Preoperative Weight Reduction Research Articles

P.365: Is preoperative weight reduction of living-donor liver transplant recipients and donors harmful to postoperative outcomes?

P.365: Is preoperative weight reduction of living-donor liver transplant recipients and donors harmful to postoperative outcomes?

Is Preoperative Weight Reduction in Patients Who Have Body Mass Index ≥ 40 Associated With Lower Complication Rates After Primary Total Hip Arthroplasty?

BackgroundGiven the heightened risk of postoperative complications associated with obesity, delaying total hip arthroplasty (THA) in patients who have a body mass index (BMI) > 40 to maximize preoperative weight loss has been advocated by professional societies and orthopaedic surgeons. While the benefits of this strategy are not well-understood, previous studies have suggested that a 5% reduction in weight or BMI may be associated with reduced complications after THA. MethodsWe identified 613 patients who underwent primary THA in a single institution during a 7-year period and who had a BMI >40 recorded from 9 to 12 months prior to surgery. Subjects were stratified into 3 cohorts based on whether their baseline BMI decreased by >5% (147 patients, 24%), was unchanged ( ± 5%) (336 patients, 55%), or increased by >5% (130 patients, 21%) on the day of surgery. The frequency of 90-days Hip Society and Centers for Medicare & Medicaid Services complications was compared between these cohorts. There were significant baseline differences between the cohorts with respect to baseline American Society of Anesthesiologists class (P < .001) and hemoglobin A1C (P = .011), which were accounted for in a multivariate regression analysis. ResultsIn univariate analysis, there was a lower incidence of readmission (P = .025) and total complications (P = .005) in the increased BMI cohort. The overall complication rate was 18.4% in the decreased BMI cohort, 17.6% in the unchanged cohort, and 6.2% in the increased cohort. However, multivariable regression analysis controlling for potential confounders did not find that preoperative change in BMI was associated with differences in 90-days complications between cohorts (P > .05). ConclusionsPatients who have a BMI >40 and achieved a clinically significant (>5%) BMI reduction prior to THA did not have a lower risk of 90-days complications or readmissions. Thus, delaying THA in these patients to encourage weight loss may result in restricting access to a beneficial surgery without an appreciable safety benefit.

Is preoperative weight reduction of living-donor liver transplant recipients and donors harmful to postoperative outcomes?

AimAlthough the incidence of overweight and obese recipients and donors is increasing worldwide, few reports have focused on outcomes of preoperative weight reduction (WR) in living-donor liver transplantation (LDLT). We therefore examined the outcomes and the impact of WR on the postoperative course. MethodsWe analyzed 217 consecutive LDLT procedures performed from 2017 to 2022. We divided the recipients and donors into a WR group and non-WR group. ResultsTwenty-two recipients (10.1%) achieved WR (preoperative recipient WR [RWR] group), reducing their weight by 6.8% ± 6.0% within 2.2 ± 1.4 months with a significant decrease in body mass index (BMI) (p < 0.0001). The RWR group showed no significant differences in short-term postoperative outcomes (operative factors, postoperative liver function tests, amount of ascites, and morbidity) or in the graft survival rate as a long-term outcome (p = 0.24) compared with the non-RWR group. Forty-one (18.9%) donors achieved WR (preoperative donor WR [DWR] group), reducing their weight by 9.7% ± 6.3% within 3.2 ± 5.8 months with a significant decrease in BMI (p < 0.0001). Compared with the non-DWR group, the DWR group showed no significant differences in short-term postoperative outcomes between themselves and recipients or in the graft survival rate (p = 0.49). Furthermore, WR resulted in an increase to 32 donor-eligible and 6 recipient-eligible patients. ConclusionWR in LDLT recipients and donors had no harmful effect on postoperative outcomes and should lead to increase recipients’ chance of undergoing LDLT and to expand the donor pool.

Weight reduction among females undergoing laparoscopic ventral hernia repair: The role of Calcium and Vitamin D3.

