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Smoking after surgery

Bariatric surgery has no impact on smoking cessation

Only few studies have investigated the smoking status in obese patients before and after bariatric procedures

Bariatric procedures have no effects on the smoking habits of moderate-to-heavy smokers in severe obese patients who had undergone surgery, according to research published in Tobacco Induced Diseases. The authors of the paper call for a greater use of traditional smoking cessation methods in post-op bariatric patients.

The researchers state that only few studies have investigated the smoking status in obese patients before and after bariatric procedures. As a result, they designed a study to prospectively examine the effect of different bariatric procedures (intra-gastric balloon (IB), lap–band laparoscopic surgery (LAGB) or sleeve gastrectomy/gastric by-pass (SPG) on the smoking habits of the severe obese.

The study involved 78 (69 females) smoking morbid obese subjects who underwent bariatric surgery between January 2008 and December 2011. Patients who smoked less than 10 cigarettes per day were not included in the study. Evaluations were performed before (less than one month before the procedure), and three, six and 12 months after the procedures. Before procedures all patients were suggested to stop smoking, but none had specific smoking cessation programme.

The researchers issued the participants with the following questionnaires that assessed:

  • Baseline on smoking habit (smoking initiation age, duration of smoking, number of cigarettes smoked per day, number of attempted cessations)
  • The Fagerström test on smoking dependence; and
  • A follow-up questionnaire (the daily cigarette smoking and reasons for quitting (only for quitters)

Of the 78 patients, 28 underwent IB, 30 LAGB, and 20 surgical procedures (SPG, 5 patients laparoscopic gastric bypass, and 15 patients sleeve gastrectomy). The researchers reported no differences in daily cigarette smoking, smoking behaviour/cessation and pack/year among all the three groups (all p>0.05). In addition, no differences in smoking dependence as calculated by Fagerström test were found among groups (p=0.26).

In the IB, LAGB and SPG the BMI of obese patients was significantly reduced after three, six and 12 months following the procedures (all p< 0.001). After three months, the IB group showed a quitting rate higher than LAGB and SPG groups (36%, 6% and 5%, respectively; p=0.02). No differences were found among the three groups at six months as well as 12 months after the procedures (IB 21%, LAGB 6 %, and SPG 5%; and IB 14%, LAGB 3%, SPG 5%, respectively) (Figure 1).

Figure 1: Percentage of smoking quitters who underwent intragastric ballon (IB), lap–band laparoscopic surgery (LAGB) and surgical procedures (SPG) at baseline and after 3, 6 and 12 months.*p=0.02

After three months, most of the IB group quitters (seven patients) associated their quitting to nausea and vomit suffered during the post-intervention period, while three reported personal reasons. In the LAGB and in the SPG the patients referred to have stopped smoking for personal reasons. No difference was observed for persistent smokers in the number of daily smoked cigarettes after one year in all groups (all p>0.05). No correlation between BMI or weight loss and the number of smoked cigarettes was found. No differences in weight lost between smokers and non-smokers after bariatric surgery were observed.

“We have shown that the weight loss after bariatric procedures in obese patients was not associated with a significant reduction or stopping in cigarette smoking,” they note. “…Interestingly, in the first three months after the procedures, differently from surgical procedures, weight loss in the IB group was associated with a reduction or stopping in cigarette smoking. This result is quite surprising because an average weight gains usually occurs when people stop smoking. As similar weight loss was attained after bariatric surgery, it is unlikely that the higher frequency of stopping smoking in IB could depend on differences in BMI. Furthermore, we could exclude that surgical interventions itself have caused a greater tendency to stop as there were no differences in all three groups of patients after 6 and 12 months.”

They note that there the causal mechanism of stopping smoking in obese subjected to IB may only be speculative, but the involvement of gastric distension induced by balloon is likely. They explain that smoke delays gastric emptying of solids (an effect not modulated by nicotine) and may enhance the side effects of nausea and vomit usually occurring after IB procedure.

“…there is a lack of information about approaches to reduce tobacco use in populations that are particularly vulnerable or where tobacco has a disproportionately adverse effect, including people who have co-occurring conditions,” they conclude. “Although recent ASMBS guidelines recommend to avoid tobacco at all times by all obese patients before and after bariatric surgery given the increased risk for of poor wound healing and overall impaired health, no smoking cessation interventions, including counselling and/or pharmacotherapy have been indicated.”

To access this paper, please click here

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