The impact of preoperative weight loss in patients undergoing laparoscopic Roux-en-Y gastric bypass.
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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ABSTRACT: The incidence of obesity and particularly super obesity, has increased tremendously. At our institution, super obesity represents 30.1% of all severely obese individuals in the bariatric surgery program. In super obesity, surgical morbidity is higher and the results are worse compared with morbid obesity, independent of the surgical technique. The primary strategy for minimizing complications in these patients is to decrease the body mass index before surgery. Preoperative weight reduction can be achieved by a hypocaloric diet, drug therapy, an intragastric balloon, or hospitalization. The objective of this study was to analyze the results of a period of hospitalization for preoperative weight loss in a group of super-obese patients. Twenty super-obese patients were submitted to a weight loss program between 2006 and 2010. The mean patient age was 46 years (range 21-59). The mean BMI was 66 kg/m2 (range 51-98) and 12 were women. The average hospital stay was 19.9 weeks and the average weight loss was 19% of the initial weight (7-37%). The average caloric intake was 5 kcal/kg/day. After the weight loss program, the patients underwent gastric bypass surgery. The statistical analysis revealed that after 14 weeks of treatment (15% loss of initial weight), the weight loss was not significant. All patients had satisfactory surgical recovery and were discharged after an average of 4.6 days. In super obesity, preoperative weight loss is an important method for reducing surgical risks. Hospitalization and a hypocaloric diet are safe and effective. After 14 weeks, the weight loss rate stabilized, signaling the time of surgical intervention in our study.Clinics (São Paulo, Brazil) 01/2014; 69(12):828-34. DOI:10.6061/clinics/2014(12)07 · 1.59 Impact Factor
SEMINÁRIO NACIONAL DE MANEJO DA OBESIDADE NAS REDES DE ATENÇÃO À SAÚDE DO SUS, Brasília; 12/2014
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ABSTRACT: Background: The My True Body (MTB) group intervention incorporates cognitive restructuring and social support into bariatric surgery preparation. Purpose: To identify and describe program components that support long-term behavioral modifications and influence confidence in healthy weight maintenance. Methods: Semistructured telephone interviews exploring motivations for participation, advantages, disadvantages, and differentiating characteristics of MTB were conducted among participants who completed MTB between March 2010 and December 2011. Qualitative data analysis was performed to identify emergent themes. Results: Four primary themes emerged: (1) the value of interpersonal support and shared experiences, (2) possibilities for psychological transformations, (3) MTB's philosophy as an alternative to dieting, and (4) increased capacity for healthy weight maintenance. All study participants identified at least one psychosocial benefit. Key cognitive benefits included clarified motivations for weight loss surgery and changed attitudes toward food and eating. Discussion: Support and shared experiences and adoption of MTB's philosophical orientation provide pathways to psychological transformation; such transformation appears to be prerequisite to increasing capacity for healthy weight maintenance through increased self-efficacy. Translation to Health Education Practice: Integrating psychological self-exploration, social support, and behavior modification training into presurgical education might enhance weight loss and stress management, with or without bariatric surgery, among obese individuals.09/2013; 44(5):278-285. DOI:10.1080/19325037.2013.811363