Cross Validation of the Moorehead-Ardelt Quality of Life Questionnaire II with WHOQOL and SF36 andClinical Application

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Bariatric & Metabolic International Surgery Center,E-Da hospital,Taiwan 2Department of InternalMedicine,E-Da hospital,Taiwan
Huai-Ching

Kuo1,Chi-Hsien Lo1,Chih-Kun

Huang1,Chi-Yang

Chang2

Background: Obesity has become a major worldwide public health issue. There is a need for tools to measurepatient reported bariatric outcomes. The Moorehead-Ardelt Quality of Life Questionnaire II (MA-II)
contains six items. The objective of this study was to translate the MA II into Chinese and validate
it in patients with morbid obesity.
Methods: The MA-II was translated into Chinese and backtranslated into English by two language specialists
to create the Taiwan version, which was validated by correlations with two other generic questionnairesof health-related quality of life (HRQOL), Medical Outcomes Study 36-Item Short-Form Health Survey(SF-36), and World Health Organization Quality of Life (WHOQOL)-BREF Taiwan version. The convergent
validity was accomplished by a series of Spearman rank correlations. Reliability of the MA-II Taiwanversion was determined by internal consistency obtained by Cronbach alpha coefficient and test-retest
reliability obtained by intraclass correlation coefficient.
Results:One hundred subjects with morbid obesity were enrolled to test the MA II Taiwan version convergent
validity and internal consistency. Test-retest studies (2 weeks apart) were applied to 30 morbidly obese
patients. Satisfactory internal consistency was demonstrated by a Cronbach alpha coefficient of 0.79.
Good test&-retest reliability was shown by intraclass correlations ranging from 0.73 to 0.91. The totalsum of MA-II scores was significantly correlated with all four domains of the WHOQOL-BREF and two major
components of SF-36 . All six MA-II items showed significant correlations with each other , and totalsum of MA-II scores was negatively correlated with body mass index , indicating a one-dimensionalquestionnaire of HRQOL.
Conclusions:The MA-II Taiwan version is an obesity-specific questionnaire for QOL evaluation withsatisfactory reliability and validity. It has the advantages of extensive evaluation for HRQOL,
cross-cultural application, rapid completion, high response rates, and an advanced scoring system.

Change in Quality of life at 12 months after Bariatric Surgery in Morbidly Obese patients

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The Department of Weight Loss Surgery, Yotsuya Medical Cube, Tokyo, Japan

Kazuko Sonoda1,Kazunori Kasama1,Yosuke Seki1,Hideharu Shimizu1,Kikkawa Eri1,Tetsuya Nakazato1,Toshie
Shiraishi1

Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the gold standard method in BariatricSurgery. However, considering that gastric cancer is one of the most common diseases in Asia, Kasama
has introduced Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass (LSG/DJB). Now LSG/DJB isbecoming an effective procedure for the treatment of morbidly obese patients in Japan. In this study,
we compared Quality of Life (QOL) and excess weight loss (EWL) 12 months after LRYGB and LSG/DJB.MethodsWe
compared 38 patients who under went LRYGB (Group B) and 25 patients who under went LSG/DJB (Group SB)
between June 2006 and March 2009. QOL factors assessed were Social Life, Confidence, Figure, Depression,Healthiness, Activity and Exercise. We had given Q&A sheets to the patients and asked them to evaluate
their improvement in these factors. We have created an Improvement Score from 1 to 5 (5 beingthe bestcondition). We have also analyzed EWL in both groups.Results12 months after surgery, all QOL factors
were improved in both groups. There was no significant difference in mean score of QOL in all factors
between Group B and Group SB. There was no significant difference in EWL between both groups.
ConclusionLRYGB is considered to be the most popular procedure in Bariatric Surgery, but we suggest that
LSG/DJB could also be an effective procedure from a view point of QOL and EWL.

An Individual Surgeon versus a Team Approach: Surgical Outcomes of Laparoscopic Roux-en-Y Gastric Bypass

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E-Da Bariatric & Metabolic International Surgery Center

