PSYCHOLOGICAL PROBLEMS : The farewell party before obesity surgery
Bariatric surgery entails a careful preparation, including a balanced diet and a psychological supervision.The ultimate success of it depends upon the quality of this preparation. Moreover, a patient may be called a "good candidate" to surgery after having achieved this pe-operative course. Whatever the confidence one can have in the technical specifics of an operation (stapling devices, stitches, adjustable banding, etc.), surgery cannot claim success just by itself! The eating behaviour has a great influence on the results of surgery, notwithstanding the well designed anatomical procedure. If post-operative eating is not coordinated, for instance with repeated ingestion of high-caloric liquid or semi-liquid food, a correctly placed adjustable band can become pointless, as well as the connexion of a tiny gastric pouch with the small bowel... Portuguese surgeons have reported the case of a 40 years old patient with a high BMI (65 kg per square meter),and having multiple pathologies related to obesity (hypertension, liver steatosis, severe restrictive respiratory syndrome). She gained 30 kg in three months while waiting for surgery and suddenly died during one night owing to respiratory failure*. Authors suggest that these patients should be more strongly taken care of before surgery. One such behaviour is common though, but in most cases weight-gain before surgery is moderate (a few pounds). This also leads to consider the actual weight that should be taken into account when we calculate the post-operative excess-weight loss! It is exaggerated to state that any weight-gain before surgery is a major issue, or is related to the patient's immaturity. In order to face the difficulties dure to the operation, discipline is mandatory, but the emotionnal investment in surgery is sometimes so huge that one cannot blame the so-called "farewell party"... if it one keeps it moderate!

* How to avoid weight gain before bariatric surgery: "The obesity farewell party". Cardoso MH, Bastos AS et col. Obesity Surgery 2003; 13: 513.