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

Mrad, Bushr; Johnson-Stoklossa, Carlene; Birch, Daniel W.

doi:10.1016/j.amjsurg.2007.12.043

Cited by 31 publications

(19 citation statements)

References 13 publications

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“…de peso adequada e durável (7)(8)(9). No Brasil, a cirurgia inclui-se entre os procedimentos de alta complexidade cobertos pelo Sistema Único de Saúde (SUS), conforme regulamentação legal estabelecida em 2001 (10).…”

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Evolução e classificação do peso corporal em relação aos resultados da cirurgia bariátrica: derivação gástrica em Y de Roux

Novais

Rasera²,

Leite³

et al. 2010

Arq Bras Endocrinol Metab

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Objetivo: Avaliar a evolução e a classificação do peso corporal em relação aos resultados da cirurgia bariátrica em mulheres submetidas ao procedimento cirúrgico há mais de dois anos. Sujeitos e método: Foram avaliadas 141 mulheres submetidas à derivação gástrica em Y de Roux (DGYR) com anel de contenção. As participantes foram divididas de acordo com o tempo de pós-operatório e conforme o percentual da perda do excesso de peso (%PEP): < 50; 50 ┤ 75; e, ≥ 75. Resultados: As mulheres do grupo com %PEP ≤ 50 (15,6%) se mantiveram obesas, enquanto aquelas que apresentaram %PEP ≥ 75 (36,2%) situaram-se entre a eutrofia e pré-obesidade e tiveram menor índice de recuperação tardia de peso em relação aos demais grupos. Conclusão: A evolução de peso após dois ou mais anos da cirurgia mostrou sua esperada redução com variados graus de resposta, apontando a necessidade de monitoramento, investigação e intervenção para obtenção dos resultados esperados. Arq Bras Endocrinol Metab. 2010;54(3):303-10 Descritores Obesidade mórbida; cirurgia bariátrica; peso corporal; perda de peso ABSTRACT Objective: The objective of this study was to assess the evolution and classification of body weight in relation to the results of bariatric surgery in women who underwent the procedure more than two years ago. Subjects and method: A total of 141 women underwent banded Roux-en-Y gastric bypass (RYGB). The participants were divided according to the time elapsed since surgery and the percentage of excess weight lost (%EWL): < 50; 50 ┤ 75; and ≥ 75. Results: The women in the group with %EWL ≤ 50 (15.6%) remained obese, while those with %EWL ≥ 75 (36.2%) ranged from normal to pre-obese and presented lower late weight gain than the women in the other groups. Conclusion: Weight evolution two or more years after surgery showed the expected reductions, with some individuals responding better to surgery than others. This shows that it is necessary to monitor, investigate and intervene to obtain the desired results. Arq Bras Endocrinol Metab. 2010;54(3):303-10 Keywords Morbid obesity; bariatric surgery; body weight; weight loss INTRODUÇÃO A obesidade tornou-se epidemia e problema de saúde pública em todo o mundo, sem distinção de sexo e idade (1-3). As consequências da obesidade no indivíduo, principalmente em seu grau mais avançado, são evidentes, como a redução na expectativa e na qualidade de vida, os problemas psicossociais e a incidência de doen ças concomitantes (4-6).Em situação grave, a cirurgia bariátrica tem configurado como o único tratamento para alcançar perda

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Evolução e classificação do peso corporal em relação aos resultados da cirurgia bariátrica: derivação gástrica em Y de Roux

Novais

Rasera²,

Leite³

et al. 2010

Arq Bras Endocrinol Metab

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“…2,27,28 For example, Mrad et al 28 reported a significant relationship between pre-and postoperative weight loss in men (P ¼ 0.02) but not in women. In an analysis of data on 884 RYGB patients grouped by preoperative % EBW change (45 gain, 0-5 gain, 0-5 loss, 5-10 loss, 410 loss), Still et al 2 reported that patients who showed 410% preoperative EBWL were 2.1 times more likely to achieve postoperative EBWL of 70% (P ¼ 0.001) as compared with patients who showed o5% EBWL preoperatively.…”

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confidence: 99%

“…This effect did not persist at 24-month follow-up; however, power may have been limited in 24-month analyses due to attrition. 27 There are also a number of studies reporting no relationship between pre-and postoperative weight change, 11,13,14,26,[27][28][29][30][31][32][33][34] including a prospective analysis 14 reporting no difference in weight loss outcome between preoperative dieters (n ¼ 47; losing an average of 7.8 kg) and non-dieters (n ¼ 53; no significant weight loss) across a 4-year follow-up. Several of the studies reporting no relationship do appear to be underpowered but do not provide adequate detail to conduct post-hoc power analyses.…”

