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

Department of Surgery, Stanford University, Palo Alto, California, United States
Obesity Surgery (Impact Factor: 3.75). 11/2005; 15(9):1282-6. DOI: 10.1381/096089205774512429
Source: PubMed

ABSTRACT Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is a widely performed bariatric operation. Preoperative factors that predict successful outcomes are currently being studied. The goal of this study was to determine if preoperative weight loss was associated with positive outcomes in patients undergoing LRYGBP.
A retrospective analysis was performed of all patients undergoing LRYGBP at our institution between July 2002 (when a policy of preoperative weight loss was instituted) and August 2003. Outcome measures evaluated at 1 year postoperatively included percent excess weight loss (EWL) and correction of co-morbidities. Statistical analysis was performed by multiple linear regression. P<0.05 was considered significant.
The study included 90 subjects. Initial BMI ranged from 35.4 to 63.1 (mean 48.1). Preoperative weight loss ranged from 0 to 23.8% (mean 7.25). At 12 months, postoperative EWL ranged from 40.4% to 110.9 % (mean 74.4%). Preoperative loss of 1% of initial weight correlated with an increase of 1.8% of postoperative EWL at 1 year. In addition, initial BMI correlated negatively with EWL, so that an increase of 1 unit of BMI correlated with a decrease of 1.34% of EWL. Finally, preoperative weight loss of >5% correlated significantly with shorter operative times by 36 minutes. Preoperative weight loss did not correlate with postoperative complications or correction of co-morbidities.
Preoperative weight loss resulted in higher postoperative weight loss at 1 year and in shorter operative times with LRYGBP. No differences in correction of co-morbidities or complication rates were found with preoperative weight loss in this study. Preoperative weight loss should be encouraged in patients undergoing bariatric surgery.

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    • "Laparoscopic Roux-en-Y gastric bypass (LRYGB) has proved efficacious in terms of stable weight loss, low complication rates, and reduction of co-morbidities. LRYGB is the most commonly used gastric bypass technique, resulting in 65%–74% of excess weight lost within 1 year [12] [13] [14]. Contradictory data have been reported on mortality rates associated with bariatric surgery, depending on the population under study, the type of intervention, and the characteristics of the institutions involved, as well as the expertise of the surgeon (number of interventions carried out per year) [15] [16] [17] [18] [19]. "
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    ABSTRACT: Background Surgical treatment of morbid obesity with laparoscopic Roux-en-Y gastric bypass (LRYGB) is technically challenging and involves high-risk patients. In this study, the short-term outcome of LRYGB in a large population of patients has been evaluated, and morbimortality before and after overcoming the learning curve has been assessed. The objective of this study was to establish the learning curve for laparoscopic Roux-en-Y gastric bypass. Methods This retrospective study involved 2281 patients submitted to LRYGB at São José do Avaí Hospital between August 1999 and December 2011. The parameters analyzed were operating time, rates of short-term postoperative complications, mortality, and conversion. Results The study population was predominantly female (71.3%) and presented a mean age of 37.5 years and mean body mass index (BMI) of 45.15 kg/m2. The average time in surgery was 119 minutes, and average hospital stay was 4.3 days. The incidence of postoperative complications (hemorrhage, fistula, and bowel obstruction) was 1.75%. The relative risk of complications diminished in line with the increased experience of the surgical team and tended to stabilize at<2.5% after the first 500 procedures. The mortality rate was .43%, and the main causes of death were pulmonary embolism and leaks (.14% each). The conversion rate was .17%. Conclusion Operating time and risks of adverse outcome were significantly reduced after a long learning curve of 500 consecutive procedures. The number of surgeries performed and the standardization of the laparoscopic technique used were the main factors contributing to the low rates of postoperative complications, mortality, and conversion.
    Surgery for Obesity and Related Diseases 02/2013; · 4.07 Impact Factor
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    • "Further, a weight loss of at least 5% of initial body weight was achieved by over half of the lifestyle intervention group at 6 months, an amount of preoperative weight loss that has been associated with shorter operating room times (20) and greater postoperative weight loss one year following Roux-en-Y gastric bypass (11). Furthermore, these results may be compared to data from nonsurgical samples of severely overweight individuals participating in university-based clinical trials of behavioral lifestyle interventions. "
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    ABSTRACT: To document preoperative outcomes of a behavioral lifestyle intervention delivered to patients prior to bariatric surgery in comparison to treatment as usual (insurance-mandated physician supervised diet). After completing a baseline assessment, candidates for surgery were randomized to a 6-month, evidence-informed, manualized lifestyle intervention (LIFESTYLE, n = 121) or to preoperative care as usual (USUAL CARE, n = 119). At 6 months, 187 participants remained candidates for bariatric surgery and were included in the analyses. LIFESTYLE participants lost significantly more weight than those receiving USUAL CARE [8.3 ± 7.8 kg vs. 3.3 ± 5.5 kg, F(1,183) = 23.6, P < 0.0001], with an effect size of 0.72. Additionally, logistic regression modeling indicated that LIFESTYLE patients were significantly more likely to lose at least 5% of initial body weight than those in USUAL CARE [OR (95% CI) = 2.94 (1.253, 6.903)], as were participants who were heavier [OR (95% CI) = 1.07 (1.001-1.14) for each unit increase in BMI] or with larger improvements in eating behaviors [OR (95% CI) = 1.1 (1.049, 1.145) for each unit increase on the Eating Behavior Inventory). A behavioral lifestyle intervention for severely overweight individuals leads to clinically significant weight loss prior to bariatric surgery. Post-surgery follow-up will allow us to examine the impact of the preoperative intervention on postoperative outcomes.
    Obesity 02/2013; 21(2). DOI:10.1002/oby.20069 · 3.73 Impact Factor
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    • "Weight loss prediction is one of the common aims of these predictive models. Pre-operative weight loss can predict post-operative weight loss, putatively as a marker of 'intrinsic motivation' [30,31]. These data are contentious and not without bias as many of them are retrospective uncontrolled studies [32]. "
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    ABSTRACT: Obesity is recognized as a global health crisis. Bariatric surgery offers a treatment that can reduce weight, induce remission of obesity-related diseases, and improve the quality of life. In this article, we outline the different options in bariatric surgery and summarize the recommendations for selecting and assessing potential candidates before proceeding to surgery. We present current data on post-surgical outcomes and evaluate the psychosocial and economic effects of bariatric surgery. Finally, we evaluate the complication rates and present recommendations for post-operative care.
    BMC Medicine 01/2013; 11(1):8. DOI:10.1186/1741-7015-11-8 · 7.25 Impact Factor
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