OBES SURG DOI 10.1007/s11695-013-1165-y
ORIGINAL CONTRIBUTIONS
The Impact of Preoperative Weight Loss Before Laparoscopic Gastric Bypass Salvatore Giordano & Mikael Victorzon
# Springer Science+Business Media New York 2013
Abstract Background The impact of preoperative weight loss on outcomes following laparoscopic Roux-en-Y gastric bypass (LRYGB) is a controversial issue. We evaluated our outcomes of LRYGB in patients who lost different amount of weight prior to surgery. Methods Patients who underwent primary LRYGB were divided in three groups on the basis of preoperative weight loss percentage. Group A comprised 166 patients, who lost 5 to 10 % and group C included 143 patients who lost >10 %. Intra- and postoperative complications at 30 days, hospital stay, and outcomes were evaluated. Results Significant difference was found in operative (mean ± SD) time [104.43±36.40 min in group A, 80.08±23.07 min in group B, and 76.99±23.23 min in group C; p10 % of their weight before surgery.
Materials and Methods S. Giordano (*) Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland e-mail: [email protected] S. Giordano : M. Victorzon Department of Gastrointestinal Surgery, Vaasa Central Hospital, Vaasa, Finland
This is a retrospective review of prospectively collected data. Between 2006 and 2010, 629 patients underwent LRYGB at Vaasa Central Hospital. Of these patients, 548 (87.12 %) lost at least 1 kg of weight preoperatively. Patients’ BMI and percentage excess weight loss (EWL%) were calculated in the hospital’s database for bariatric patients, and excess weight
OBES SURG
(EW) was taken as the weight in kilograms above the weight at BMI of 25 kg/m2. For the purposes of the present study, patients were divided into three groups on the basis of the amount of preoperative weight loss achieved, 5 to 10 % (group B), and >10 % (group C), in a similar fashion as previously reported by others (9,10). The mean overall preoperative BMI was 46.86±7.56 and mean EW (kg) was 63.44±23.57, EW% 87.42±30.30. Patient characteristics per group are outlined in Table 1. One or more of the most typical comorbid conditions associated with heavy overweight was present in 90.4 % of the patients. A medically supervised weight management program was not mandatory; however, patients were encouraged to follow a very low calorie diet for 2–4 weeks preoperatively, aiming at approximately 8 % weight loss before surgery [9]. Operative time, intraoperative complications, hospital stay, and major and minor complications were compared. Major complications were defined as either life-threatening complications or complications that required rehospitalization and/or reoperation. Minor complications were defined as complications managed at outpatient clinic and/or with medications. Patients were followed every 3 months for the first year and every 6 months for the subsequent years. Data were entered prospectively into the hospital’s database for bariatric patients and retrospectively reviewed. Weight loss (WL), body mass index (kg/m2, BMI), and EWL% were evaluated at 6, 12, and 24 months postoperatively. Operative Technique and Perioperative Management Patients were treated by a fast track pathway as introduced by Grantcharov and Kehlet [10] and Kehlet [11] and as recently
described in details [12]. Shortly, most of the gatrojejunal anastomoses were performed by using linear staplers. Only 30patients were operated by the means of circular stapler as described earlier [13]. Statistical Analysis The results of parametric and nonparametric data were expressed as mean ± standard deviation (SD) and IBM SPSS statistical software (IBM SPSS 20.0.0.1, Chicago, IL 60606, USA) was used for all statistical analyses. Confidence intervals were set at 95 %. A two-sided p value of ≤0.05 was considered as statistically significant. Comparisons between both groups were determined using Fisher’s exact test for discrete variables and Student’s t test for continuous variables. Univariate association between preoperative weight loss and process variables were evaluated with Pearson’s correlation coefficient.
Results The majority of patients (65.41 %) lost over 5 % of their weight preoperatively and the three groups were comparable, although some slight differences are present (Table 1). Particularly, the mean weight the day before the procedure was higher in group C, and this group also showed the highest preoperative weight loss (>10 %). Significant differences were found in operative time, conversion rates, and hospital stay between groups A and B or C (Table 2). Furthermore, a significant negative correlation was detected between the amount of preoperative weight loss percentage and the length of hospital stay (r=−0.370, p< 0.001). Intraoperative
Table 1 Demographics of patients at time of study Group A (n=166)
Group B (n=239)
Group C (n=143)
p valuea
p valueb
p valuec
Age (mean ± SD) Sex ratio (F:M) Mean preoperative weight loss (kg) Mean preoperative weight loss (%) Mean preoperative weight (kg) BMI (kg/m2) Excess weight (kg) Excess weight (%) ASA score DM type 2 (%)
46.29±10.82 108:58 4.45±1.89 2.00±1.98 129.84±25.03 44.90±6.71 57.61±20.99 79.41±26.95 2.78±0.52 46.06 %
45.18±10.99 168:71 10.05±2.55 7.52±1.39 133.56±22.59 46.60±6.29 61.89±19.03 86.39±25.17 2.66±0.53 62.76 %
45.23±10.85 76:67 21.58±12.13 14.30±4.47 146.25±32.69 49.59±9.32 72.62±29.29 98.37±37.30 2.70±0.52 47.55 %
0.345 0.280 0.000 0.000 0.120 0.010 0.034 0.010 0.027 0.054
0.423 0.037
ORIGINAL CONTRIBUTIONS
The Impact of Preoperative Weight Loss Before Laparoscopic Gastric Bypass Salvatore Giordano & Mikael Victorzon
# Springer Science+Business Media New York 2013
Abstract Background The impact of preoperative weight loss on outcomes following laparoscopic Roux-en-Y gastric bypass (LRYGB) is a controversial issue. We evaluated our outcomes of LRYGB in patients who lost different amount of weight prior to surgery. Methods Patients who underwent primary LRYGB were divided in three groups on the basis of preoperative weight loss percentage. Group A comprised 166 patients, who lost 5 to 10 % and group C included 143 patients who lost >10 %. Intra- and postoperative complications at 30 days, hospital stay, and outcomes were evaluated. Results Significant difference was found in operative (mean ± SD) time [104.43±36.40 min in group A, 80.08±23.07 min in group B, and 76.99±23.23 min in group C; p10 % of their weight before surgery.
