Abstract
Bariatric surgery is increasing exponentially to address the steep rise in the prevalence of severe obesity. Most centers require pre-specified preoperative weight loss before allowing patients to receive surgery. We examined the current evidence surrounding the potential benefits of this requirement on postoperative outcomes. We reviewed the current literature by conducting a multistage advance electronic search in Ovid®/MEDLINE® and PubMed for publications indexed after 2008 reporting preoperative weight loss and postoperative outcomes. Thirteen original publications, three randomized control trials (RCT), and five systematic reviews that met inclusion criteria were included. These were analyzed with regards to weight loss before surgery and postoperative outcomes. There were varied reports regarding the significant effect of preoperative weight loss. Six of the original articles (50%) did not identify a significant difference in the outcome while two of the RCT (essentially the same patient population, started in 2007 and reanalyzed in 2009) demonstrated some advantage. A later RCT (2012) did not show any advantage, albeit in the short term. The results of the systematic reviews, some with heterogenic designs, show no conclusive evidence that weight loss before surgery conferred improved postoperative outcomes. There is not enough high-quality evidence to back up the requirement of pre-specified preoperative weight loss before receiving surgery. Further validation of the possible benefits of pre-specified preoperative weight loss may need to be carried out.
Highlights
BackgroundThe purpose of this article is to review available up to date evidence on pre-specified weight loss before bariatric surgery and its significance on postoperative outcomes and to identify possible gaps
In the earlier mentioned study requiring four-week low-calorie diet (LCD) amongst patients who had laparoscopic sleeve gastrectomy (LSG) and roux-en-Y gastric bypass (RYGB) divided into two cohorts of achieving 8% excess weight loss (EWL) or not
Many bariatric centers practice the requirement of ensuring pre-specified weight loss before receiving surgery; many of the recent high-quality reviews are not conclusive of the evidence supporting this practice
Summary
The purpose of this article is to review available up to date evidence on pre-specified weight loss before bariatric surgery and its significance on postoperative outcomes and to identify possible gaps. How to cite this article Chinaka U, Fultang J, Ali A, et al (December 31, 2020) Pre-specified Weight Loss Before Bariatric Surgery and Postoperative Outcomes. This expanding pool of patients has led to the introduction of preoperative assessment guidelines to assist in patient selection for an optimized outcome from surgery [11, 12]. A notable contributory factor is a requirement by some non-public-funded medical providers and bariatric centers to successfully complete preoperative weight loss programs. These programs are aimed at achieving weight loss in the range of 510%, hoping to optimize postoperative outcomes. The articles reviewed and their considered postoperative outcomes are shown in Table 1 [12,13,14,15,16,17,18,19,20,21,22,23]
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