Early Postoperative Weight Loss Research Articles

Early postoperative weight loss predicts nadir weight and weight regain after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass.

Weight regain (WR) post bariatric surgery affects almost 20% of patients. It has been theorized that a complex interplay between physiologic adaptations and epigenetic mechanisms promotes WR in obesity, however, reliable predictors have not been identified. Our study examines the relationship between early postoperative weight loss (WL), nadir weight (NW), and WR following laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG). A retrospective review of prospectively collected data was conducted for LRYGB or LSG patients from 2012 to 2016. Demographics, preoperative BMI, procedure type, and postoperative weight at 6, 12, 24, 36, and 48 months were recorded. WR was defined as > 20% increase from NW. Univariate and multivariate linear and logistic regression models were used to determine the association between early postoperative WL with NW and WR at 4years. Thousand twenty-six adults were included (76.8% female, mean age 44.9 ± 11.9years, preoperative BMI 46.1 ± 8); 74.6% had LRYGB and 25.3% had LSG. Multivariable linear regression models showed that greater WL was associated with lower NW at 6months (Coef -2.16; 95% CI -2.51, -1.81), 1year (Coef -2.33; 95% CI -2.58, -2.08), 2years (Coef -2.04; 95% CI -2.25, -1.83), 3years (Coef -1.95; 95% CI -2.14, -1.76), and 4years (Coef -1.89; 95% CI -2.10, -1.68), p≤0.001. WR was independently associated with increased WL between 6months and 1year (Coef 1.59; 95% CI 1.05,2.14; p≤0.001) and at 1year (Coef 1.24; 95% CI 0.84,1.63;p≤0.001) postoperatively. The multivariable logistic regression model showed significantly increased risk of WR at 4years for patients with greater WL at 6months (OR 1.20, 95% CI 1.08,1.33; p = 0.001) and 1year (OR 1.14; 95% CI 1.06,1.23; p≤0.001). Our findings demonstrate that higher WL at 6 and 12months post bariatric surgery may be risk factors for WR at 4years. Surgeons may need to follow patients with high early weight loss more closely and provide additional treatment options to maximize their long-term success.

Early postoperative weight loss is associated with poor prognosis in patients with esophageal cancer.

Surgery for esophageal cancer (EC) causes morphological and functional changes in the upper gastrointestinal tract, resulting in postoperative weight loss (PWL). PWL has been shown to lead to poor nutritional status and immunocompetence, which may worsen the prognosis for several types of cancer. However, few reports have examined the relationship between weight loss (WL) in the early postoperative period and cancer prognosis. A total of 421 esophageal cancer patients underwent curative esophagectomy at Osaka University Hospital from 2010 to 2016. Based on the patients' body weight 1.5months after surgery, they were classified into severe WL (n = 50) and slight-moderate WL (n = 371) groups. The 5-year overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were significantly lower in the severe WL group than the slight-moderate WL group (p = 0.0002, p < 0.0001, and p = 0.0004, respectively). In the multivariate analysis, tumor invasion depth (pT3, 4), lymph node metastasis (pN2, 3), preoperative Prognostic Nutrition Index (< 45), postoperative complications (≥ G3), and severe WL were independent prognostic factors for CSS (hazard ratio [HR] 2.5, 95% confidence interval [CI] 1.7-3.7; HR 1.6, 95% CI 1.1-2.4; HR 1.9, 95% CI 1.3-2.8; HR 1.6, 95% CI 1.1-2.4; and HR 2.7, 95% CI 1.7-4.2, respectively). In a multivariate analysis of risk factors leading to severe WL, thoracotomy (VATS) and postoperative MAX CRP (high) were independent risk factors (odds ratio [OR 0.48, 95% CI 0.24-0.97; OR 1.9, 95% CI 1.0-3.5). Early PWL would be a useful marker of poor cancer prognosis in EC patients. Highly inflammatory conditions due to surgical invasion and postoperative complications may contribute to early PWL.