To evaluate the role of Vitamin-D and calcium supplementation on preoperative weight reduction in obese women before laparoscopic ventral hernia repair. This double-blind clinical trial was conducted at the affiliated health centers of King Faisal University, Al-Ahsa, Saudi Arabia from January 2021 to December 2021. It included forty-five obese women aged 24-56 years, with body mass index (BMI) of 34.0-48.0kg/m2. They were randomly allocated into two groups; the Group-A (N=22) included obese women who received supplementation of 5000IU cholecalciferol (Vitamin-D3), and 1000mg calcium daily for 12 months, while the Group-B (N=23) received no treatment. Measurement of change in weight and BMI and comparison of their pre-operative weight reduction, laparoscopic operative time, and length of hospital stay was done. There were no differences in patients' biographic data between the two groups. During the study, Vitamin-D level in the patients increased and there was a significant positive association with weight loss. In group-A, the mean weight loss was 11.8±3.5 kg. At the end of first year, their BMI decreased from 36.1±1.6kg/m2 at baseline to 29.7±2.6 kg/m2, whereas in-group-B, the mean weight loss was 6.8±3.1 kg and their BMI decreased from 36.9±2.69kg/m2 at baseline to 32.7±0.93kg/m2. The operation time and the length of hospital stay were shorter in group-A (107 vs.128.min) and (3 vs. 5 days) respectively as compared to Group-B. Vitamin-D and calcium supplementation contributes to a remarkable weight reduction of preoperative obese female patients, which in turn is associated with significantly better outcome of laparoscopic repair of ventral hernia.

Institutional Adherence to the American Association of Hip and Knee Surgeons Body Mass Index Guidelines Lowers Perioperative Emergency Department Visits in Primary Total Knee Arthroplasty

BackgroundIn 2013, the American Association of Hip and Knee Surgeons tasked a workgroup to provide obesity-related recommendations in total joint arthroplasty and determined that patients who had body mass index (BMI) ≥ 40 seeking hip/knee arthroplasty were at increased perioperative risk and recommended preoperative weight reduction. Few studies have shown the actual results of instituting this; therefore, we reported the effect of instituting a BMI < 40 threshold in 2014 on our elective, primary total knee arthroplasties (TKAs). MethodsWe queried an institutional database to select all TKAs conducted from January 2010 to May 2020. There were 2,514 TKA pre-2014 and 5,545 TKA post-2014 that were identified. The 90-day emergency department (ED) visits, readmissions, and returns-to-operating room (OR) outcomes were identified. Patients were propensity score weight-matched as per comorbidities, age, initial surgical consultation (consult) BMI, and sex. We conducted 3 outcome comparisons: (1) pre-2014 patients who had a consult and surgical BMI ≥ 40 against post-2014 patients who had a consult BMI ≥ 40 and surgical BMI < 40; (2) pre-2014 patients against post-2014 patients who had a consult and surgical BMI < 40; (3) post-2014 patients who had a consult BMI ≥ 40 and surgical BMI < 40 against post-2014 patients who had a consult BMI ≥ 40 and surgical BMI ≥ 40. ResultsPre-2014 patients who had a consult and surgical BMI ≥ 40 had more ED visits (12.5% versus 6%, P = .002) but similar readmissions and returns-to-OR than post-2014 patients who had a consult BMI ≥ 40 and surgical BMI < 40. Pre-2014 patients who had a consult and surgical BMI < 40 had more readmissions (8.8% versus 6%, P < .0001) but similar ED visits and returns-to-OR when compared to their post-2014 counterparts. Post-2014 patients who had a consult BMI ≥ 40 and surgical BMI < 40 had fewer ED visits (5.8% versus 10.6%) but similar readmissions and returns-to-OR than patients who had a consult BMI ≥ 40 and surgical BMI ≥ 40. DiscussionPatient optimization prior to total joint arthroplasty is essential. Enacting BMI reduction pathways prior to total knee arthroplasty seems to afford morbidly obese patients major risk mitigation. We must continue to ethically balance the pathology, expected improvement after surgery, and the overall risks of complications for each patient. Level of EvidenceIII.

Changes in Eating Behaviors and Their Associations with Weight Loss in Japanese Patients Who Underwent Laparoscopic Sleeve Gastrectomy.

