatulence severity score correlated inversely with quality of life estimated by BAROS in BPD and RYGB, but not in AGB patients.
Conclusions
The type of bariatric surgery affects bowel habits in an operation-specific manner, resulting mainly in diarrhea after BPD and RYGB, and constipation after AGB. Flatulence severity impairs quality of life most in BPD, is intermediate in RYGB, and is only minor after AGB, a phenomenon that was only partially mirrored in quality-of-life measures of BAROS.
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References
Scopinaro N, Gianetta E, Adami GF, et al. Biliopancreatic diversion for obesity at eighteen years. Surgery. 1996;119:261–8.
Scopinaro N, Marinari G, Camerini G, et al. Biliopancreatic diversion for obesity: State of the art. SOARD. 2005;1:317–28.
Totté E, Hendrickx L, van Hee R. Biliopancreatic diversion for treatment of morbid obesity: experience in 180 consecutive cases. Obes Surg. 1999;9:161–5.
Marinari GM, Murelli F, Camerini G, et al. A 15-year evaluation of biliopancreatic diversion according to the Bariatric Analysis Reporting Outcome System (BAROS). Obes Surg. 2004;14:325–8.
Oria HE. The BAROS and the Moorehead-Ardelt Quality of Life Questionnaire. Obes Surg. 2003;13:965.
National Institutes of Health Consensus Development Conference Draft Statement. Gastrointestinal surgery for severe obesity 25–27 March. Obes Surg. 1991;1:257–66.
Marceau P, Hould FS, Lebel S, Marceau S, Biron S. Complications of combined gastric restrictive and malabsorptive procedures: part 2. Curr Surg. 2003;60:274–9.
Buchwald H. 2004 ASBS Consensus Conference, Consensus Conference Statement Bariatric surgery for morbid obesity: Health implications for patients, health professionals, and third-party payers.
Scopinaro N, Gianetta E, Pandilfo N, et al. Biliopancreatic bypass. Proposal and preliminary experimental study of a new type of operation for the functional surgical treatment of obesity. Minerva-Chir. 1976;31:560–6.
Biertho L, Steffen R, Branson R, et al. Management of failed adjustable gastric banding. Surgery. 2005;137:33–41.
Brolin RE. Bariatric surgery and long-term control of morbid obesity. JAMA. 2002;288:2793–6.
Born P, Sekatcheva M, Rösch T, Classen M. Carbohydrate malabsorption in clinical rutine: a prospective observational study. Hepatogastroenterology. 2006;53(71):673–7.
Karlsson J, Taft C, Rydén A, et al. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes. 2007;31:1248–61.
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This work is original and has not been published previously, nor is it under consideration by another journal. We understand that the exclusive copyright of manuscripts accepted for publication will be assigned to Obesity Surgery. There are no commercial interests we need to disclose, nor any financial or material support.
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Potoczna, N., Harfmann, S., Steffen, R. et al. Bowel Habits After Bariatric Surgery. OBES SURG 18, 1287–1296 (2008). https://doi.org/10.1007/s11695-008-9456-4
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DOI: https://doi.org/10.1007/s11695-008-9456-4