Effect of preoperative weight loss on laparoscopic gastric bypass outcomes

Riess, Kevin P.; Baker, Matthew T.; Lambert, Pamela J.; Mathiason, Michelle A.; Kothari, Shanu N.

doi:10.1016/j.soard.2008.05.007

Cited by 72 publications

(65 citation statements)

References 13 publications

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“…Several of the studies reporting no relationship do appear to be underpowered but do not provide adequate detail to conduct post-hoc power analyses. One recent retrospective analysis 36 reported that individuals losing less weight (o vs 44.5 kg) showed greater postoperative %EBWL. However, these individuals weighed significantly less (P ¼ 0.001) at the time of surgery, and operative weight was not entered as a covariate.…”

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confidence: 99%

Pre-bariatric surgery weight loss requirements and the effect of preoperative weight loss on postoperative outcome

et al. 2012

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Pre-bariatric surgery requirements vary between surgeons and surgical centers, with standards of practice not yet established. The goal of this systematic review was to summarize and evaluate the available literature on pre-bariatric surgery weight loss requirements and the relation between preoperative weight loss and postoperative outcome. Major databases, including Medline, PubMed and PsychINFO were searched for relevant articles. Case studies, studies420 years old and studies that utilized selfreported body weight data were excluded. Data on the effect of the following was summarized: (1) preoperative requirements on preoperative weight loss; (2) insurance-mandated preoperative requirements; (3) the contingency of receipt of surgery; (4) preoperative weight loss on postoperative weight loss and (5) preoperative weight loss on perioperative and postoperative complication and comorbidity rates. The majority of studies suggest that: (1) current preoperative requirements held by the majority of third party payer organizations in the United States are ineffective in fostering preoperative weight loss; (2) making receipt of surgery contingent upon achieving preoperative weight loss, and meal-replacement diets, may be particularly effective in fostering preoperative weight loss and (3) preoperative weight loss may lead to improvements in at least some relevant postoperative outcomes. However, a preoperative weight loss mandate may lead to the denial of surgery and subsequent health benefits to individuals who are unable to achieve a prespecified amount of weight. Overall, the limited number and quality of prospective studies in this area prohibits the much-needed establishment of standards of practice for pre-bariatric requirements.

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confidence: 99%

Pre-bariatric surgery weight loss requirements and the effect of preoperative weight loss on postoperative outcome

et al. 2012

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“…In these uncontrolled studies, LoS as a parameter obviously suffers from several biases, some of the most important being the time relationship between changes in routines for postoperative hospital stay and preoperative dietary recommendations, increased hospital volume and surgical skills. Accordingly, in several studies, the authors have not been able to find any differences in LoS in patients who did versus those who did not lose weight preoperatively (7,14,15,18,21,22). In the only randomized study in which LoS was commented on (18), no beneficial effect could be demonstrated between groups.…”

Section: Losmentioning

confidence: 96%

“…In some of these (11,15,20), the findings suggest a reduction in complication rates in response to preoperative weight reduction, whereas other report no beneficial effect (7,14,18,19,21). In addition to the conflicting results, these studies suffer from the weaknesses of the non-randomized design and/or limited number of included patients.…”

Section: Postoperative Complicationsmentioning

confidence: 99%

“…In most studies, retrospective analysis was performed and protocols as well as degree of weight loss achieved varied. Again, some authors reported improved weight loss at time points varying between 6 and 24 months postoperatively (15,32,33). In other, no benefit in terms of postoperative weight development could be demonstrated in patients who were submitted to mandatory weight loss prior to bariatric surgery (30,34,35).…”

Section: Postoperative Weight Lossmentioning

confidence: 99%

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Weight loss prior to bariatric surgery: An updated review of the literature