Metabolic and bariatric surgery (MBS) has been established to provide long-term weight loss in severe obesity. In this study, we investigated the factors that affect post-operative weight loss, with a particular focus on changes in eating behaviors. Time-course changes in body weight and eating behaviors were examined in 49 Japanese patients who underwent laparoscopic sleeve gastrectomy from the first visit to 12 months after surgery. Each eating behavior was evaluated via the questionnaire of the Japan Society for the Study of Obesity. Pre-operative weight reduction mediated by dietary and lifestyle interventions showed significant positive correlations with weight loss outcomes at 12 months after surgery. We observed significant decreases in scores for most of the eating behaviors 12 months after surgery. However, "emotional eating behavior" scores declined temporarily in the early post-operative period of one month but thereafter returned to the pre-operative level at 12 months. Furthermore, increases in the scores for "emotional eating behavior" and "sense of hunger" from 1 to 12 months post-operatively were significantly associated with poor weight loss. Our results demonstrate the beneficial effects of MBS on obesity-related eating behaviors, as well as highlighting "emotional eating behavior" as requiring particular attention.

Ketogenic Diet for Preoperative Weight Reduction in Bariatric Surgery: A Narrative Review.

Bariatric surgery (BS) is the most effective treatment in reducing weight and the burden of comorbidities in patients with severe obesity. Despite the overall low mortality rate, intra- and post-operative complications remains quite common. Weight loss before BS reduces surgical risk, but studies are inconclusive regarding which is the best approach to apply. In this review, we summarize the current evidence on the effect of a ketogenic diet (KD) before BS. All studies agree that KD leads to considerable weight loss and important improvements in terms of surgical risk, but populations, interventions and outcomes are very heterogeneous. KD appears to be a safe and effective approach to induce weight loss before BS. However, randomized controlled trials with better-defined dietary protocols and homogeneous outcomes are necessary in order to draw firm conclusions.

The Three-Hour Lower Body Lift: Evolution of a Technique and Personal Experience after 155 Consecutive Cases.

Body-contouring is a surgical field in growing demand, as the number of massive weight loss patients following bariatric surgery is increasing. The purpose of this study was to provide a straightforward and time-efficient circumferential body lift technique to achieve optimal lower truncal contouring. A total of 155 massive weight loss patients (133 women and 22 men) underwent lower body lift surgery between 2006 and 2018. The mean preoperative weight reduction and body mass indices were 56.5 ± 16.6 kg and 26.7 ± 4.7 kg/m2, respectively. The preoperative markings focused on the back and gluteal region, and the modified surgical technique are described. Additionally, improvements of intra-operative repositioning of the patient and how to deal with sterilization and dressings are elucidated. The average intra-operative time was 178 ± 54.6 minutes. The mean follow-up of all patients was 8.2 ± 2.4 years. The most common complications were related to wound dehiscence (n = 38) and seroma (n = 18). The mean weight of the resected tissue was 3 056 ± 1 816.5 g. The lower body lift represents an effective and safe body contouring procedure to treat massive weight loss patients with multiple regions of concern. The current study describes a modified surgical technique that reduces operating time and complications, notably. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Effect of preoperative diet regimen on liver size before laparoscopic sleeve gastrectomy in morbidly obese patients.

Low caloric diet can reduce liver volume; however, there is no consensus regarding preoperative weight reduction before bariatric surgery. This study evaluates the effect of preoperative very-lowcalorie diet (VLCD) in patients undergoing laparoscopic sleeve gastrectomy (LSG). This prospective study included patients scheduled for LSG stratified into two groups, Diet Group (n = 183) who followed a preoperative VLCD regimen for three weeks and underwent assessment of the liver lobes span before and after regimen, and Control Group (n = 138) who underwent sonographic assessment once before surgery and were operated upon without diet. The outcome measures were the impact of preoperative diet on the liver span, intraoperative complications, anthropometric factors affecting the liver span. Diet regimen resulted in a significant reduction of the right and left lobes. The percentage of the reduction of the left lobe span was significantly higher than that of the right lobe (p < 0.001). Change of the size of the two lobes was correlated positively with weight and body mass index and initial size of both lobes. There was no significant difference between the two groups in the frequency of operative complications. VLCD for three weeks before bariatric surgery effectively reduced liver size. The reduction is more in the left lobe. The changes of both lobes were correlated well with the pre- and post-regimen weight and BMI. It was also positively correlated with the initial size of both lobes.

