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Sweet-eaters and surgery

[Sweet-eating and surgery: does it affect the results?]

SWEET-EATING BEFORE AND AFTER BARIATRIC SURGERY: DOES IT AFFECT THE OUTCOME ?
The set of bariatric operations that are currently proposed require strict environmental conditions in order to achieve success in terms of weight-loss, resolution of comorbidities, and improvement of the quality of life. Diet counseling is mandatory before surgery and all over the post-operative period. Treatment success depends on this, but unfortunately these requirements are not always fullfilled and diet mistakes are quite common in the long run. The most frequent mistake is an excessive consumption of sugar food or nibling. Some operations are accused of favoring this type of behavior more often than others, namely restrictive operations such as vertical banded gastroplasties (Mason procedure) and for the time beeing particularly the Lap-banding. They have been even accused to encourage it.
One should separate two issues: 1. Patient selection before surgery: can those who have pre-op tests (eating questionnaires) indicating that they are sweet-eaters have the same operation as others ?
2. Secondary patient behavior (post-operatively): owing to food restriction and the poor ability to eat such food as red meat, some patients turn themselves to sweets, under the liquid form (sodas) or the semi-liquid form (ice-creams, chocolates, etc.). They are then likely to regain weight. Lap-banding authorizes adjustability, thus making it possible to correct this type of adverse effect. Very often one should not tighten the band in this case, because the problem will get worse; on the contrary it should be loosened, so that the patient get some time ahead to cope with more solid food, with a diet help. Meanwhile, the oesophagus will be relieved.
There is still an ongoing and tough debate over the surgical procedure: a recent controversy between two famous surgical teams has brought it to attention. Australian surgeons* stand for the placement of a gastric adjustable lap-band whatever the clinical situation (even for sweet-eaters), owing to the good results they have in the long run. Patients will change their habit eventually. American surgeons** think that this is too optimistic and are still in favor of bypass (Roux-en-Y gastro-jejunal bypass or RYGBP); it is indeed more agressive, but opposes specifically the excessive consumption of sugars through the well known "dumping syndrom". This is not a matter going to be settled down soon, and one has also described differences in behavior in various countries. This website is more inclined to adopt the Australian position... because the Lap-band offers good results for the time beeing and because patient selection according to their eating habits is not an easy task!

* SM Dixon, JB Dixon, PE O'Brien. Sweet eating is not a predictor of outcome after Lap-band placement. Can we finally bury the myth? Obesity Surgery 2002; 12: 789-94.
** HJ Sugerman et col. A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters. Ann Surg 1987; 205: 613-24.


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