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Modest weight loss before bariatric surgery predicts postoperative success.

High-risk morbidly obese patients who lose 10% or more of their excess body weight before undergoing bariatric surgery shed postoperative weight more rapidly than do those who do not lose the excess weight preoperatively, reported Dr. Christopher D. Still and his associates.

The investigators, of the center for nutrition and weight management at the Geisinger Medical Center in Danville, Pa., said patients who lose that "modest" amount in the preoperative period also are less likely to have a long hospital stay, probably because they have fewer complications.

"Optimal preparation for high-risk individuals with significant comorbid medical problems remains controversial," they noted. Geisinger Medical Center's preoperative program encourages modest short-term weight loss to help control existing medical problems such as diabetes, sleep apnea, steatohepatitis, and cardiometabolic syndrome.

Dr. Still and his associates assessed the postoperative course in 884 patients who underwent open or laparoscopic Roux-en-Y gastric bypass between 2002 and 2006 at their center. Preoperative weight loss was initially attempted by means of a prudent low-fat diet and modest exercise. If that approach was ineffective, patients were instructed to follow a 1,000-1,500-kcal liquid diet.

The mean patient age was 45 years, and mean body mass index was 51.3 kg/[m.sup.2]. Patients were followed for an average of 1 year after the operation. Nearly half (425 patients) achieved a short-term weight loss of 10% or more of their excess body weight before surgery. Those who did so were more than twice as likely to achieve 70% excess body weight loss during follow-up.

They also were less likely to need a long hospital stay, possibly because of a reduced rate of postoperative complications, Dr. Still and his associates said (Arch. Surg. 2007;142:994-8).

It is possible that those who lost weight preoperatively were the most motivated and compliant patients, and thus the most likely to have successful surgical results. Longer follow-up should answer this question, they said.


Contributing Writer
Adjusted Hazard Ratios for More Than 70% Excess Body Weight Loss After
Gastric Bypass Surgery

Preoperative Excess Body Weight Loss

> 5% gain (n = 67) 1.16
0%-5% gain (n = 86) 1.08
0%-5% loss (n = 137) 1.00 reference
5%-10% loss (n = 169) 1.20
> 10% loss (n = 425) 2.12

Note: Based on a mean 12-month follow-up.
Source: Archives of Surgery

Note: Table made from bar graph.
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Article Details
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Title Annotation:Gastroenterology
Author:Moon, Mary Ann
Publication:Internal Medicine News
Article Type:Clinical report
Geographic Code:1USA
Date:Dec 15, 2007
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