2014

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Background and Aims: prior to bariatric surgery, a preoperative weight-reducing regimen is usually adhered to in most centers. the clinical effects of such a regimen are yet to be determined.Material and Methods: We reviewed the current literature by searching in pubMed for publications reporting clinical effects resulting from a preoperative weight loss regimen prior to bariatric surgery published from January 1, 1995 to april 30, 2014.Results: in total, we identified 23 original publications and 2 review articles which met all inclusion criteria. these were included and fully analyzed with regard to effects of preoperative weight loss. in general, for parameters such as operating time and intraoperative complications including blood loss and recovery, inconsistent data were reported. Most studies included low number of patients and with heterogenic designs, and the results could not form the base for recommendations. however, for outcomes such as postoperative complications and weight development over time, data from large-scale studies and randomized controlled trials suggest beneficial effects following adherence to weight loss prior to bariatric surgery.Conclusion: although a large amount of data in the current literature on the effects of weight loss prior to bariatric surgery are inconsistent for many outcome parameters, recently published results regarding effects on postoperative complications and weight development over time strongly suggest that such a regimen should be recommended. Whether a certain degree of weight loss should be mandatory before being accepted for bariatric surgery is, however, still controversial.

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“…However, other retrospective studies have found that a pre-surgical weight loss of 5-10% EWL will have an impact on post-surgical morbidity (9,10,16,20), on the time duration of the surgery (19), on the amount of transfusions, and on the rate of conversions to open surgery (6,21,22). Other authors have found that pre-surgical weight loss is a predictive factor for a higher loss weight during post-surgical evolution (6,17), and would help to select those obese population who would benefit most from bariatric surgery.…”

Section: Obesity (Bmi ≥ 30 Kg/mmentioning

confidence: 98%

Usefulness of an intra-gastric balloon before bariatric surgery

et al. 2017

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Introduction: There are only few reports regarding the use of intragastric-balloons (IGB ® ) to achieve weight loss and subsequently decrease surgical complications. In this study, we try to assess whether presurgery weight loss using IGB decreases the postsurgical mortality after bariatric surgery.Material and methods: This is a prospective case-control study. We matched 1:1 by gender, age (± 10 y-o) and type of surgery (sleeve resection [LSG] or gastric bypass [LGBP]), matching cases (A) and controls (H, from a historic cohort). Morbidly obese patients with an indication for bariatric surgery were included in the study. Cases (A) were recruited from an ongoing clinical trial, and the controls (H) came from a historic cohort prior to the start of the clinic trial. The presurgical weight loss in group A was reached by IGB combined with diet, versus only diet in group H.Results: We included 58 patients, 65.5% women, 69% LGBP/31% LSG. The mean age of group A was 42 and 43.4 years old for group H. ASA III of 24.1% group A vs 58.6% group H, p = 0.012. The mean total weight loss (TWL) before surgery was greater in group A (16.2 kg, SD 9.75) than in group H (1.2 kg, SD 6.4), p < 0.0001. The % of EWL before surgery was 23.5 (SD 11.6) in group A vs 2.4 (SD 8) in group H, p < 0.001. Hospital stay was seven days for group A, and eight days for group H, p = 0.285. The rate of unsuccessful IGB treatment to accomplish the scheduled weight loss was 34.5%. The balloon morbidity was 17.2% (6.9% severe). All in all, morbidity (due to bariatric surgery and IGB) was 41% in both groups. Postsurgical morbidity moderate-severe was 20.3% in group A (6.9% severe) and 27.3% in group H (17.2% severe) without statistical significance. One patient died in group H (mortality rate, 3.44%).Conclusion: Preoperative IGB treatment in morbid obesity has not been found to be effective at decreasing postsurgical morbidity LSG and LGBP, despite the fact that it acheives a greater weight loss than diet and exercise.

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Effect of preoperative weight loss on laparoscopic gastric bypass outcomes

Cited by 72 publications

References 13 publications

Pre-bariatric surgery weight loss requirements and the effect of preoperative weight loss on postoperative outcome

Pre-bariatric surgery weight loss requirements and the effect of preoperative weight loss on postoperative outcome

Weight loss prior to bariatric surgery: An updated review of the literature

Usefulness of an intra-gastric balloon before bariatric surgery

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