Impact of preoperative weight loss achieved by gastric balloon on peri- and postoperative outcomes of bariatric surgery in super-obese patients: a retrospective matched-pair analysis

Abstract

Background An intragastric balloon is used to cause weight loss in super-obese patients (BMI > 60 kg/m2) prior to bariatric surgery. Whether weight loss from intragastric balloon influences that from bariatric surgery is poorly studied. Methods In this retrospective, single-center study, the effects of intragastric balloon in 26 patients (BMI 69.26 ± 6.81) on weight loss after bariatric surgery (primary endpoint), postoperative complications within 30 days, hospital readmission, operation time, and MTL30 (secondary endpoints) were evaluated. Fifty-two matched-pair patients without intragastric balloon prior to bariatric surgery were used as controls. Results Intragastric balloon resulted in a weight loss of 17.3 ± 14.1 kg (BMI 5.75 ± 4.66 kg/m2) with a nadir after 5 months. Surgical and postoperative outcomes including complications were comparable between both groups. Total weight loss was similar in both groups (29.0% vs. 32.2%, p = 0.362). Direct postoperative weight loss was more pronounced in the control group compared to the gastric balloon group (29.16 ± 7.53% vs 23.78 ± 9.89% after 1 year, p < 0.05 and 32.13 ± 10.5% vs 22.21 ± 10.9% after 2 years, p < 0.05), who experienced an earlier nadir and started to regain weight during the follow-up. Conclusion A multi-stage therapeutic approach with gastric balloon prior to bariatric surgery in super-obese patients may be effective to facilitate safe surgery. However, with the gastric balloon, pre-treated patients experienced an attenuated postoperative weight loss with an earlier nadir and earlier body weight regain. This should be considered when choosing the appropriate therapeutic regime and managing patients’ expectations.

The current status and challenges of perioperative management of patients with a BMI of greater than or equal to 50 kg/m2 undergoing bariatric surgery in China: a multicenter cross-sectional study

“…In our study, only three centres recommended preoperative weight loss by intragastric balloon placement. It was similar to the result of this article 19 , which assessed the effect of intragastric balloon placement before bariatric surgery on weight loss. The results showed that intragastric balloon placement before bariatric surgery did not have a significant impact on postoperative weight-loss outcomes.…”

Efficacy of Intragastric Balloon versus Liraglutide as Bridge to Surgery in Super-Obese Patients

“…In contrast, Busetto et al [ 27 ] and Zerrweck et al [ 28 ] reported decreased intraoperative conversion to open surgery, intraoperative time, and length of stay in the cohort of patients treated with IGB prior to definitive surgery. To reduce severe side effects, Hering et al [ 8 ], in line with our methods, suggested a time interval of 21 days between IGB removal and bariatric surgery, thus allowing resolution of gastric inflammation and hypertrophy. Moreover, during bridging therapy with IGB, they reported a spike of weight loss at 3 months followed by a plateau and even a slight weight regain at 5 months, suggesting a reduction of preconditioning period to reduce peri-operative complications such as perforation, nausea, vomiting, and dehydration.…”

“…In line with this study, our results showed an EWL of 39.9% and EBWL of 71.2% with a statistically significant difference compared to the group treated with medical therapy prior to surgery. Conversely, Hering et al [ 8 ] and Banks et al [ 23 ] reported comparable weight loss in patients without IGB prior to LSG, at 12 months and 24 months, respectively. However, both these studies included a very small number of patients, precluding a definitive comment on this subject.…”

“…Therefore, the increased risk associated with these patients led to the creation of several therapeutic strategies with two-stage approach including the use of an intragastric balloon (IGB) or medical treatment, as liraglutide, to achieve weight loss, before definitive surgery [ 7 , 8 ]. IGB is an Food and Drug Administration (FDA)-approved treatment for obese patients, offering a potentially safe and less invasive method for reducing gastric capacity and inducing weight loss with a lower complication rate than bariatric surgery [ 9 ].…”