Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial

Alami, Ramzi S.; Morton, John M.; Schuster, Rob; Lie, Jie; Sanchez, Barry R.; Peters, Anna; Curet, Myriam J.

doi:10.1016/j.soard.2006.11.006

Cited by 233 publications

(189 citation statements)

References 8 publications

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“…However, other studies similar to ours concerning morbid obesity (excluding super-obese patients) have not found any differences in terms of post-surgical morbidity, conversion to open surgery, or mortality, even when taking into consideration other randomized studies which have compared patients with a significant weight loss on a strict hipocaloric diet vs patients without weight loss (18,42). In addition, low-calorie intake diets, even in super obese patients, have been shown to be as equally effective as IGB (43).…”

Section: Discussionsupporting

confidence: 53%

“…It is not clear in the published literature that the weight loss prior to bariatric surgery has any impact on surgical morbidity (10,13,16,18). In fact, the influence of pre-surgical weight on surgical morbidity is also uncertain.…”

Section: Discussionmentioning

confidence: 99%

“…There are some observational non-controlled clinical trials (17,18) that have not demonstrated that a pre-surgical weight loss (EWL) will determine differences in post-surgical morbidity or the subsequent evolution of the patient (18,19). However, other retrospective studies have found that a pre-surgical weight loss of 5-10% EWL will have an impact on post-surgical morbidity (9,10,16,20), on the time duration of the surgery (19), on the amount of transfusions, and on the rate of conversions to open surgery (6,21,22).…”

Section: Obesity (Bmi ≥ 30 Kg/mmentioning

confidence: 99%

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Usefulness of an intra-gastric balloon before bariatric surgery

et al. 2017

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Introduction: There are only few reports regarding the use of intragastric-balloons (IGB ® ) to achieve weight loss and subsequently decrease surgical complications. In this study, we try to assess whether presurgery weight loss using IGB decreases the postsurgical mortality after bariatric surgery.Material and methods: This is a prospective case-control study. We matched 1:1 by gender, age (± 10 y-o) and type of surgery (sleeve resection [LSG] or gastric bypass [LGBP]), matching cases (A) and controls (H, from a historic cohort). Morbidly obese patients with an indication for bariatric surgery were included in the study. Cases (A) were recruited from an ongoing clinical trial, and the controls (H) came from a historic cohort prior to the start of the clinic trial. The presurgical weight loss in group A was reached by IGB combined with diet, versus only diet in group H.Results: We included 58 patients, 65.5% women, 69% LGBP/31% LSG. The mean age of group A was 42 and 43.4 years old for group H. ASA III of 24.1% group A vs 58.6% group H, p = 0.012. The mean total weight loss (TWL) before surgery was greater in group A (16.2 kg, SD 9.75) than in group H (1.2 kg, SD 6.4), p < 0.0001. The % of EWL before surgery was 23.5 (SD 11.6) in group A vs 2.4 (SD 8) in group H, p < 0.001. Hospital stay was seven days for group A, and eight days for group H, p = 0.285. The rate of unsuccessful IGB treatment to accomplish the scheduled weight loss was 34.5%. The balloon morbidity was 17.2% (6.9% severe). All in all, morbidity (due to bariatric surgery and IGB) was 41% in both groups. Postsurgical morbidity moderate-severe was 20.3% in group A (6.9% severe) and 27.3% in group H (17.2% severe) without statistical significance. One patient died in group H (mortality rate, 3.44%).Conclusion: Preoperative IGB treatment in morbid obesity has not been found to be effective at decreasing postsurgical morbidity LSG and LGBP, despite the fact that it acheives a greater weight loss than diet and exercise.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Obesity (Bmi ≥ 30 Kg/mmentioning

confidence: 99%

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Usefulness of an intra-gastric balloon before bariatric surgery

et al. 2017

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“…Indeed, we are currently conducting a randomized controlled trial (R01DK077102) to evaluate the benefits of an empirically supported 6-month behavioral weight management program relative to usual preoperative care. We anticipate that preoperative weight loss will lead to fewer surgical complications and may enhance postoperative weight loss as found by Alami and colleagues [2]. Moreover, we hypothesize that a comprehensive program including education about surgery and training in behavioral self-management will confer additional benefits, such as better compliance and lower overall health care utilization after operation.…”

Section: To the Editormentioning

confidence: 69%

“…Tarnoff, Kaplan, and Shikora [1] summarizing the current literature on the topic of preoperative weight loss in bariatric surgery. As noted in the piece, there is only one published prospective randomized trial on this topic [2]. Results suggest that patients guided to lose 10% of their initial body weight prior to surgery had a shorter operative time and greater weight loss 3 months after gastric bypass as compared to a group who underwent surgery at their presenting weight.…”

Section: To the Editormentioning

confidence: 97%

Preoperative Weight Loss in Bariatric Surgery

Kalarchian

Marcus

2008

OBES SURG

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Outcomes of Preoperative Weight Loss in High-Risk Patients Undergoing Gastric Bypass Surgery

Still¹

2007

Arch Surg

157

102

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Hypothesis: Modest, preoperative weight loss will improve perioperative outcomes among high-risk, morbidly obese patients undergoing Roux-en-Y gastric bypass.Design: A prospective, longitudinal assessment of characteristics and outcomes of gastric bypass patients. Setting:All patients undergoing open or laparoscopic Roux-en-Y gastric bypass surgery for morbid obesity or its comorbid medical problems at Geisinger Medical Center in Danville, Pennsylvania, during a 3-year period from May 31, 2002, to February 24, 2006, were included in this analysis. Patients were required to participate in a standardized multidisciplinary preoperative program that encompasses medical, psychological, nutritional, and surgical interventions and education. In addition, patients were encouraged to achieve a 10% loss of excess body weight prior to surgical intervention.Results: Of the 884 subjects, 425 (48%) lost more than 10% of their excess body weight prior to the operation. After surgery (mean follow-up, 12 months), this group was more likely to achieve 70% loss of excess body weight (PϽ .001). Those who lost more than 5% of excess body weight prior to surgery were statistically less likely to have a length of stay of greater than 4 days (P =.03). Conclusions:This study shows that high-risk morbidly obese candidates for bariatric surgery who are able to achieve a loss of 5% to 10% excess body weight prior to surgery have a higher probability of a shorter length of hospital stay and more rapid postoperative weight loss.

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Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial

Cited by 233 publications

References 8 publications

Usefulness of an intra-gastric balloon before bariatric surgery

Usefulness of an intra-gastric balloon before bariatric surgery

Preoperative Weight Loss in Bariatric Surgery

Outcomes of Preoperative Weight Loss in High-Risk Patients Undergoing Gastric Bypass Surgery

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