Materials and Methods S. Giordano (*) Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland e-mail: [email protected] S. Giordano : M. Victorzon Department of Gastrointestinal Surgery, Vaasa Central Hospital, Vaasa, Finland
This is a retrospective review of prospectively collected data. Between 2006 and 2010, 629 patients underwent LRYGB at Vaasa Central Hospital. Of these patients, 548 (87.12 %) lost at least 1 kg of weight preoperatively. Patients’ BMI and percentage excess weight loss (EWL%) were calculated in the hospital’s database for bariatric patients, and excess weight
OBES SURG
(EW) was taken as the weight in kilograms above the weight at BMI of 25 kg/m2. For the purposes of the present study, patients were divided into three groups on the basis of the amount of preoperative weight loss achieved, 5 to 10 % (group B), and >10 % (group C), in a similar fashion as previously reported by others (9,10). The mean overall preoperative BMI was 46.86±7.56 and mean EW (kg) was 63.44±23.57, EW% 87.42±30.30. Patient characteristics per group are outlined in Table 1. One or more of the most typical comorbid conditions associated with heavy overweight was present in 90.4 % of the patients. A medically supervised weight management program was not mandatory; however, patients were encouraged to follow a very low calorie diet for 2–4 weeks preoperatively, aiming at approximately 8 % weight loss before surgery [9]. Operative time, intraoperative complications, hospital stay, and major and minor complications were compared. Major complications were defined as either life-threatening complications or complications that required rehospitalization and/or reoperation. Minor complications were defined as complications managed at outpatient clinic and/or with medications. Patients were followed every 3 months for the first year and every 6 months for the subsequent years. Data were entered prospectively into the hospital’s database for bariatric patients and retrospectively reviewed. Weight loss (WL), body mass index (kg/m2, BMI), and EWL% were evaluated at 6, 12, and 24 months postoperatively. Operative Technique and Perioperative Management Patients were treated by a fast track pathway as introduced by Grantcharov and Kehlet [10] and Kehlet [11] and as recently
described in details [12]. Shortly, most of the gatrojejunal anastomoses were performed by using linear staplers. Only 30patients were operated by the means of circular stapler as described earlier [13]. Statistical Analysis The results of parametric and nonparametric data were expressed as mean ± standard deviation (SD) and IBM SPSS statistical software (IBM SPSS 20.0.0.1, Chicago, IL 60606, USA) was used for all statistical analyses. Confidence intervals were set at 95 %. A two-sided p value of ≤0.05 was considered as statistically significant. Comparisons between both groups were determined using Fisher’s exact test for discrete variables and Student’s t test for continuous variables. Univariate association between preoperative weight loss and process variables were evaluated with Pearson’s correlation coefficient.
Results The majority of patients (65.41 %) lost over 5 % of their weight preoperatively and the three groups were comparable, although some slight differences are present (Table 1). Particularly, the mean weight the day before the procedure was higher in group C, and this group also showed the highest preoperative weight loss (>10 %). Significant differences were found in operative time, conversion rates, and hospital stay between groups A and B or C (Table 2). Furthermore, a significant negative correlation was detected between the amount of preoperative weight loss percentage and the length of hospital stay (r=−0.370, p< 0.001). Intraoperative
Table 1 Demographics of patients at time of study Group A (n=166)
Group B (n=239)
Group C (n=143)
p valuea
p valueb
p valuec
Age (mean ± SD) Sex ratio (F:M) Mean preoperative weight loss (kg) Mean preoperative weight loss (%) Mean preoperative weight (kg) BMI (kg/m2) Excess weight (kg) Excess weight (%) ASA score DM type 2 (%)
46.29±10.82 108:58 4.45±1.89 2.00±1.98 129.84±25.03 44.90±6.71 57.61±20.99 79.41±26.95 2.78±0.52 46.06 %
45.18±10.99 168:71 10.05±2.55 7.52±1.39 133.56±22.59 46.60±6.29 61.89±19.03 86.39±25.17 2.66±0.53 62.76 %
45.23±10.85 76:67 21.58±12.13 14.30±4.47 146.25±32.69 49.59±9.32 72.62±29.29 98.37±37.30 2.70±0.52 47.55 %
0.345 0.280 0.000 0.000 0.120 0.010 0.034 0.010 0.027 0.054
0.423 0.037