Early Postoperative Weight Loss Predicts Weight Loss up to 5 Years After Roux-En-Y Gastric Bypass, Banded Roux-En-Y Gastric Bypass, and Sleeve Gastrectomy

PurposePrevious studies showed that patients with lower weight loss after bariatric surgery could be identified based on early postoperative weight loss. However, these studies had only 12–36-month follow-up. This study aimed to explore whether patients in the lowest weight loss quartile at 3 months had lower weight loss trajectories up to 5 years after Roux-en-Y gastric bypass (RYGB), banded Roux-en-Y gastric bypass (BRYGB), and sleeve gastrectomy (SG) surgery.MethodsWeight was assessed preoperatively, and 3, 6, 9, 12, 24, 36, 48, and 60 months postoperatively. Patients were grouped into four categories based on quartiles of percentage total weight loss (%TWL) at 3-month follow-up. Results were compared between the lowest %TWL quartile group and other quartile groups.ResultsPatients underwent either RYGB (n=13,106; 72%), SG (n=3585; 20%), or BRYGB (n=1391, 8%) surgery. Weight loss trajectories of patients in the lowest %TWL quartile group remained lower than that of other quartile groups throughout a 5-year follow-up, for all three types of surgery. Patients in the lowest %TWL quartile group had higher age at surgery, higher baseline BMI, and were more likely to be male (in the SG group), and to suffer from diabetes, hypertension, dyslipidemia, and osteoarthritis.ConclusionThis study showed a positive association between weight loss at 3 and 12 to 60 months after bariatric surgery. Weight loss at 3 months after surgery could be used to identify patients whose anticipated weight loss trajectories are below average, to potentially improve their outcomes through early behavioral or medical interventions.Graphical

S157-a structured early intervention program in patients with predicted poor long-term outcome following bariatric surgery: a prospective randomized study.

Early postoperative weight loss can be predictive of one-year outcomes. It is unclear if poor performers identified in the first post-operative month can have improvement in outcomes with additional support and education. To evaluate the impact of a structured targeted support program for patients with lower-than-average early post-operative weight loss on 1-year outcomes. This was a prospective randomized study of bariatric surgery patients who experienced less than 50th percentile excess body weight loss (%EWL) at 3 weeks. Subjects with EWL < 18% were randomized into two groups: an intervention (IV) arm or a control (NI, no intervention) arm. The IV arm was offered a program with 7-weekly behavioral support sessions, while the NI patients received routine post-operative care. A total of 128 patients were randomized: 65 NI and 63 IV. In the IV group, 20 attended all sessions, 7 attended < 4, and 36 did not participate. There was no difference in baseline demographics, procedure type, or BMI. At 1 year, there was no difference in %EWL (ratio 0.993, 95% CI 0.873, 1.131), %EBMIL (ratio 0.997, 95% CI 0.875, 1.137), and %TWL (ratio 1.016, 95% CI 0.901, 1.146) between groups. A subgroup analysis including only the subjects who participated in all seven sessions showed similar results. Patients who present with suboptimal weight loss early after bariatric surgery do not experience a significant weight loss improvement with a structured behavioral support program. Importantly, despite being alerted to their poor early weight loss, patients demonstrated poor adherence to the proposed interventions.

Predictive Factors of Cholelithiasis After Prophylactic Administration of Ursodeoxycholic Acid Following Laparoscopic Bariatric Surgery: Tehran Obesity Treatment Study.

Cholelithiasis is a well-known consequence of obesity as well as rapid weight loss especially after bariatric surgery. A routine postoperative course of ursodeoxycholic acid (UDCA) is recommended as a prophylactic measure against gallstone formation. However, the efficacy of UDCA after bariatric surgery and predictors of cholelithiasis despite prophylaxis are not well understood. We assessed the incidence and predictors of de novo cholelithiasis after bariatric surgery in patients who received UDCA prophylaxis. Uniform data from 2629 consecutive patients who underwent either sleeve gastrectomy or gastric bypass between March 2013 and 2018 were collected prospectively. All patients received a 6-month course of UDCA 300mg twice daily. Cholelithiasis was assessed with abdominal ultrasound at baseline as well as 6, 9, 12, 18, and 24months postoperatively. The association between cholelithiasis and its predictors was examined by Cox proportional hazards models and restricted cubic spline regression. The cumulative rate of cholelithiasis in 24months after surgery was 10.8% (n = 283) with the greatest incidence within the first year. After multivariate analysis, 6-month body mass index (BMI) loss was found to be the only independent predictor for postoperative cholelithiasis (HR = 1.10 [95% CI: 1.04-1.16]). The concordance index for predicting cholelithiasis was 0.60 (0.56-0.64) for 6-month BMI loss. Early postoperative rapid weight loss as represented by 6-month BMI loss is the main predictor of de novo cholelithiasis after bariatric surgery, although this parameter does not have enough power for discrimination of postoperative cholelithiasis.

