Preoperative weight gain does not predict failure of weight loss or co-morbidity resolution of laparoscopic Roux-en-Y gastric bypass for morbid obesity

Harnisch, Michael C.; Portenier, Dana; Pryor, Aurora D.; Prince-Petersen, Rebecca; Grant, John P.; DeMaria, Eric J.

doi:10.1016/j.soard.2007.09.016

Cited by 45 publications

(43 citation statements)

References 20 publications

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“…2,27,28 For example, Mrad et al 28 reported a significant relationship between pre-and postoperative weight loss in men (P ¼ 0.02) but not in women. In an analysis of data on 884 RYGB patients grouped by preoperative % EBW change (45 gain, 0-5 gain, 0-5 loss, 5-10 loss, 410 loss), Still et al 2 reported that patients who showed 410% preoperative EBWL were 2.1 times more likely to achieve postoperative EBWL of 70% (P ¼ 0.001) as compared with patients who showed o5% EBWL preoperatively.…”

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confidence: 99%

“…However, no difference was found between patients who gained or lost 0-10% EBW, and the data presented suggest that no linear relationship was present. Harnisch et al 27 found no difference in EBWL from surgery to 12-month follow-up between RYGB patients who lost 44.5 kg (10 lbs) vs patients who gained weight Articles reported in order of rigor of methodological design: randomized control trial, followed by prospective study, followed by retrospective study. preoperatively.…”

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confidence: 99%

“…This effect did not persist at 24-month follow-up; however, power may have been limited in 24-month analyses due to attrition. 27 There are also a number of studies reporting no relationship between pre-and postoperative weight change, 11,13,14,26,[27][28][29][30][31][32][33][34] including a prospective analysis 14 reporting no difference in weight loss outcome between preoperative dieters (n ¼ 47; losing an average of 7.8 kg) and non-dieters (n ¼ 53; no significant weight loss) across a 4-year follow-up. Several of the studies reporting no relationship do appear to be underpowered but do not provide adequate detail to conduct post-hoc power analyses.…”

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confidence: 99%

“…In the retrospective analyses of 90 RYGB patients by Alvarado et al, 16 preoperative weight loss of 45% was associated with shorter operative time (36 min) but not 15 no differences between the preoperative weight loss and no weight loss groups were seen in complication rate, conversion rate or medical comorbidities at 3 or 6 months post surgery. Harnisch et al 27 reported no difference between patients who lost vs gained weight preoperatively in perioperative complication or conversion rates, or in the remission of diabetes, hypertension or continuous positive airway discontinuation. Patients losing weight did, however, have a significantly shorter operation time (P ¼ 0.02).…”

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

et al. 2012

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“…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).…”

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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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Meta-analysis of the influence of lifestyle changes for preoperative weight loss on surgical outcomes

Roman

Monaghan

Serraino

et al. 2018

British Journal of Surgery

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Background The aim was to investigate whether preoperative weight loss results in improved clinical outcomes in surgical patients with clinically significant obesity. Methods This was a systematic review and aggregate data meta‐analysis of RCTs and cohort studies. PubMed, MEDLINE, Embase and CINAHL Plus databases were searched from inception to February 2018. Eligibility criteria were: studies assessing the effect of weight loss interventions (low‐energy diets with or without an exercise component) on clinical outcomes in patients undergoing any surgical procedure. Data on 30‐day or all‐cause in‐hospital mortality were extracted and synthesized in meta‐analyses. Postoperative thromboembolic complications, duration of surgery, infection and duration of hospital stay were also assessed. Results A total of 6060 patients in four RCTs and 12 cohort studies, all from European and North American centres, were identified. Most were in the field of bariatric surgery and all had some methodological limitations. The pooled effect estimate suggested that preoperative weight loss programmes were effective, leading to significant weight reduction compared with controls: mean difference –7·42 (95 per cent c.i. –10·09 to –4·74) kg (P < 0·001). Preoperative weight loss interventions were not associated with a reduction in perioperative mortality (odds ratio 1·41, 95 per cent c.i. 0·24 to 8·40; I2 = 0 per cent, P = 0·66) but the event rate was low. The weight loss groups had shorter hospital stay (by 27 per cent). No differences were found for morbidity. Conclusion This limited preoperative weight loss has advantages but may not alter the postoperative morbidity or mortality risk.

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Preoperative weight gain does not predict failure of weight loss or co-morbidity resolution of laparoscopic Roux-en-Y gastric bypass for morbid obesity

Cited by 45 publications

References 20 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

Meta-analysis of the influence of lifestyle changes for preoperative weight loss on surgical outcomes

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