An Evidenced-based Assessment of Preoperative Weight Loss in Bariatric Surgery

Abstract

Surgeons in all disciplines have always known that obese patients suffer from a higher incidence of perioperative complications than more normal-weight individuals. In addition to the physiologic derangements and comorbid conditions associated with obesity (i.e., type II diabetes, hypertension, sleep apnea, etc.), the presence of excess abdominal fat also increases the technical difficulties of the operative procedure and jeopardizes the healing response thereby compromising the integrity of surgical repairs, organ function and the incisions used in modern surgery [1–7]. Recently, the potential benefits of preoperative weight loss has become of interest to surgeons and in particular, bariatric surgeons who routinely perform complex operative procedures on high-risk severely obese individuals. Traditionally, the concept has been considered controversial. For many bariatric surgeons, the concept of mandatory preoperative weight loss was considered unjustified, an exercise in futility, and even inhumane. Yet, others were convinced of its benefits. In the last few years, several studies have been published demonstrating value to mandatory weight loss prior to bariatric surgery. This review will summarize the current literature on the topic. The Surgical Consequences of Obesity