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
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.
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