Preoperative Weight Loss Decreases the Operative Time of Gastric Bypass at a Veterans Administration Hospital

Huerta, Sergio; Dredar, Serag; Hayden, Elizabeth P.; Siddiqui, Ali A.; Anthony, Thomas; Asolati, Michele; Varela, J. Esteban; Livingston, Edward H.

doi:10.1007/s11695-007-9334-5

Cited by 57 publications

(53 citation statements)

References 18 publications

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“…Accordingly, this was also reported in several of the included studies (11,14,18,21,22). In a meta-analysis from 2009 (25) including "the only three high-quality studies that reported this finding," a reduction in mean operating time of 23 min (95% confidence interval (CI) 13.8-32.8) was reported.…”

Section: Intraoperative Outcomessupporting

confidence: 69%

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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Section: Intraoperative Outcomessupporting

confidence: 69%

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

2014

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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: 96%

“…There are some observational non-controlled clinical trials (17,18) that have not demonstrated that a pre-surgical weight loss (EWL) will determine differences in post-surgical morbidity or the subsequent evolution of the patient (18,19). 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).…”

Section: Obesity (Bmi ≥ 30 Kg/mmentioning

confidence: 99%

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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“…In another study, in which body composition changes were assessed by dual energy densitometry (DXA), multifrequency bioelectrical impedance analysis and air displacement plethysmography in obese patients who lost weight by following a VLCD for four months, it was found that loss of weight (an average of 20.2 kg in four months) occurred mainly at the expense of body fat and visceral mass, while muscle mass and strength were maintained [56]. In obese, elderly patients, VLCD should be used under medical supervision, especially when they have comorbidities, as these patients usually present a loss of lean mass and their vitamin and mineral requirements are often higher than young obese and middle-aged patients [55,59].…”

Section: Diet and Supplementationmentioning

confidence: 99%

Challenges in Treatment of Obesity in the Elderly

Sajoux¹,

Bellon²,

Vidal³

2017

EMIJ

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Obesity is a very common problem that affects one in three people over 65 in Spain. In addition to the risk derived from the appearance of comorbidities in organs and systems, obesity in seniors exhibits a particular set of characteristics, such as loss of muscle mass and a specific distribution of fat which directly contributes to an increase in morbimortality. The purpose of this review is to study the epidemiology and physiopathological mechanisms of obesity in the elderly, as well as the therapeutic approach aimed at preserving lean mass in these patients. An extensive bibliographical search was carried out using scientific publications in various specialised electronic databases (PubMed, Scielo and Elsevier) and Google Scholar. For obese patients over 65 years of age, preserving muscle mass is a priority in any weight-loss programme, as this is associated with decreased cardiometabolic risk and increased resistance which in turn inversely correlates with mortality. For this reason, reducing calorie intake while maintaining a high protein intake is recommended. This goal can be attained through a very-low-calorie diet accompanied by a personalised physical exercise programme to improve the patient's functional capacity.

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Preoperative Weight Loss Decreases the Operative Time of Gastric Bypass at a Veterans Administration Hospital

Abstract: An 8% reduction of body weight is associated with a decrease in operative time. These preliminary data suggest that preoperative weight loss results in a technically less challenging operation in the super-obese patient.

Cited by 57 publications

References 18 publications

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

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

Usefulness of an intra-gastric balloon before bariatric surgery

Challenges in Treatment of Obesity in the Elderly

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