Preoperative weight loss in super-obese patients: study of the rate of weight loss and its effects on surgical morbidity

Santo, Marco Aurélio; Riccioppo, Daniel; Pajecki, Dênis; Cleva, Roberto de; Kawamoto, Flávio; Cecconello, Ivan

doi:10.6061/clinics/2014(12)07

Cited by 27 publications

(14 citation statements)

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“…The incidence of complications in super-obese patients has been reported to be fourfold higher compared to morbidly obese group (BMI < 50 kg/m 2 ) and 80% of the post bariatric surgery deaths occur in super-obese bariatric patients [ 17 ]. A study evaluating 185,315 patients based on the Bariatric Outcomes Longitudinal Database identified BMI greater than 50 as the strongest predictor of mortality [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Endobarrier as a Pre Bariatric Surgical Intervention in High-Risk Patients: a Feasibility Study

et al. 2018

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BackgroundObesity surgery mortality risk scoring system (OS-MRS) classifies patients into high, intermediate and low risk, based on age, body mass index, sex and other comorbidities such as hypertension and history of pulmonary embolism. High-risk patients not only have a higher mortality but are more likely to develop post-operative complications necessitating intervention or prolonged hospital stay following bariatric surgery. Endoscopically placed duodenal-jejunal bypass sleeve (Endobarrier) has been designed to achieve weight loss and improve glycaemic control in morbidly obese patients with clinically proven effectiveness.The aim of this study was to assess if pre-operative insertion of endobarrier in high-risk patients can decrease morbidity and length of stay after bariatric surgery.Materials and MethodsBetween 2012 and 2014, a cohort of 11 high-risk patients had an Endobarrier inserted (E&BS group) for 1 year prior to definitive bariatric surgery. These patients were compared against a similar group undergoing primary bariatric surgery (PBS group) during same duration. The two groups were matched for age, gender, body mass index, comorbidities, surgical procedure and OS-MRS using propensity score matching. Outcome measures included operative time, morbidity, length of stay, intensive therapy unit (ITU) stay, readmission rate, percentage excess weight loss (%EWL) and percentage total weight loss (%TWL).ResultsPatient characteristics and OS-MRS were similar in both groups (match tolerance 0.1). There was no significant difference in total length of stay, readmission rate, %EWL and %TWL. Operative time, ITU stay, post-operative complications and severity of complications were significantly less in the E&BS group (p < 0.05) with significant likelihood of planned ITU admissions in the PBS group (p < 0.05).ConclusionEndobarrier could be considered as a pre bariatric surgical intervention in high-risk patients. It may result in improved post-operative outcomes in high-risk bariatric patients.

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Section: Discussionmentioning

confidence: 99%

Endobarrier as a Pre Bariatric Surgical Intervention in High-Risk Patients: a Feasibility Study

et al. 2018

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“…One of the purposes of the Clinic is to offer bariatric surgery to qualifying patients, who are defined as those who achieve an appropriate weight loss (EBWL of 10%). Several studies have proven that weight reduction prior to surgery decreases surgery-related complications and decreases hospitalization time [17]. Unfortunately, as previously observed in a quasiexperimental study performed at our Obesity Clinic, 46% of our patients do not achieve the required weight loss after a year of dietary treatment.…”

Section: Discussionmentioning

confidence: 62%

“…Patients under evaluation for bariatric surgery have been suggested to decrease 10% of their excess weight to improve the control of some of the comorbidities that are associated with a higher surgical risk such as diabetes, hypertension, or sleep apnea [17]. This also allows evaluating the patients' adherence to medical therapy and their capability to follow a diet.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of the treatment with dapagliflozin and metformin compared to metformin monotherapy for weight loss in patients with class III obesity: a randomized controlled trial