Baseline Presence of NAFLD Predicts Weight Loss after Gastric Bypass Surgery for Morbid Obesity.

Background. Bariatric surgery is a widely used treatment for morbid obesity. Prediction of postoperative weight loss currently relies on prediction models, which mostly overestimate patients’ weight loss. Data about the influence of Non-alcoholic fatty liver disease (NAFLD) on early postoperative weight loss are scarce. Methods. This prospective, single-center cohort study included 143 patients receiving laparoscopic gastric bypass surgery (One Anastomosis-Mini Gastric Bypass (OAGB-MGB) or Roux-en-Y Gastric Bypass (RYGB)). Liver biopsies were acquired at surgery. NAFLD activity score (NAS) assigned patients to “No NAFLD”, “NAFL” or “NASH”. Follow up data were collected at 3, 6 and 12 months. Results. In total, 49.7% of patients had NASH, while 41.3% had NAFL. Compared with the No NAFLD group, NAFL and NASH showed higher body-mass-index (BMI) at follow-up (6 months: 31.0 kg/m2 vs. 36.8 kg/m2 and 36.1 kg/m2, 12 months: 27.0 kg/m2 vs. 34.4 and 32.8 kg/m2) and lower percentage of total body weight loss (%TBWL): (6 months: 27.1% vs. 23.3% and 24.4%; 12 months: 38.5% vs. 30.1 and 32.6%). Linear regression of NAS points significantly predicts percentage of excessive weight loss (%EWL) after 6 months (Cologne-weight-loss-prediction-score). Conclusions. Histopathological presence of NAFLD might lead to inferior postoperative weight reduction after gastric bypass surgery. The mechanisms underlying this observation should be further studied.

The Effect of Family Member Attendance at Bariatric Surgery Appointments on Patient and Family Weight-Related Outcomes.

To assess the effect of family member attendance at routine pre- and postoperative appointments on early postoperative patients' weight loss and physical activity levels and family members' weight control practices. As part of a RCT, patients were randomized to (1) invite a romantic partner or cohabitating family member to attend routine appointments (FA arm) or (2) proceed with treatment as usual (TAU arm). Patients in FA arm were asked to invite their family member to attend four routine appointments (T1 = pre-surgery class, T2 = 1month pre-surgery, T3 = 2weeks post-surgery, T4 = 2months post-surgery). Assessments of patients' percent excess weight loss (%EWL), change in body mass index (ΔBMI), and levels of physical activity and family members' weight control practices (dietary control, self-monitoring, physical activity, and psychological coping) were conducted at T1-T4 with all dyads, and attendance was documented. Of the 213 dyads approached, 63 dyads consented to participate. There were no significant differences in patient outcomes between FA and TAU arms or based on consistent attendance of family members. There were no significant differences in weight control practices between FA and TAU dyads. At T3 and T4, family members with consistent attendance reported higher self-monitoring, physical activity, and psychological control practices. Family members with consistent attendance reported significant increases in physical activity and psychological control practices from T1 to T4. Family member attendance at routine appointments had greater positive effects on family members rather than on patient outcomes.

Predicting Weight Loss and Comorbidity Improvement 7 Years Following Laparoscopic Sleeve Gastrectomy: Does Early Weight Loss Matter?

Predicting the variables that affect the outcomes following laparoscopic sleeve gastrectomy (LSG) would allow focused resource allocation with a view to improving results. Whilst greater early post-operative weight loss following LSG is associated with greater short-term weight loss, the relationship between early results and long-term outcomes has not been described. A retrospective cohort analysis was performed on patients who underwent LSG 7years before a follow-up telephone interview was performed. Multivariate regression analysis was used to explore the relationship between early weight loss at 4weeks following surgery and weight loss at 7years. A non-inferiority analysis assessed whether early weight loss was associated with either improvement or resolution of hypertension or type 2 diabetes mellitus (T2DM) at 7years after surgery. Of the 156 patients identified between April and October 2012, 130 (83.3%) met the inclusion criteria and were included in the analysis. The average preoperative BMI was 42.5kg/m2 (standard deviation 5.2). The change in BMI was 4.6kg/m2 (4.0) at 4weeks and 12.2kg/m2 (5.4) at 7years. There was improvement or resolution in 19/31 (61.3%) patients with T2DM and 14/26 (53.8%) patients with hypertension. Whilst younger age was associated with greater weight loss at 7years follow-up, no such relationship was identified with early post-operative weight loss. Early post-operative weight loss was also not associated with long-term improvement or resolution in hypertension or T2DM. Early weight loss does not appear to be associated with greater weight loss nor comorbidity improvement 7years following LSG. ClinicalTrials.gov (SZMC-95/19).

