Long-term follow-up after gastric surgery for morbid obesity: Preoperativeweight loss improves the long-term control of morbid obesity after vertical banded gastroplasty

Background: Gastric restrictive surgery in a large non-university teaching hospital has been combined with preoperative weight toss by diet. The aims of preoperative dieting were to test patient motivation, to reduce perioper ative morbidity, to accustom patients to the restriction of food intake aft er surgery, and to increase total weight toss. This study was performed to investigate the long-term results of this approach. Methods: 200 morbidly obese persons were operated on between 1978 and 1986 after they had lost more than 50% of their excess weight by diet. 100 Roux- en-Y gastric bypasses (RYGB) and, after 1983, 100 vertical banded gastropla sties (VBG) were performed. Data from medical records and data concerning p resent weight, complaints, food intolerance, nutritional deficiencies, and medical follow-up visits were obtained by questionnaire. Results: The lowest body weight was obtained 1 year after operation with an average excess weight loss (EWL) of 78% after RYGB and 75% after VBG. Body weight gradually increased, and 7 years after surgery the average EWL was 67% after RYGB and 63% after VBG. Ten patients had died (three postoperativ ely after RYGB). Preoperative dieting did not decrease perioperative morbid ity and mortality in comparison with other reports. Conclusions: After combined preoperative dieting and VBG, weight loss is gr eater than after surgery alone. No additional weight loss after preoperativ e dieting was observed in RYGB patients. Most patients who underwent bariat ric surgery still experience nutritional, physical, and cosmetic problems 7 years after surgery.