Validity and efficacy of diets used for preoperative weight reduction among patients qualified for bariatric surgery.

Bariatric surgery is the most effective method of weight reduction among patients suffering from morbid obesity. Reduction of body weight before surgery is an important element. The aim of the study was to present the current knowledge on preoperative weight reduction and diet for this purpose. To achieve the aims of the paper, articles available in the PubMed / MEDLINE database published in 2005-2020 were used, as well as the guidelines of societies such as Metabolic and Bariatric Surgery Chapter of the Association of Polish Surgeons, American Association of Clinical Endocrinologists, The Obesity Society and American Society for Metabolic &amp; Bariatric Surgery, International Federation for Surgery of Obesity and Metabolic Disorders-European Chapter and European Association for the Study of Obesity. Studies show that even a modest reduction in weight in the early preoperative period facilitates surgery and reduces the number of complications. The available data do not support the effect of preoperative weight loss on increased postoperative weight loss. The use of balanced, energy-restricted diet in the preoperative period prepares the patient for changes in the way of nutrition, which improves the nutritional status of patient. Low calorie (LCD) or very low calorie (VLCD) diet can be an effective method of weight loss before surgery, however, this approach does not allow to modify eating habits. The use of a very low calorie ketogenic diet (VLCKD) remains under discussion. There is a need for large randomized trials to assess short and long term benefits of preoperative weight loss and methods of weight loss among patients qualified for bariatric surgery, also the standardization of nutritional management in the preoperative period.

Microbiological and clinical characteristics of sternal wound infections following cardiac surgery in a teaching hospital in Kuwait: A 5-year retrospective study

Background: Sternal wound infections (SWI) following cardiac surgery are health-care-associated infections which have to be prevented as the morbidity and mortality attributed to SWI are high. Objective: The aim is to study incidence, microbial etiology, risk factors, and outcome of SWI that followed cardiac surgery in our hospital. Methods: A retrospective, single-center study involving 833 patients who underwent cardiac surgery from January 2012 to December 2016 was conducted in Al-Amiri hospital in collaboration with the Cardiac Coronary Care Unit, Sabah Al Ahmed Cardiac Centre, Kuwait. Microbiological data were retrieved from laboratory computers, and clinical details from patient files. Age, sex, microbial etiology, risk factors, and outcome were analyzed. A statistical study was done using the SPSS statistical package. Results: The incidence of SWI was 2.1%. Predominant microorganisms isolated were Staphylococcus epidermidis (27.7%) and Pseudomonas aeruginosa (27.7%). The most common risk factor was diabetes mellitus, 88.9% cases. About 50% cases were obese and 72.2% cases had a hospital stay for more than 10 days, with the median length of stay being 13.50 days. 30-day mortality outcome was zero. Conclusion: SWI lead to bacteremia, sepsis and extended hospital stay placing the patient at risk of further hospital acquired infections, and increased cost. Preoperative blood sugar control and weight reduction are important. Infection control measures such as nasal screen for Staphylococcus aureus and rectal screen for multidrug-resistant Gram-negative bacilli have to be considered. Based on the most common organisms isolated, ceftazidime with vancomycin could be a better option for surgical antibiotic prophylaxis in our center.

A randomised controlled trial comparing the use of omega-3 polyunsaturated fatty acid supplements versus very low calorie dietary restriction in obese Malaysian patients awaiting bariatric surgery

Background: A large liver can be a bariatric surgeon’s nightmare as it interferes with the operative field particularly during posterior fundal and hiatal dissection. Various methods have been employed to achieve hepatic volume reduction (HVR) prior to surgery. This study aims to compare the effect of ome-ga-3-polyunsaturated fatty acid (PUFA) supplements and very low calorie diet (VLCD) restriction on hepatic volume. Methods: A total of 52 obese patients were randomized into two groups. For various reasons only 41 patients were included for final analysis; VLCD group (n=20) and omega-3-PUFA group (n=21). MRI vo-lumetry of liver, weight, and serum alanine transaminase (ALT) levels were measured at enrollment and again at 4 weeks. Results: Mean HVR of VLCD group and omega-3-PUFA group at day-30 was 37.10±15.76 and 34.88±9.99 cm3. Comparative analysis of HVR between the two groups showed no statistical dif-ference (P=0.29). Similarly there was no statistical difference in ALT levels of both groups. Significant weight loss (kg) was noted in both VLCD and omega-3-PUFA group, measuring up to 2.21±2.29 and 2.85±4.62, although no sta-tistical difference was noted when compared between the two (P=0.58). Conclusions: Pre-operative hepatic volume and weight reduction were noted in both groups with no superiority of one modality over the other. As dietary restriction is often confronted with non-compliance, omega-3-PUFA does appear to be a more attractive alternative. A larger study including cost effec-tiveness analysis may be able to further ascertain the economic impact and feasibility of pre-bariatric surgery ome-ga-3-PUFA supplementation in a developing economy such as Malaysia.