Ya-WeiHuang1,Chi-Hsien Lo1,Chih-Kun

Huang1

Purpose: Laparoscopic Roux-5 en-Y gastric bypass (LRYGB) has been shown to improve both the health andquality of life of morbidly obese patients. We studied to compare the efficacy and safety of using ateam approach to LRYGB versus an individual surgeon.Materials and Methods:Data were retrospectively
collected from 200 consecutive patients undergoing LRYGB for morbid obesity between August 2005 andFebruary 2008. Group I (GI) and Group II (GII) included 50 patients who underwent surgery and were cared
for by the same surgeon. Group III (GIII) included the next 100 consecutive patients, who underwent LRYGB
by the same surgeon, but were cared for by a dedicated bariatric team.Results: Among the 76 males (38%)
and 124 females (62%) in the study, excess weight loss at 1and 3 months follow-up did not differ; however,it was significantly different at 6 months and 12 months. At mean follow-up, 30% in GI, 6% in GII, and
8% in GIII experienced complications. Most complications in the GI group occurred early and were related
to surgical technique, while in groups GII and GIII, complications related to technique were markedly
reduced. Males were 4.57 times as likely as females to have complications related to bariatricsurgery.Conclusions: A team-based approach is a better option for patients undergoing LRYGB than is caredby a single surgeon. With an experienced bariatric surgeon, the team approach resulted in shorter
operative times and hospital stays, better weight loss without increased complications.

Difference Between Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Regarding Weight Loss
Effect and Amount of Food Intake According to Level of BMI

Yotsuya Medical CubeEri Kikkawa , Kazunori Kasama , Yosuke Seki , Hideharu Shimizu , Tetsuya Nakazato , Kazuko Sonoda<Background>Laparoscopic sleeve gastrectomy (LSG) for morbidly obese patients is gaining popularity in Japan. It’s
indications and long-term results are currently under evaluation, whereas laparoscopic Roux-en-Y gastricbypass (LRYGB) is the golden standard procedure with good long term outcomes. In addition, some articles
reported that LSG could not lead to sufficient weight loss for super morbid obesity. This study aimed
to compare the difference of excess weight loss (EWL) and amount of food intake of patients with BMI< 50 or ≧ 50 between LSG and LRYGB.
<Methods>
For this study, 123 patients who underwent LRYGB (48patients) or LSG (75 patients) were retrospectively
analyzed for 24 months after surgery. There are 101 patients with BMI < 50 in LSG group (n=60) or LRYGB
group (n=41), and 22 patients with BMI ≧ 50 in LSG group (n=15) or LRYGB group (n=7). We compare theEWL and the amount of food intake after LSG to those after LRYGB according to BMI. We analyzed the amountof food intake by means of diet recall and a questionnaire.

We defined the preoperative amount of foodintake as 100% and calculated the rate of change after surgery.
<Results>
As for BMI < 50, the percentage of EWL and the rate of change of food intake at 24 –month follow up point
were 81.7% and 52% in LSG group and 82.8% and 47% in LRYGB group. As for BMI ≧ 50, the percentage ofEWL and the rate of change of food intake at 24-month follow up point were 29.8% and 54% in LSG group
and 62.3% and 58% in LRYGB group. This data show that the EWL of patients with BMI≧50 after LSG at 24-monthfollow up point is not comparable to the other results, but the rate of change of food intake of thesame group is comparable.
<Conclusion>
As for BMI≧50, we need to restrict the amount of food intake after LSG more than LRYGB for the purposeof bettering the EWL. However, it means that LSG can be a standalone procedure for morbidly obese patientswith BMI<50 as well as LRYGB, but LSG is not expected to be performed as a solo procedure for the patientswith BMI≧50.

Evaluation of the Clinical Pathway for Laparoscopic Bariatric Surgery

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The Department of Weight Loss Surgery, Yotsuya Medical Cube, Tokyo, JapanMai Yamashita1,Kanako Yuasa1,Hideharu

Shimizu1,Yosuke Seki1,Kazunori Kasama1,Megumi Tanimura1<Background>Clinical Pathways (CPs) are comprehensive systematical patient care plans for specificprocedures. The CPs for morbid obesity were implemented in our department in February 2006. The aim of
this study is to evaluate the CPs for laparoscopic bariatric surgery.<Methods>The CPs were applied to
the 189 patients who underwent bariatric surgery. The assessment criteria included degree of compliancewith hospital stay, indicators of clinical care effectiveness, and comparison with the other CP reported
in Pubmed.<Results>Fig. shows the number and rate of noncompliance with hospital stay in different
bariatric procedures. The only reason for noncompliance with hospital stay was patient-dependent causes.
There was no staff-related or institution-related reason. This result was almost similar to that reported
in the past from Spain.<Conclusion>Our data show that compliance with hospital stay depends on thedifficulty of bariatric surgery. From the point of view of the reason of noncompliance with hospitalstay, clinical pathway which is controlled by a team with a wide experience in bariatric surgery canoffer our patients with morbid obesity bariatric surgery with the smallest possible range ofcomplications.