Ferreira‐Hermosillo

Molina-Ayala

Molina-Guerrero

et al. 2020

Trials

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Background: Mexico has one of the highest prevalence rates of obesity worldwide. New pharmacological strategies that focus on people with class III obesity are required. Metformin and dapagliflozin are two drugs approved for the treatment of diabetes. Beyond its effects on glucose, metformin has been suggested by some studies to result in weight loss. Therapy with dapagliflozin is associated with a mild but sustained weight loss in patients with diabetes. The primary outcome of the study is to determine if the combined treatment with dapagliflozin and metformin is more effective than monotherapy with metformin for weight loss in patients with class III obesity and prediabetes or diabetes who are awaiting bariatric surgery (including those patients who do have surgery). We also aimed to assess the effect of this combined treatment on waist circumference, triglycerides, blood pressure, and inflammatory cytokines. Methods: This randomized phase IV clinical trial will include patients with diabetes or prediabetes who are between the ages of 18 and 60 years and exhibit grade III obesity (defined as body mass index ≥ 40 kg/m 2). Patients using insulin will be excluded. Subjects will be randomized to one of two groups as follows: 1) metformin tablets 850 mg PO bid or 2) metformin tablets 850 mg PO bid plus dapagliflozin tablets 10 mg PO qd. The sample size required is 108 patients, which allows for a 20% dropout rate: 54 patients in the metformin group and 54 in the metformin/dapagliflozin group. All participants will receive personalized nutritional advice during the study. A run-in period of one month will be used to assess tolerance and adherence to treatment regimens. Anthropometric and biochemical variables will be recorded at baseline and at 1, 3, 6, and 12 months. A serum sample to determine glucagon, ghrelin, adiponectin, resistin, interleukin 6, and interleukin 10 will be collected at baseline and before surgery, or at 12 months (whatever happens first). Adherence to treatment and adverse and secondary events will be recorded throughout the study. An intention-to-treat analysis will be used.

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“…The incidence of complications in super-obese patients (BMI > 50 kg/m 2 ) has been reported to be fourfold higher compared to the morbidly obese group (BMI < 50 kg/m 2 ). Eighty percent of the deaths following bariatric surgery occur in the super-obese patients [30][31][32]. Benotti et al [33] confirmed that BMI > 50 kg/m 2 is the strongest predictor of mortality in a cohort of 185,315 patients undergoing RNYGB.…”

Section: Discussionmentioning

confidence: 99%

Bariatric Surgery in Cirrhotic Patients: Is It Safe?

et al. 2019

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Introduction Ten percent of cirrhotic patients are known to have a high risk of postoperative complications. Ninety percent of bariatric patients suffer from non-alcoholic fatty liver disease (NAFLD), and 50% of them may develop non-alcoholic steatohepatitis (NASH) which can progress to cirrhosis. The aim of this study was to assess whether the presence of cirrhosis at the time of bariatric surgery is associated with an increased rate and severity of short-and long-term cirrhotic complications. Methods A cohort of 110 bariatric patients, between May 2003 and February 2018, who had undergone liver biopsy at the time of bariatric surgery were reassessed for histological outcome and divided into two groups based on the presence (C, n = 26) or absence (NC, n = 84) of cirrhosis. The NC group consisted of NASH (n = 49), NAFLD (n = 24) and non-NAFLD (n = 11) liver histology. Medical notes were retrospectively assessed for patient characteristics, development of 30-day postoperative complications, severity of complications (Clavien-Dindo (CD) classification) and length of stay. The C group was further assessed for long-term cirrhosis-related outcomes. Results The C group was older (52 years vs 43 years) and had lower BMI (46 kg/m 2 vs 52 kg/m 2 ) and weight (126 kg vs 145 kg) compared to the NC group (p < 0.05). The C group had significantly higher overall complication rate (10/26 vs 14/84, p < 0.05) and severity of complications (CD class ≥ III, 12% vs 7%, p < 0.05) when compared to the NC group. The length of stay was similar between the two groups (5 days vs 4 days). The C group had significant improvement in model end-stage liver disease scores (7 vs 6, p < 0.01) with median follow-up of 4.5 years (range 2-11 years). There were no long-term cirrhosis-related complications or mortality in our studied cohort (0/26). Conclusion Bariatric surgery in cirrhotic patients has a higher risk of immediate postoperative complications. Long-term cirrhosis-related complications or mortality was not increased in this small cohort. Preoperative identification of liver cirrhosis may be useful for risk stratification, optimisation and informed consent. Bariatric surgery in well-compensated cirrhotic patients may be used as an aid to improve long-term outcome.

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Preoperative weight loss in super-obese patients: study of the rate of weight loss and its effects on surgical morbidity

Cited by 27 publications

References 30 publications

Endobarrier as a Pre Bariatric Surgical Intervention in High-Risk Patients: a Feasibility Study

Endobarrier as a Pre Bariatric Surgical Intervention in High-Risk Patients: a Feasibility Study

Efficacy of the treatment with dapagliflozin and metformin compared to metformin monotherapy for weight loss in patients with class III obesity: a randomized controlled trial

Bariatric Surgery in Cirrhotic Patients: Is It Safe?

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