Page 144 - When surgery alone won’t cut it - Valerie Maureen Monpellier

Chapter 8 - Discussion
for BCS had a lower HRQoL compared to patients who do desire BCS. Once again showing that the influence of excess skin on patient well-being is important; and thus, that the evaluation of influence of excess skin on patient well-being should be part of decision making for reimbursement.
GASTRIC SLEEVE
The first part of this thesis focused solely on the RYGB, which is the most performed type of bariatric surgery in the Netherlands 65. Looking at the world trends in bariatric surgery, the question is whether the results of these chapters can be extrapolated to other types of bariatric surgery, such as the gastric sleeve (GS), which was the most performed type of surgery in 2014 worldwide 66. Two recent studies have shown that effect on weight loss, HRQoL and comorbidities are comparable between RYGB and GS 67, 68. And thus, it would seem that the implications of results of the first part of this thesis could be similar to patients undergoing a GS.
CONCLUSION
This thesis proves that self-reported, preoperative binge eating, depressive symp- toms, eating style and physical activity are not predictive of weight loss after surgery. It also shows that postoperative physical and psychological factors are related to weight loss and thereby HRQoL after bariatric surgery. Several of these factors, like depressive symptoms, body image and weight loss, are also related to each other. In order to improve weight loss results in the bariatric population, more focus should be directed to these factors. Not only in research, but also in pre- and post-opera- tive counselling. Efforts should also be made to extensively inform the morbid obese patients of both the positive and negative side-effects of bariatric surgery, including excess skin and criteria for reimbursement of BCS.
In addition, excess skin seems to be a very important parameter in patient well-being after bariatric surgery, and thereby maybe also weight loss maintenance. In collabora- tion with the bariatric surgeons, plastic surgeon should improve Dutch reimbursement guidelines for BCS. Communication of these guidelines to bariatric patients should also be a joint effort.
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