Sara Monfared1, Dimitrios I Athanasiadis2,3, Alvin Furiya4, Annabelle Butler1, Don Selzer1, William Hilgendorf4, Ambar Banerjee1, Dimitrios Stefanidis1. 1. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. 2. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. dathanas@iu.edu. 3. Rotary Building at Indiana University, 702 Rotary Circle, Suite 022, Indianapolis, IN, 46202, USA. dathanas@iu.edu. 4. Department of Surgery, Indiana University Health, Indianapolis, IN, USA.
Abstract
BACKGROUND: Most patients pursuing bariatric surgery undergo mandated preoperative weight management programs. The purpose of this study was to assess whether preoperative mandated weight loss goals lead to improved perioperative morbidity, postoperative weight loss, and resolution of comorbidities. METHODS: Data from patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic sleeve gastrectomy (LSG) between October 2012 and October of 2015 was reviewed. Patients were divided in two groups: those with BMI of 35-45 were not required to achieve a weight loss goal prior to surgery (no-WLG group) while those with BMI > 45 were given a weight loss goal proportionate to their weight (WLG group). Body mass index (BMI), history of diabetes mellitus type-II (DM-II), hypertension (HTN), hyperlipidemia (HLD), and obstructive sleep apnea (OSA) were recorded at baseline and 4 years postoperatively. Length of hospital stay (LOS) and reinterventions were considered proxies for postoperative morbidity. RESULTS: A total of 776 patients, 81.4% LRYGB, were included in the study (age 45.1 ± 11.9). There was no difference in %ΔBMI, DM-II, HDL, HTN, LOS, or reinterventions among the two groups at 4 years postoperatively in both LRNY and LSG patients. This lack of difference persisted even when patients with similar BMI (43-45 vs 45.01-47) were compared. CONCLUSION: WLG group did not have decreased perioperative morbidity, nor improved weight loss and comorbidity resolution 4 years after surgery. While these findings should also be confirmed by multicenter trials, they question the value of mandated WLG prior to bariatric surgery as they seem ineffective and may limit patient access to surgery.
BACKGROUND: Most patients pursuing bariatric surgery undergo mandated preoperative weight management programs. The purpose of this study was to assess whether preoperative mandated weight loss goals lead to improved perioperative morbidity, postoperative weight loss, and resolution of comorbidities. METHODS: Data from patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic sleeve gastrectomy (LSG) between October 2012 and October of 2015 was reviewed. Patients were divided in two groups: those with BMI of 35-45 were not required to achieve a weight loss goal prior to surgery (no-WLG group) while those with BMI > 45 were given a weight loss goal proportionate to their weight (WLG group). Body mass index (BMI), history of diabetes mellitus type-II (DM-II), hypertension (HTN), hyperlipidemia (HLD), and obstructive sleep apnea (OSA) were recorded at baseline and 4 years postoperatively. Length of hospital stay (LOS) and reinterventions were considered proxies for postoperative morbidity. RESULTS: A total of 776 patients, 81.4% LRYGB, were included in the study (age 45.1 ± 11.9). There was no difference in %ΔBMI, DM-II, HDL, HTN, LOS, or reinterventions among the two groups at 4 years postoperatively in both LRNY and LSG patients. This lack of difference persisted even when patients with similar BMI (43-45 vs 45.01-47) were compared. CONCLUSION:WLG group did not have decreased perioperative morbidity, nor improved weight loss and comorbidity resolution 4 years after surgery. While these findings should also be confirmed by multicenter trials, they question the value of mandated WLG prior to bariatric surgery as they seem ineffective and may limit patient access to surgery.
Authors: Michael C Harnisch; Dana D Portenier; Aurora D Pryor; Rebecca Prince-Petersen; John P Grant; Eric J DeMaria Journal: Surg Obes Relat Dis Date: 2008 May-Jun Impact factor: 4.734
Authors: Lars Sjöström; Kristina Narbro; C David Sjöström; Kristjan Karason; Bo Larsson; Hans Wedel; Ted Lystig; Marianne Sullivan; Claude Bouchard; Björn Carlsson; Calle Bengtsson; Sven Dahlgren; Anders Gummesson; Peter Jacobson; Jan Karlsson; Anna-Karin Lindroos; Hans Lönroth; Ingmar Näslund; Torsten Olbers; Kaj Stenlöf; Jarl Torgerson; Göran Agren; Lena M S Carlsson Journal: N Engl J Med Date: 2007-08-23 Impact factor: 91.245