Bleeding during laparoscopic gastric bypass surgery as a risk factor for less favorable outcome. A cohort study from the Scandinavian Obesity Surgery Registry

BackgroundIntraoperative adverse events are known to be associated with postoperative complications; however, little is known about whether or not blood loss during laparoscopic gastric bypass surgery affects the outcome. ObjectiveTo see if intraoperative bleeding was associated with a less favorable outcome, and to identify patient-specific risk factors for intraoperative bleeding. SettingNationwide, Sweden. MethodsPatients who underwent laparoscopic gastric bypass surgery between January 8, 2007, and September 15, 2015, were included in the study. The volume of intraoperative blood loss was compared with data from follow-up at day 30 and 1 and 2 years after surgery. Patient-specific factors were analyzed as potential risk factors for intraoperative bleeding. ResultsThe study included 43,157 patients. Intraoperative bleeding was associated with an increased risk for postoperative complication (100–499 mL, odds ratio [OR] 2.97, 95% confidence interval [95%CI] 2.53–3.50;>500 mL OR 3.34, 95%CI 2.05–5.44), lower weight loss (<100 mL, 82.4±24.19% excess body mass index-loss [%EBMIL]; 100–499 mL, 76.9±24.24 %EBMIL, P<.0001;>500 mL 76.9±23.89 %EBMIL, P = .063) and lower reported quality-of-life 2 years after surgery (<100 mL, Obesity-related Problem scale (OP) 21.1±24.46; 100–499 mL, OP 25.0±26.62, P = .008;>500 mL, OP 25.2±24.46, P = .272). Diabetes (OR 1.30, 95%CI 1.08–1.58), age (OR 1.02, 95%CI 1.02–1.03), and body mass index (OR 1.03, 95%CI 1.02–1.05) were patient-specific risk factors for intraoperative bleeding≥100 mL, whereas intentional preoperative weight loss was associated with a lower risk (OR .50, 95%CI .43–.57). ConclusionIntraoperative bleeding was associated with less favorable outcome after laparoscopic gastric bypass surgery. Age, body mass index, and diabetes were risk factors for intraoperative bleeding, while preoperative weight reduction seems to be protective.

Weight loss before bariatric surgery and postoperative complications: data from the Scandinavian Obesity Registry (SOReg).

A preoperative weight-reducing regimen is usually adhered to in most centers performing bariatric surgery for obesity. The potential to reduce postoperative complications by such a routine is yet to be defined. Data on 22,327 patients undergoing primary gastric bypass from January 1, 2008, to June 30, 2012, were analyzed. In all patients, median preoperative total weight change was -4.8%. Corresponding values in the 25th, 50th, and 75th percentile were 0.5, -4.7, and -9.5%, respectively. Complications were noted in 9.1% of the patients. When comparing patients in the 75th with those in the 25th percentile of preoperative weight loss, the risk of complications was reduced by 13%. For specific complications, the corresponding risks were reduced for anastomotic leakage by 24%, for deep infection/abscess by 37%, and for minor wound complications by 54%. Similarly, however, less pronounced risk reductions were found when comparing patients in the 50th with those in the 25th percentile of preoperative weight loss. For patients in the highest range of body mass index (BMI), the risk reduction associated with preoperative weight loss was statistically significant for all analyzed complications, whereas corresponding risk reductions were only occasionally encountered and less pronounced in patients with lower BMI. Weight loss before bariatric surgery is associated with marked reduction of risk of postoperative complications. Moreover, the degree of risk reduction seems to be related to amount of weight lost and patients in the higher range of BMI are likely to benefit most from preoperative weight reduction.

