Outcomes associated with preoperative weight loss after laparoscopic Roux-en-Y gastric bypass

Abstract

Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective treatment for achieving and maintaining weight loss and for improving obesity-related comorbidities. As part of the approval process for bariatric surgery, many insurance companies require patients to have documented recent participation in a supervised weight loss program. The goal of this study was to evaluate the relationship of preoperative weight changes with outcomes following LRYGB. Methods A retrospective review was conducted of adult patients undergoing LRYGB between 2008 and 2012 at a single institution. Patients were stratified into quartiles based on % excess weight gain (0–4.99 % and ≥5 % EWG) and % excess weight loss (0–4.99 % and ≥5 % EWL). Generalized linear models were used to examine differences in postoperative weight outcomes at 6, 12, and 24 months. Covariates included in the final adjusted models were determined using backwards stepwise selection. Results Of the 300 patients included in the study, there were no significant demographic differences among the quartiles. However, there was an increased time to operation for patients who gained or lost ≥5 % excess body weight (p < 0.001). Although there was no statistical significance in postoperative complications, there was a higher rate of complications in patients with ≥5 % EWG compared to those with ≥5 % EWL (12.5 vs. 4.8 %, respectively; p = 0.29). Unadjusted and adjusted generalized linear models showed no statistically significant association between preoperative % excess weight change and weight loss outcomes at 24 months. Conclusion Patients with the greatest % preoperative excess weight change had the longest intervals from initial visit to operation. No significant differences were seen in perioperative and postoperative outcomes. This study suggests preoperative weight loss requirements may delay the time to operation without improving postoperative outcomes or weight loss.

Weight loss in adults following bariatric surgery, a systematic review of preoperative behavioural predictors

“…Eighteen studies reported on associations of preoperative weight loss on postoperative weight loss. Thirteen articles found no association 23‐35 . Four studies showed a positive association, 36‐39 and one study found a negative association 40 .…”

“…After excluding studies of poor quality, seven of the 18 studies remained. Four of these were deemed good quality 30,32‐34 (Table 2). All of these showed a no association between preoperative weight loss and postoperative weight loss.…”

Pre-specified Weight Loss Before Bariatric Surgery and Postoperative Outcomes

“…A few other studies have reported different outcomes from preoperative weight loss [ 3 , 15 ]. An observational study to assess mandatory medically supervised preoperative weight loss (MPWL), which had a compulsory requirement of at least 10% excess body weight loss before surgery, compared postoperative weight loss outcomes.…”

“…Some may require people to lose about 5-10% excess weight loss before surgery, while many non-public-funded services, especially insurance companies, require active participation in a 6-12 month supervised dietary program. Others recommend a short preoperative period (not more than three weeks) of a low-calorie diet (LCD) [ 3 , 7 ].…”

“…Various studies have contrasting conclusions [ 5 , 6 , 8 , 9 ]. Presently, there is no clear consensus on preoperative weight loss requirements for patients undergoing bariatric surgery [ 3 ].…”