Feasibility of a Supervised Inpatient Low-Calorie Diet Program for Massive Weight Loss Prior to RYGB in Superobese Patients
ABSTRACT This study was undertaken to determine the feasibility of an inpatient low-calorie program for a substantial decrease of preoperative weight (>10 points in BMI) in superobese patients.
Five patients were hospitalized for an average of 11 weeks and were placed on a low-calorie liquid diet (<900 kcal/day) and an exercise program. Following a drop of ten points in BMI, they underwent a Roux-en-Y gastric bypass (RYGB). Hemoglobin A1c and lipid profiles were obtained at the beginning of the diet, prior to surgery and at the last follow-up appointment. Our results were compared to the National Surgical Quality Improvement Program (NSQIP) database, which included 1,046 bariatric operations performed at VA centers between October 1999 and August 2007.
All five patients were massively obese men (body mass index (BMI) = 64.3 +/- 2.1 kg/m(2); 54.7 +/- 2.6 years old; four of five were white) with multiple comorbid conditions, which placed them in a substantially higher risk for bariatric surgery. Of the four diabetic patients, two were insulin dependent. There was an average decrease in BMI by 12.7 points (85.8 +/- 6.0 lb) during the preoperative diet period (11 weeks). All patients underwent RYGB without complications. This cohort of patients further decreased their BMI by 10.6 points (88.4 +/- 29.4 lb) following surgical intervention. The total combined preoperative and postoperative excess body weight loss was 89% (10.6-month average follow-up). Sleep apnea resolved following gastric bypass but did not improve during the preoperative weight loss period. Hypertension, osteoarthritis, and dyslipidemia all improved following surgical intervention. Hemoglobin A1c decreased by 1.9% during diet-induced weight loss with no further improvement being noted after surgery. The two insulin-dependent diabetic patients discontinued insulin therapy following surgery. The NSQIP database contained 77 patients with similar characteristics to our cohort of patients. The 30-day mortality for this cohort of patients was 3.9% with a complication rate of 33.8%.
Massive preoperative weight loss is possible to achieve with a liquid protein diet in superobese patients greatly facilitating gastric bypass surgery in an otherwise high-risk patient population.
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- "Although an inpatient stay can be resource intensive and costly, it may be justifiable to initiate a strict treatment plan when outpatient treatment has been unsuccessful. An 11-week very low calorie liquid inpatient regimen (<900 kcal/day) for adult bariatric patients resulted in an average loss of 38.9 kg (85.8 lbs), but this occurred entirely during the supervised inpatient stay . In this adolescent patient's 13-day inpatient stay with a 1,440 kcal/day regimen, he lost 13 kg and went on to lose an additional 10 kg in 6 weeks after being discharged, resulting in a total of 23 kg (50.7 lbs) total loss in 8 weeks. "
ABSTRACT: For severely obese patients planning bariatric surgery, many surgeons advise pre-operative weight loss which can be difficult for some to achieve. We report a 16-year-old male who was referred for weight loss surgery in a very late stage of severe obesity with a weight and BMI of 310 kg and 93 kg/m(2), respectively. He also suffered from obstructive sleep apnea and hypertension. To prepare him for laparoscopic gastric bypass, a strict pre-operative nutritional intervention with inpatient and outpatient phases was designed. He lost 22 kg pre-operatively and an additional 86 kg by 67 months post-operatively, representing a 35 % total reduction in BMI. This case illustrates the feasibility and value of a defined pre-operative dietary intervention to effectively manage the weight of an adolescent referred late in the progression of severe obesity.Pediatric Surgery International 04/2013; 29(8). DOI:10.1007/s00383-013-3311-y · 1.06 Impact Factor
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ABSTRACT: A circular array of prototype divergent electrostatic ultrasonic transducer elements has been used to produce tomographic images of air flows in a pipe. The array formed part of a 100mm diameter pipe network through which air flows of up to 18 m/s could be achieved. Ultrasonic time of flight measurements in a fan beam geometry were used to reconstruct images of the disruption to air flows produced by various cylindrical bluff bodies with different diameters, using a filtered back-projection algorithm with a difference technique. The air flows through the pipe and array were modelled using FLOTRAN, and there was good agreement between the models and the reconstructed tomographic data.
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ABSTRACT: Morbidity and mortality after bariatric surgery in superobese (body mass index [BMI] >50 but <60 kg/m2) and super-superobese (BMI >60 kg/m2) patients can allegedly be reduced by performing surgery in 2 steps. We report a retrospective study gathered from a prospective database for superobese and super-superobese patients who underwent laparoscopic biliopancreatic diversion/duodenal switch (LBPD/DS) after laparoscopic sleeve gastrectomy (LSG) as the first step. From October 2004 to June 2010, 31 patients underwent LBPD/DS after LSG. The mean age was 45.8 ± 10.1 years (range 21-64). The mean interval between the 2 procedures was 13.9 ± 8.4 months (range 6-37). At LSG, the mean weight and BMI was 168.8 ± 35.4 kg (range 127-255) and 58.3 ± 6.7 kg/m2 (range 50-74.5). At LBPD/DS, the mean weight, BMI, and percentage of excess weight loss was 136.3 ± 32.6 kg (range 92-220), 47.1 ± 7.2 kg/m(2) (range 37.8-64.3), and 31.6% ± 12.2% (range -11.7 to +54.6). At LSG, 26 patients had 43 obesity co-morbidities. Three co-morbidities (6.9%) resolved in 3 patients before the second step of LBPD/DS was performed. The mean operative time was 175.5 ± 60.6 minutes (range 75-285). There were no deaths or conversions to open surgery. Four patients had early complications (1 anastomotic leak, 1 small bowel perforation, 1 case of renal insufficiency, and 1 case of pneumonia). The mean hospital stay was 6.6 ± 8 days (range 3-35). All patients, with the exception of 3, were followed up for a mean of 28.8 ± 21.4 months (range 4-71). At follow-up, the mean weight, BMI, and percentage of excess weight loss (compared with the pre-LSG weight) was 99.4 ± 23.7 kg (range 62-150), 34.5 ± 5.8 kg/m2 (range 24.9-46.3), and 54.8% ± 16% (range 18.9-84.8). A total of 22 obesity co-morbidities (51.1%) resolved in 14 patients. Three patients presented with late complications (1 ventral hernia, 1 case of protein deficiency, 1 anastomotic stenosis). In the treatment of superobese and super-superobese patients with 2-step LBPD/DS, we experienced no deaths and achieved acceptable morbidity, considering the high operative risk in this group. This procedure is effective for both weight loss and resolution of co-morbidities.Surgery for Obesity and Related Diseases 11/2011; 7(6):703-8. DOI:10.1016/j.soard.2011.09.007 · 4.94 Impact Factor