Postoperative pulmonary complications in living-liver donors: a retrospective analysis of 188 patients.

Living-donor liver transplant has become a viable option and an important source of hepatic grafts. The goal of this study is to establish postoperative pulmonary complications of liver donation surgery in our center. Data from 188 subjects (median age, 33.7 ± 8.4 y; male/female, 51.1%/48.9%) who had liver donation surgery from 1988 to 2013 were analyzed retrospectively. Patient demographic and clinical features were recorded. Postoperative complications and the correlation of risk factors for postoperative pulmonary complications were investigated. The incidence of early postoperative complications was 17% (n = 32), and 16 of these patients had postoperative pulmonary complications (8.5%); 2 of the postoperative pulmonary complications were detected on the day of surgery and the other 14 complications were observed between the second and seventh day after surgery. Most postoperative pulmonary complications were minor complications including atelectasis, pleural effusion, and pneumonia. There was 1 major postoperative pulmonary complication: pulmonary embolism that occurred on the fourth day after surgery in 1 patient. Late pulmonary complications also were reviewed and no late postoperative pulmonary complications were observed. There was no significant difference in early and late postoperative pulmonary complications between ex-smokers and smokers. Postoperative atelectasis was significantly higher in patients with body mass index ≤ 20 kg/m ² than patients with body mass index > 21 kg/m ² (P = .027). In our study population, no postoperative mortality was recorded. We believe that preoperative weight reduction strategies and early mobilization with postoperative respiratory physiotherapy could be important factors to reduce postoperative pulmonary complications in liver donors.

Preoperative weight loss in super-obese patients: study of the rate of weight loss and its effects on surgical morbidity

OBJECTIVES:The incidence of obesity and particularly super obesity, has increased tremendously. At our institution, super obesity represents 30.1% of all severely obese individuals in the bariatric surgery program. In super obesity, surgical morbidity is higher and the results are worse compared with morbid obesity, independent of the surgical technique. The primary strategy for minimizing complications in these patients is to decrease the body mass index before surgery. Preoperative weight reduction can be achieved by a hypocaloric diet, drug therapy, an intragastric balloon, or hospitalization. The objective of this study was to analyze the results of a period of hospitalization for preoperative weight loss in a group of super-obese patients.METHODS:Twenty super-obese patients were submitted to a weight loss program between 2006 and 2010. The mean patient age was 46 years (range 21-59). The mean BMI was 66 kg/m2 (range 51-98) and 12 were women. The average hospital stay was 19.9 weeks and the average weight loss was 19% of the initial weight (7-37%). The average caloric intake was 5 kcal/kg/day. After the weight loss program, the patients underwent gastric bypass surgery.RESULTS:The statistical analysis revealed that after 14 weeks of treatment (15% loss of initial weight), the weight loss was not significant. All patients had satisfactory surgical recovery and were discharged after an average of 4.6 days.CONCLUSION:In super obesity, preoperative weight loss is an important method for reducing surgical risks. Hospitalization and a hypocaloric diet are safe and effective. After 14 weeks, the weight loss rate stabilized, signaling the time of surgical intervention in our study.

What to do when it is technically impossible to perform laparoscopic sleeve gastrectomy.

Laparoscopic sleeve gastrectomy (LSG) is increasingly popular with surgeons because of its apparent technical ease. However, performing LSG safely is sometimes not possible during laparoscopy. The objectives of the present study were to (i) describe the context of LSG failure and (ii) suggest preoperative care options or strategies that enable secondary LSG to be performed safely. We studied patients having undergone primary and secondary LSG between January 2008 and July 2013. The primary efficacy criterion was the LSG success rate. The secondary efficacy criteria were preoperative care procedures, the complication rate, the failure rate, and the frequency of conversion to open surgery. During the study period, 954 patients underwent first- or second-line LSG. Laparoscopic sleeve gastrectomy was technically impossible in 12 patients (1.2 %). The cause of failure was a large left liver lobe in seven cases (58.3 %) and a lack of space in five cases. Of these 12 patients, nine underwent secondary LSG. The median preoperative BMI before the first LSG was 51.5 kg/m(2). The median (range) time interval between the two LSG attempts was 6 months (3-37). Prior to secondary LSG, the preoperative weight reduction measure was a diet in seven cases (78 %), an intragastric balloon in one case, and no treatment in one case. The median preoperative excess weight loss (EWL) before the second LSG was 10 % (0-20). Five LSGs were successful, two required conversion to open surgery, and two failed again. There were two postoperative complications (22 %), both of which concerned the two patients with conversion to laparotomy. In the event of LSG technical failure, preoperative weight loss may enable a second attempt at laparoscopic treatment. A preoperative EWL of at least 10 % appears to be required for the avoidance of conversion to laparotomy.