Prebariatric surgery care and postoperative outcomes: increased number of visits associated with smaller weight losses over first 2 postoperative years

BackgroundThe prebariatric surgery assessment process can be challenging to patients and serve as a barrier to surgery. There is limited evidence to support its utility in improving postoperative outcomes for the majority of patients. ObjectivesTo assess the relationship between preoperative care and postoperative weight loss and follow-up in the first 2 postoperative years. SettingUniversity Hospital, United States. MethodsFrequency and duration of preoperative assessment and medical weight management contacts were retrospectively collected and assessed in relation to percent weight change over the first 24 months postoperatively in adults who underwent an initial bariatric surgical procedure between 2009 and 2014. ResultsPatients (n = 1303) were 44.4 ± 11.9 years with a body mass index of 48 ± 8.6 kg/m2. The frequency of preoperative contacts (all types) and duration of preoperative care were not associated with postoperative weight loss or follow-up. A greater number of individual (one-to-one) visits with the bariatric surgery team and additional psychology visits were associated with smaller postoperative weight losses (individual = −.27%, 95% confidence interval −.47%, −.07%; P = .01; psychology = −1.46%, 95% confidence interval −2.79%, −.12%; P = .03). ConclusionsThese observations suggest the intensity and length of the preoperative assessment period is unrelated to early postoperative weight loss. Additional individual visits with the bariatric team and the psychologist before surgery were associated with smaller postoperative weight loss, suggesting that clinicians may be appropriately identifying complex patients and are making efforts to address this complexity with additional preoperative assessment and care.

A189 - The Relationship between the Frequency and Duration of the Preoperative Assessment Process and Early Postoperative Weight Loss

Background: The frequency of clinical visits and duration of the preoperative assessment process prior to bariatric surgery is often dictated by third party payers. Few studies have investigated if these encounters are associated with greater postoperative weight loss or promote postoperative follow up with the bariatric surgery program.

A285 - Preoperative Diabetes and Early Postoperative Weight Loss Can Predict 1-year Weight Loss Success after Sleeve Gastrectomy

A285 - Preoperative Diabetes and Early Postoperative Weight Loss Can Predict 1-year Weight Loss Success after Sleeve Gastrectomy

Demographic, clinical, and behavioral determinants of 7-year weight change trajectories in Roux-en-Y gastric bypass patients

BackgroundWeight change trajectories after weight-loss surgery may vary significantly. ObjectivesThis study evaluated the weight trajectories of Roux-en-Y gastric bypass (RYGB) patients and identified the distinct clinical, behavioral, and demographic features of patients by trajectory. SettingData from 2918 RYGB patients from a comprehensive medical center between January 2004 and November 2016 were included. MethodsThis retrospective, observational study used data for RYGB patients up to year 7 postsurgery. Group-based trajectory models were fitted for percentage weight change. Variables evaluated by trajectory included age, sex, diagnoses, medications, smoking, presurgical body mass index, preoperative weight loss, and early postoperative weight loss. ResultsOf 3215 possible patients, 2918 (90.8%) were included (mean age = 46.2 ± 11.2 yr, body mass index = 46.9 ± 7.9 kg/m2 at the time of surgery). Three weight change trajectories were identified (above average, average, and below average). Mean percentage weight change at the nadir for the above average group was −42.85% ± 5.7% compared with −31.57% ± 5.0% in the average group and −22.74% ± 5.7% in the below average group. Compared with the above average group, the below average group was more likely to be male (odds ratio [OR] = 2.40, P < .0001) and have diabetes (noninsulin users, OR = 2.08, P < .0001), but less likely to have a smoking history (OR = .62, P = .0007) or take sleep medications (OR = .50, P = .005). Below average group patients had a lower BMI at the time of surgery (OR = .91, P < .0001). Lower initial weight loss postsurgery was associated with a greater chance of a poorer weight outcomes (OR = 1.64, P < .0001). ConclusionSelect clinical, demographic, and behavioral factors may increase or decrease the chance for better weight loss after RYGB.

