Adaptability and compliance of the obese patient to restrictive gastric surgery in the short term

Background: Low compliance, as well as recurrent vomiting, are often pointe d out as the main causes of both postoperative technical complications and poor weight loss. Methods: 50 patients were examined. All underwent preoperative psychologica l assessment through an intensive clinical interview. Between October 1999 and January 2000, all the patients underwent vertical banded gastroplasty ( VBG). Excess Weight Loss (EWL) was followed, and the number of vomiting epi sodes was recorded at 1, 3 and 6 months after surgery. Results: 3 different groups of patients could be distinguished: 1) those wi th no vomiting and good weight loss; 2) those with sporadic vomiting and fa irly good weight loss; and 3) those with frequent vomiting and poorer weigh t loss. However, this last group of patients was not homogeneous and should be divided into 2 subgroups: 1) patients who lose weight, while vomiting; 2) patients who do not lose weight, while vomiting. Conclusions: The experience of vomiting is a crucial cross-roads. The influ ence of psychosocial factors was noticed in all patients. The absence of ps ychosocial stressors, together with realistic expectations and a strong mot ivation to change, should be considered as reliable and replicable predicto rs of success. However, even those patients with accentuated psychological difficulties were able to succeed in coping with them, and achieved a good weight outcome, with good effects on the psychic side. Therefore, the evide nce of psychological disorders cannot be taken as an absolute criterion of selection/exclusion of candidates for the operation. Accurate presurgical e ducation and postoperative psychological support are likely to increase the patient's compliance and the percentage of successful cases.