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Patients' Perspectives on Laparoscopic Adjustable Gastric Banding (LAGB) Aftercare Attendance: Qualitative Assessment

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Abstract

Background

Despite recognition of the importance of laparoscopic adjustable gastric banding (LAGB) aftercare for optimal surgical outcomes and the failure of some patients to attend regularly, factors influencing LAGB aftercare attrition have not been thoroughly examined in the literature.

Methods

Patients' perspectives on LAGB aftercare attendance were explored using a qualitative research methodology. Twenty-four LAGB patients who either (1) did not attend aftercare (n = 12) or (2) attended aftercare regularly (n = 12) were interviewed. Data were analysed using grounded theory methods.

Results

Four common processes emerged from patients' descriptions: (1) barriers to attendance, (2) purely medical service, (3) non-patient centred approach, and (4) behavioural and psychological aspects of behavioural changes. Regular attendees typically reported (1) a commitment to aftercare, (2) a need to make the band work, (3) regular monitoring motivated attendance, and (4) happiness with the improved health. Non-regular attendees perceived (1) that aftercare is more relevant early on after the surgery, (2) insufficient follow-up from the centre, (3) failure and shame, (4) not comfortable to be vulnerable, and (5) an intention to reconnect.

Conclusions

Patients perceive LAGB post-operative medical management to be professional, effective, and valuable. Patients' difficulty to actively participate during aftercare visits contributes to reduced satisfaction and a range of compromised outcomes. Management of LAGB post-operative patients may be improved with the use of patient-centred strategies that encourage patients' active participation. Further research is required to evaluate the emerged themes and determine whether interventions targeting identified barriers enhance attendance and improve outcomes.

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Conflict of Interest

Irina Moroshko (irina.moroshko@gmail.com) declares no conflict of interests.

Leah Brennan (leah.brennan@acu.edu.au): The Centre for Obesity Research and Education (CORE) receives a grant from Allergan for research support. The grant is not tied to any specified research projects and Allergan has no control of the research protocols, analysis, or reporting of any studies. CORE also receives a grant from Applied Medical towards the educational programs.

Narelle Warren (narelle.warren@monash.edu) declares no conflict of interests.

Wendy Brown (wendy.brown@monash.edu): The CORE at Monash University receives a grant from Allergan for research support. The grant is not tied to any specified research projects and Allergan has no control of the protocol, analysis and reporting of any studies. CORE also receives a grant from Applied Medical towards educational programs. Prof. Wendy Brown received an Honorarium from Allergan to attend a Surgical Advisory Panel in London in 2009.

Paul O'Brien (paul.obrien@monash.edu): The CORE receives a grant from Allergan for research support. The grant is not tied to any specified research projects and Allergan has no control of the research protocols, analysis, or reporting of any studies. CORE also receives a grant from Applied Medical towards the educational programs. Prof. Paul O'Brien reported having written a patient information book entitled The LAP-BANDSolution: A Partnership for Weight Loss, which was published by Melbourne University Publishing in 2007. Most copies are given to patients without charge, but he reports that he derives a financial benefit from the copies that are sold. Prof. Paul O'Brien also reports receiving compensation as the national medical director of the American Institute of Gastric Banding, a multicentre facility, based in Dallas, Texas, which treats obesity predominantly by gastric banding.

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Authors and Affiliations

  1. Division of Psychology, School of Health Sciences, RMIT University, Melbourne, 3083, Australia

    Irina Moroshko

  2. Australia Centre for Obesity Research and Education, Monash University, Melbourne, 3004, Australia

    Irina Moroshko, Leah Brennan, Wendy Brown & Paul O’Brien

  3. School of Psychology, Australian Catholic University, 115 Victoria Parade/Locked Bag 4115, Melbourne, VIC, 3065, Australia

    Leah Brennan

  4. School of Psychology and Psychiatry, Monash University, Melbourne, 3800, Australia

    Narelle Warren

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  1. Irina Moroshko
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  2. Leah Brennan
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  3. Narelle Warren
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  4. Wendy Brown
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  5. Paul O’Brien
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Correspondence to Leah Brennan.

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Moroshko, I., Brennan, L., Warren, N. et al. Patients' Perspectives on Laparoscopic Adjustable Gastric Banding (LAGB) Aftercare Attendance: Qualitative Assessment. OBES SURG 24, 266–275 (2014). https://doi.org/10.1007/s11695-013-1086-9

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