Relationship between the resected stomach volume and early postoperative weight loss following laparoscopic sleeve gastrectomy

Background: The aim of the study was evaluation of the effect of the resected gastric volume (RGV) on weight loss after laparoscopic sleeve gastrectomy (LSG).Methods: This prospective study included 40 morbidly obese patients undergoing LSG. Multi Detector Computed Tomography (MDCT) was used to measure preoperative stomach volume and sleeve volume. The actual RGV was measured after surgery. The primary outcome measure was the relation between RGV and percentage of excess body weight loss (%EBWL) after 3 and 6 months. The secondary outcome was early postoperative complications.Results: The mean preoperative BMI was 43.5±4.3 kg/m2. The actual RGV was substantially correlated with that estimated by CT (r=0.996, p&lt;0.001). The former was significantly larger with a mean deviation of 17.6 cc (95%CI: 12.2-23.0 kg). The actual and CT-estimated RGV were positively correlated with% EBWL after 3 months (r=0.361, p=0.022 and r=0.471, p&lt;0.001, respectively) and after 6 months (r=0.466, p=0.002 and r=0.553, p&lt;0.001, respectively). Percentage of volume reduction was positively correlated with weight reduction after 3 and 6 months (r=0.0.525, p=0.001 and r=0.564, p&lt;0.001, respectively).Conclusions: The resected gastric volume during LSG was significantly correlated with weight reduction after 3 and 6 months of surgery. Sleeve volume was not correlated with early weight reduction. MDCT is a reliable method to measure gastric volume before and after surgery.

Preoperative Weight Loss and Operative Outcome After Laparoscopic Sleeve Gastrectomy.

Use of a preoperative diet before bariatric surgery to improve postoperative complications and weight loss has been reported. However, evidence supporting this diet for laparoscopic sleeve gastrectomy (LSG) is insufficient. We aimed to investigate postoperative outcomes influenced by preoperative diet before LSG. This study included 247 patients who underwent LSG after preoperative weight management. They were classified according to preoperative weight changes (group 1, weight gain; group 2, 0-3.0% total weight loss (TWL); group 3, 3.1-5.0% TWL; group 4, >5.1% TWL) and investigated for early postoperative complications and weight loss at 1year. There were 37 patients in group 1, 79 in group 2, 64 in group 3, and 67 in group 4. There were no statistical differences in initial physical status among the 4 groups. The median BMI declined to 27.6kg/m2 in the entire group. Although the average %TWL during the combined preoperative and postoperative periods showed no statistical differences (P=0.69), the average %TWL during the postoperative period decreased gradually as the extent of preoperative weight loss increased (P=0.01). The early postoperative complication rate for the entire group was 6.9%; it tended to be lower as the extent of preoperative weight loss increased. However, a multiple logistic regression model demonstrated that the preoperative diet was not a statistical predictor of reduced early postoperative complications (P=0.28). The extent of preoperative weight loss statistically affected postoperative weight loss. A preoperative diet might have minor advantages in reducing the risk of early postoperative complications.

The incidence of cholelithiasis after sleeve gastrectomy and its association with weight loss: A two-centre retrospective cohort study

IntroductionGallstones commonly develop after Roux-en-Y gastric bypass and other bariatric surgery; however, incidence of gallstone development after SG has not been adequately studied. MethodsWe conducted a retrospective cohort study of patients who underwent SG at two institutions from January 1, 2011 to December 31, 2012. Patients with previous cholecystectomy, preexisting gallstones, gallbladder polyps, or the absence of preoperative abdominal imaging were excluded. Follow-up abdominal ultrasonography was performed once the patients achieved 80-lb weight loss, became symptomatic, or reached one-year post-surgery. The incidence of gallstones and symptomatic gallstones and/or bile sludge was calculated. Different parameters of early and late postoperative weight loss were compared between the patients who developed gallstones and those who did not. ResultsDuring the study period, 253 underwent laparoscopic sleeve gastrectomy. Ultimately, 96 patients met inclusion criteria and were evaluated. The incidence of gallstone formation was 47.9% (46/96), and the incidence of symptomatic gallstones was 22.9% (22/96). None of the weight loss parameters during the early and late postoperative period were significantly different between the patients who developed gallstones and those who did not. ConclusionGallstones are a common complication after rapid weight loss from SG. Our data suggest that gallstone formation during the weight loss period is not associated with amount or rate of weight loss both during the early or late postoperative period.

Early Weight Loss as a Predictor of 2-Year Weight Loss and Resolution of Comorbidities After Sleeve Gastrectomy.

