Required Preop Weight Loss

Studies demonstrating that required preop weight loss or
wait time for surgery is not a predictor of postop bariatric
surgery weight loss success.

Preoperative weight gain does not predict failure of
weight loss or co-morbidity resolution of laparoscopic
Roux-en-Y gastric bypass for morbid obesity.


Harnisch et al. May 2008


PubMed Abstract

BACKGROUND: Success with preoperative weight loss (PWL) is
often mandated by the bariatric team to assess patient compliance
and has been suggested to correlate with improved postoperative
weight loss outcomes.

METHODS: We performed a retrospective analysis of 1629 consecutive
patients undergoing laparoscopic Roux-en-Y gastric bypass
at Duke University Medical Center. Patients with a preoperative
weight gain (PWG) or loss of > or =10 lb were compared. Patients
with <12 months of follow-up were excluded.

RESULTS: We found no difference between the 2 groups (PWG,
n = 115, PWL, n = 88) with regard to age, gender, race, preoperative
body mass index, presence of co-morbidities, or interval between
the initial program-entry weight and surgery (149 versus 141 d).
No difference was found in the percentage of excess weight loss
(EWL) at 12 months, when calculated using the patient’s immediate
preoperative weight (PWG group, 63.5% EWL versus PWL group, 63.9%
EWL, P = NS). If the %EWL was calculated using the initial
program-entry weight, the PWL did confer a transient postoperative
weight loss advantage; however, this did not persist past 24
months postoperatively. At both 12 and 24 months, the resolution
rates of diabetes (82% versus 83% at 2 yr; P = NS), hypertension
(48% versus 42% at 2 yr, P = NS), and continuous positive airway
pressure discontinuation (87% versus 87% at 1 yr, P = NS) were
equivalent. No differences in perioperative complications or
conversion rates were detected. The operative time was slightly
longer for the PWG group (119.7 versus 104.9 min, P = .02).

CONCLUSION: The results of our study have shown that weight
loss before laparoscopic Roux-en-Y gastric bypass is not
mandatory and might deter patients from considering weight
loss surgery. Laparoscopic Roux-en-Y gastric bypass can be
performed safely with equivalent co-morbidity resolution and
%EWL regardless of PWG or PWL.

Does preoperative weight loss predict success following
surgery for morbid obesity?


Mrad et al. May 2008


PubMed Abstract

BACKGROUND: We analyzed preoperative weight loss as a predictor
of postoperative success in patients after bariatric surgery.

METHODS: Data were obtained from a retrospective chart review
of 562 patients in a multidisciplinary obesity clinic.

RESULTS: One hundred forty-six patients met the inclusion
criteria (23 men and 123 women). The mean age was 39.5 years,
and the mean body mass index (BMI) was 52.6 kg/m(2). Comorbid
disease includes diabetes (15.7%), hypertension (30.8%),
mental illness (38.4%), and musculoskeletal disease (56.8%).
Procedures performed were 16 vertical band gastroplasties,
43 open gastric bypasses, 52 laparoscopic gastric bypasses,
and 35 laparoscopic adjustable gastric bands. Preoperative
weight change was as follows: 31 patients gained weight (21.2%),
56 patients lost weight (38.3%), and 59 patients maintained
their weight (40.4%). Postoperative weight loss was not influenced
by preoperative weight change among women. However, men who
gained weight preoperatively had significantly worse outcomes.

CONCLUSIONS: Patients may achieve satisfactory early postoperative
outcomes despite inconsistent or marginal preoperative weight
change.

Evaluating preoperative weight loss, binge eating disorder,
and sexual abuse history on Roux-en-Y gastric bypass outcome.


Fujioka et al. Mar 2008


PubMed Abstract

BACKGROUND: Roux-en-Y gastric bypass patients often undergo
preoperative dieting and psychological assessment before
surgery. We examined preoperative weight loss, binge eating
disorder (BED), and sexual abuse history and the interactions
of these predictors to determine whether a cautionary approach
to Roux-en-Y gastric bypass is warranted.

METHODS: Consecutive subjects undergoing Roux-en-Y gastric
bypass at our institution from January 1997 to December 2002
were reviewed. The postoperative excess weight loss (EWL)
at 1, 3, 6, 12, 18, and 24 months and the perioperative complications
were measured. EWL was compared at 12 and 24 months postoperatively
in the categories of the presence/absence of preoperative
weight loss, BED, and sexual abuse history. The perioperative
complications were examined in the preoperative weight change
groups.

RESULTS: Of 154 patients, 121 were included. No significant
difference in EWL or perioperative complications was observed
between those who lost or gained weight preoperatively. Of
the 121 patients, 32% and 17% reported a history of BED and
sexual abuse, respectively. No statistically significant
difference was observed in the EWL between those with and
without BED at 12 and 24 months postoperatively. The EWL
in those with and without a sexual abuse history at 12 and
24 months was 57.67% and 66.32% (P <.05) and 64.40% and 70.97% (P = NS). No statistically significant interaction between EWL and sexual abuse*BED/sexual abuse*preoperative weight loss was observed.

CONCLUSION: Only sexual abuse history
at postoperative month 12 had a negative effect on EWL. Otherwise,
physicians can expect to see successful EWL in these subjects
up to 24 months postoperatively. We recommend that additional
investigation be done of those with BED and a sexual abuse
history.

Patients who are delayed from undergoing bariatric surgery
do not have improved weight loss.


Madan et al. Mar 2008


PubMed Abstract

BACKGROUND: Many patients have a prolonged wait time between
initial surgeon visit and actual surgery day. Whereas there
are various reasons for this, few have examined if patient
wait time for bariatric surgery has any affect on weight
loss. This investigation studies the hypothesis that patients
who wait longer for bariatric surgery do not have improved
weight loss over those with shorter wait times.

METHODS: All patients in a private academic practice who
underwent laparoscopic gastric bypass over a 6-month period
were included in this study. The time from initial office
visit to actual surgery date was calculated to be wait time
(WT). Reasons for short or long WT were not investigated.
The relationship between WT and percentage excess body weight
loss (%EBWL) was examined. In addition, patients whose WT
was greater than 6 months (WT > 6) were compared to those
less than 6 months (WT < 6). Pearson's correlation coefficients and two-tailed Mann-Whitney tests were used as appropriate.

RESULTS: There were 104 patients with 99 patients who had a
>1 year follow-up. WT did not correlate with %EBWL (r = 0.09,
p = 0.37). There was no difference in %EBWL in the WT > 6
group versus the WT < 6 group (73 vs. 70%; p = NS). Patients who had <50% EBWL waited an average of 281 versus 254 days for those who have >50% EBWL (p = NS).

CONCLUSIONS: Patients who wait longer before having bariatric
surgery do not show improved weight loss. Weight loss success
was not related to wait time. These results suggest that prolonged
mandatory weight times are not an effective method for improving
bariatric surgery weight loss outcomes. Mandatory delays for
bariatric surgery should not be required, as they have no
scientific merit.