PP236-SUN EVALUATION OF THE PARAMETERS OF THE EURO QOL-5D QUESTIONNAIRE UNDER NORMAL CLINICAL PRACTICE CONDITIONS ON HYPERTENSIVE PATIENTS WITH NORMAL AND ELEVATED BMI

six months follow up. The statistical analyzes were performed using Wilcoxon signed rank test. Results: Seventy four severe obese patients (61F/13M) with median age 39 (18 64) years old and median preoperative body mass index (BMI) 45.0 (34.6 60.1)kg/m2 were included. The mean preoperative weight loss was 9.1±6.42 kg and six months postoperative weight loss was 25.7±11.36 kg. We found a significant correlation between preoperative and postoperative weight loss (r = 0.3; p < 0.001). Conclusion: There is a positive correlation between preoperative weight reduction and postoperative weight loss after bariatric surgery.

Late gastric perforation after insertion of intragastric balloon for weight loss—video case report and literature review

The BioEnterics intragastric balloon (BIB) is used in the treatment of morbid obesity, as a method for short-term weight loss, especially before definitive surgery. Previous studies have demonstrated that patients who have a BIB inserted can achieve ≤48% reduction of their excess weight, although this is not maintained in the long term [ 1 Doldi S.B. Micheletto G. Perrini M.N. Librenti M.C. Rella S. Treatment of morbid obesity with intragastric balloon in association with diet. Obes Surg. 2002; 12: 583-587 Crossref PubMed Scopus (97) Google Scholar , 2 Melissas J. Mouzas J. Filis D. et al. The intragastric balloon—smoothing the path to bariatric surgery. Obes Surg. 2006; 16: 897-902 Crossref PubMed Scopus (84) Google Scholar , 3 Göttig S. Weiner R.A. Daskalakis M. Preoperative weight reduction using the intragastric balloon. Obes Facts. 2009; 2: S20-S23 Crossref PubMed Scopus (18) Google Scholar , 4 Lopez-Nava G. Rubio M.A. Prados S. et al. BioEnterics® intragastric balloon (BIB®): single ambulatory center Spanish experience with 714 consecutive patients treated with one or two consecutive balloons. Obes Surg. 2011; 21: 5-9 Crossref PubMed Scopus (82) Google Scholar , 5 Stimac D. Majanović S.K. Turk T. Kezele B. Licul V. Orlić Z.C. Intragastric balloon treatment for obesity: results of a large single center prospective study. Obes Surg. 2011; 21: 551-555 Crossref PubMed Scopus (34) Google Scholar ]. The BIB is recommended to stay in place for 6 months and either removed or replaced after that period, because the risk of spontaneous rupture owing to material degradation increases.

Parastomal hernia incarceration due to migrated intragastric balloon

The temporary placement of intragastric balloons is a common method to achieve rapid weight loss before planned metabolic surgery. We report the case of a 48-year-old morbidly obese patient. Ten years ago the patient underwent emergency sigmoidectomy with creation of a double-barreled ileostomy for perforated diverticulitis. Over time he developed a giant parastomal hernia. For preoperative weight reduction before planned restoration of intestinal continuity, an intragastric balloon was inserted 3 years ago. The patient was admitted to our emergency department with peritonism and a septic shock. After computed tomography showing small bowel ileus, laparotomy was performed, revealing marked ischemia of incarcerated small and large intestine. Only postoperatively was the intragastric balloon found in the resected small bowel, causing a mechanical ileus with consecutive incarceration of the bowel. We review the literature on complications due to the migration of intragastric balloons. This clinical case gives a fair warning of the possible deleterious outcome of intragastric balloons, especially in hernia patients.