The objective of this study was to investigate whether early postoperative weight loss predicts weight loss 1 and 2years after laparoscopic sleeve gastrectomy (LSG) and to determine its effect on the resolution of comorbidities. This was a prospective study of patients who underwent LSG at Jordan University Hospital from February 2009 to January 2014. One hundred ninety patients (mean age 34.0 ± 10.8years; mean preoperative body mass index 46.2 ± 7.7kg/m(2)) were included in the study. Of these, 146 were followed for 1year and 73 were followed for 2years. Thirty patients (20.5%) had hypertension, 23 (15.8%) had diabetes, 78 (53.4%) had hyperlipidemia, 30 (20.5%) had obstructive sleep apnea, and 50 (34.2%) had more than one comorbidity. The percentage of excess weight loss (%EWL) was 22.7 ± 8.1, 75.1 ± 22.8, and 72.6 ± 17.5 at 1, 12, and 24months, respectively. Fifty-five patients (37.7%) had a 1-year %EWL of ≥80%, and 29 (39.7%) had a 2-year %EWL of ≥80%. Linear regression analysis showed a strong correlation between 1-month %EWL and %EWL at 1year (r (2) = 0.23, p < 0.001) and 2years (r (2) = 0.28, p < 0.001). Resolution of comorbidities was associated with higher %EWL achieved at 1year, but early postoperative weight loss did not have a significant effect on comorbidity resolution. Early postoperative weight loss can be used to identify and target poor responders.

Early post-operative weight loss after laparoscopic sleeve gastrectomy correlates with the volume of the excised stomach and not with that of the sleeve! Preliminary data from a multi-detector computed tomography-based study.

Pre- and post-operative stomach volumes can be important determinants for effectiveness of laparoscopic sleeve gastrectomy (LSG) in causing weight loss. There is little existing data on the volumes of stomach preoperatively and that excised during LSG. This study was designed to evaluate the change in gastric volume after LSG using multi-detector CT and to correlate it with early post-operative weight loss. Twenty consecutive patients with BMI ≥ 40 kg/m(2) and medical comorbidities underwent LSG between October 2011 and October 2013 and were analysed prospectively. The pre-operative stomach volume was measured by MDCT done 1-3 days before the surgery. LSG was performed in the standard manner using a 36F bougie. The volume of excised stomach was measured by distending the specimen with saline. MDCT of the upper abdomen was repeated 3 months postoperatively to calculate the gastric sleeve volume. Weight loss and resolution of comorbidities were documented. The mean pre-operative weight of patients was 123.90 kg, and the mean pre-operative stomach volume on MDCT was 1,067 ml. The stomach volume on pre-operative MDCT correlated with pre-operative weight and BMI. The mean volume of the excised stomach was 859 ml when measured by distension of the specimen and 850 ml on MDCT. After 3 months post surgery, the mean volume of gastric sleeve on MDCT was 217 ml, and the mean weight of the patients was 101.22 kg. The volume of the excised stomach calculated by MDCT correlated with the weight loss achieved 3 months postoperatively. However, no correlation was seen between the gastric sleeve volume 3 months postoperatively and weight loss during this period. MDCT is a good method to measure gastric volume before and after LSG. Early post-operative weight loss (3 months) correlates well with the volume of the excised stomach but not with that of the gastric sleeve.

Early postoperative weight loss predicts maximal weight loss after sleeve gastrectomy and Roux-en-Y gastric bypass.