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confidence: 99%

Pre-bariatric surgery weight loss requirements and the effect of preoperative weight loss on postoperative outcome

et al. 2012

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Pre-bariatric surgery requirements vary between surgeons and surgical centers, with standards of practice not yet established. The goal of this systematic review was to summarize and evaluate the available literature on pre-bariatric surgery weight loss requirements and the relation between preoperative weight loss and postoperative outcome. Major databases, including Medline, PubMed and PsychINFO were searched for relevant articles. Case studies, studies420 years old and studies that utilized selfreported body weight data were excluded. Data on the effect of the following was summarized: (1) preoperative requirements on preoperative weight loss; (2) insurance-mandated preoperative requirements; (3) the contingency of receipt of surgery; (4) preoperative weight loss on postoperative weight loss and (5) preoperative weight loss on perioperative and postoperative complication and comorbidity rates. The majority of studies suggest that: (1) current preoperative requirements held by the majority of third party payer organizations in the United States are ineffective in fostering preoperative weight loss; (2) making receipt of surgery contingent upon achieving preoperative weight loss, and meal-replacement diets, may be particularly effective in fostering preoperative weight loss and (3) preoperative weight loss may lead to improvements in at least some relevant postoperative outcomes. However, a preoperative weight loss mandate may lead to the denial of surgery and subsequent health benefits to individuals who are unable to achieve a prespecified amount of weight. Overall, the limited number and quality of prospective studies in this area prohibits the much-needed establishment of standards of practice for pre-bariatric requirements.

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“…Quand l'équipe médicochirurgicale et le patient sont d'accord pour envisager un amaigrissement préopéra-toire, celui-ci est finalement obtenu dans 17 à 70 % des cas [2,3,7,8]. La variabilité de la réponse est en partie liée à la définition de l'objectif de perte pondérale préopératoire : plus il est sévère, plus les résultats sont décevants (Tableau 1).…”

Section: Faisabilité Et Histoire Naturelle De L'amaigrissement Préopéunclassified

“…Keywords: Gastric bypass -Bariatric surgery -Gastroplasty -Gastric banding -Obesity -Weight loss Importance et modalités de la perte de poids Les effets de la perte de poids avant chirurgie sont évalués pour des niveaux de perte de poids très variables d'une étude à l'autre, soit par exemple 10 % de l'excès de poids ou 2 à 10 % du poids préopératoire [1][2][3]. Dans d'autres travaux, aucun seuil n'est fixé ou seule l'efficacité d'un régime à très basses calories (VLCD) est évaluée, quels que soient ses effets sur le poids [4,5].…”

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La perte de poids avant chirurgie: le point de vue du chirurgien

Brunaud

2008

Obes

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L'idée de faire maigrir les patients avant une chirurgie bariatrique n'est pas nouvelle et avait été proposée, dès 1986, pour diminuer le volume hépatique et améliorer la stéatose hépatique. Le but de ce travail a été d'évaluer les données objectives disponibles concernant l'amaigrissement préopératoire avant chirurgie bariatrique. Si pour le chirurgien les bénéfices de l'amaigrissement semblent intuitivement intéressants, les données actuelles ne permettent aucune conclusion définitive (principalement en ce qui concerne la morbidité, la durée opératoire et la durée d'hospitalisation). Il semble néanmoins qu'un amaigrissement préopératoire soit souhaitable pour les patients superobèses (IMC > 50 kg/m 2 ), mais cette option doit alors être mise en balance avec la stratégie chirurgicale en deux temps (par exemple : sleeve gastectomy puis courtcircuit gastrique).Abstract: Getting patients to lose weight before bariatric surgery is not a new idea -it was first mooted in 1986 as a way of reducing hepatic volume and improving hepatic steatosis. This study aims to assess available objective data with respect to weight loss before bariatric surgery. Although the advantages of weight loss may seem to be obvious from the surgeon's point of view, current available data does not allow any clear cut conclusions to be drawn (concerning morbidity, length of operation and length of hospitalisation). Preoperative weight loss in the super obese patient (BMI > 50 kg/m 2 ), would appear to be desirable, however, but must be associated with twostage surgery (e.g. sleeve gastectomy followed by gastric bypass).

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

Cited by 31 publications

References 13 publications

Evolução e classificação do peso corporal em relação aos resultados da cirurgia bariátrica: derivação gástrica em Y de Roux

Evolução e classificação do peso corporal em relação aos resultados da cirurgia bariátrica: derivação gástrica em Y de Roux

Pre-bariatric surgery weight loss requirements and the effect of preoperative weight loss on postoperative outcome

La perte de poids avant chirurgie: le point de vue du chirurgien

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