The Impact of Preoperative Weight Loss in Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass

Alvarado, Raquel; Alami, Ramzi S.; Hsu, Gloria P.; Safadi, Bassem Y.; Sanchez, Barry R.; Morton, John M.; Curet, Myriam J.

doi:10.1381/096089205774512429

Cited by 184 publications

(133 citation statements)

References 9 publications

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“…Similar to results previously published by other authors, we did not find any significant differences in the length of hospital stay, or the time spent in the operating room (6,17). Devices for stapling and linear cut are used for conducting the vertical sleeve gastrectomy.…”

Section: Discussionsupporting

confidence: 87%

“…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%

“…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. The IGB in morbid obesity is a temporal treatment given as a second step when the multidisciplinary nutritional treatment fails (23), because it results in greater weight loss compared to conventional diet treatments (24)(25)(26)(27), although it is not clear whether it is more effective (28,29).…”

Section: Obesity (Bmi ≥ 30 Kg/mmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 87%

Section: Obesity (Bmi ≥ 30 Kg/mmentioning

confidence: 99%

Section: Obesity (Bmi ≥ 30 Kg/mmentioning

confidence: 99%

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Usefulness of an intra-gastric balloon before bariatric surgery

et al. 2017

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“…Similarly, in observational studies, a positive relation has been reported in some (19,28), while no relation could be confirmed in others (29,30). Interestingly, a negative correlation was reported in one study (31) in which preoperative weight loss was associated with less postoperative weight loss.…”

Section: Postoperative Weight Lossmentioning

confidence: 86%

“…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%

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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Outcomes of Preoperative Weight Loss in High-Risk Patients Undergoing Gastric Bypass Surgery

Still¹

2007

Arch Surg

156

102

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Hypothesis: Modest, preoperative weight loss will improve perioperative outcomes among high-risk, morbidly obese patients undergoing Roux-en-Y gastric bypass.Design: A prospective, longitudinal assessment of characteristics and outcomes of gastric bypass patients. Setting:All patients undergoing open or laparoscopic Roux-en-Y gastric bypass surgery for morbid obesity or its comorbid medical problems at Geisinger Medical Center in Danville, Pennsylvania, during a 3-year period from May 31, 2002, to February 24, 2006, were included in this analysis. Patients were required to participate in a standardized multidisciplinary preoperative program that encompasses medical, psychological, nutritional, and surgical interventions and education. In addition, patients were encouraged to achieve a 10% loss of excess body weight prior to surgical intervention.Results: Of the 884 subjects, 425 (48%) lost more than 10% of their excess body weight prior to the operation. After surgery (mean follow-up, 12 months), this group was more likely to achieve 70% loss of excess body weight (PϽ .001). Those who lost more than 5% of excess body weight prior to surgery were statistically less likely to have a length of stay of greater than 4 days (P =.03). Conclusions:This study shows that high-risk morbidly obese candidates for bariatric surgery who are able to achieve a loss of 5% to 10% excess body weight prior to surgery have a higher probability of a shorter length of hospital stay and more rapid postoperative weight loss.

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The Impact of Preoperative Weight Loss in Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass

Cited by 184 publications

References 9 publications

Usefulness of an intra-gastric balloon before bariatric surgery

Usefulness of an intra-gastric balloon before bariatric surgery

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

Outcomes of Preoperative Weight Loss in High-Risk Patients Undergoing Gastric Bypass Surgery

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