BackgroundPrevious studies show that ‘poor responders’ to Roux-en-Y gastric bypass (RYGBP) may be identified on the basis of early postoperative weight loss. Early identification of poor responders could allow earlier provision of postoperative behavioural and/or intensive lifestyle interventions and enhance their maximal weight loss. Our aim was to investigate whether early postoperative weight loss predicts the maximal weight loss response after RYGBP and sleeve gastrectomy (SG).MethodsWe undertook a retrospective cross-sectional study of 1,456 adults who underwent either RYGBP (n = 918) or SG (n = 538) as a primary procedure in one of two European centres. Postoperative weight loss was expressed as weight loss velocity (WLV) and percentage weight loss. Linear regression analyses were performed to determine the association of early postoperative weight loss with maximal %WL, including adjustment for baseline variables.ResultsThere was marked variability in maximal %WL following both RYGBP (mean 32.9 %, range 4.1–60.9 %) and SG (mean 26.2 %, range 1.1–58.3 %). WLV 3–6 months postoperatively was more strongly associated with maximal %WL (r 2 = 0.32 for RYGBP and r 2 = 0.26 for SG, P < 0.001 for both) than either WLV 0–6 weeks or 6 weeks to 3 months postoperatively (r 2 = 0.14 and 0.10 for RYGBP, respectively; r 2 = 0.18 and 0.21 for SG, respectively; P < 0.001 for all). Multiple linear regression analysis, including baseline variables of age, sex, preoperative BMI, type 2 diabetes, ethnicity, and bariatric centre, revealed that 3–6 month WLV was an independent predictor of maximal %WL in both SG and RYGBP groups (standardised β-coefficients 0.51 and 0.52, respectively; P < 0.001 for both).ConclusionsThere is a marked variability in weight loss response following RYGBP and SG. Early postoperative weight loss can be used to identify patients whose predicted weight loss trajectories are suboptimal. Early targeting of poor responders with more intensive postoperative lifestyle and behavioural support could potentially enhance their weight loss response.

Preoperative change in 6-minute walk distance correlates with early weight loss after sleeve gastrectomy.

Introduction:The 6-minute walk test (6MWT) is an objective preoperative measure of functional capacity and response to intervention in patients with heart or lung disease. In bariatric surgery, there has been no reliable preoperative measure predictive of postoperative success. Here we investigated the impact of bariatric surgery on changes in distance traveled in the 6MWT (the 6MWD) and whether preoperative changes in 6MWD correlated with weight change after surgery.Methods:This is a retrospective study of consecutive patients in which the 6MWT was performed before and after laparoscopic sleeve gastrectomy for weight loss. 6MWD and total weight were measured. Pearson correlation was used to determine association between variables.Results:Of 100 patients who underwent laparoscopic sleeve gastrectomy, 31 patients had a preoperative 6MWT. Thirty patients (97%) were available for follow-up after surgery. Percentage of excess weight loss was 45.7% over an average of 7 months after surgery. There was a weak correlation between the postoperative weight loss and the change in preoperative and postoperative 6MWD (r = 0.28; P = .13). In a subset of patients who demonstrated a change in distance traveled in 2 separate preoperative 6MWD measurements (average 18.5% increase in distance), there was a strong correlation with postoperative weight loss (r = 0.82; P = .02).Conclusions:A demonstrated increase in 6MWD before surgery correlates strongly with early postoperative weight loss after laparoscopic sleeve gastrectomy. A multidisciplinary team that includes a physical therapist is useful in preparing bariatric patients for surgery.

A case-controlled matched-pair cohort study of single-incision and conventional laparoscopic gastric band patients in a single US center with 1-year follow-up

Single-incision laparoscopic gastric banding has been reported to be safe and feasible. This matched case-control study is the first to compare the outcome in terms of weight loss and comorbidity improvement and band positioning of single-incision versus conventional laparoscopic gastric banding with 1-year follow-up. Patients undergoing gastric banding surgery by one surgeon (S.V.) were prospectively entered into a database. Data collected included basic demographics, perioperative parameters, early and late postoperative (PO) morbidity, weight loss, and phi angle. Ten patients who underwent a single-incision gastric banding procedure were matched one-to-two with 20 patients undergoing conventional gastric banding from a database of 151 patients. Match was obtained according to gender, body mass index (BMI)±4kg/m(2), age±8years, and presence of at least one comorbidity in common. Generalized linear mixed models were used for statistical analysis. Patients' initial characteristics were similar: SIL and conventional, respectively: sex (female:male) 9:10 and 18:20; age (years): 36.5±10 and 37.5±9; preoperative BMI (kg/m(2)): 41.8±4 and 42.4±3; weight (kg): 110.2±13 and 117.9±13; hospital stay (days): 1 and 1; operative time (min): 106.6±24 and 100.9±22. No significant differences were found in patients' BMI or excess weight loss during 1-year follow-up. The phi angles of the bands varied in a comparable range: PO day 1 (degrees): 62±13 and 59±15; PO week 6: 55±9 and 54±11, for SIL and conventional, respectively. In this matched case-controlled study, single-incision laparoscopic adjustable gastric banding surgery outcomes were similar to those of the conventional multi-trocar laparoscopic operation. Band position as described by phi angle was also similar in the two groups. These results suggest that use of a single-incision approach does not compromise the results or band positioning of gastric banding surgery.