Influence of Preoperative Weight Loss on Outcomes of Bariatric Surgery for Patients Under the Enhanced Recovery After Surgery Protocol

Influence of Preoperative Weight Loss on Outcomes of Bariatric Surgery for Patients Under the Enhanced Recovery After Surgery Protocol

Stefura T et al. Influence of Preoperative Weight Loss on Outcomes of Bariatric Surgery for Patients Under the Enhanced Recovery After Surgery Protocol. Obesity Surgery. PMID: 30632072. DOI: 10.1007/s11695-018-03660-z

What is already known:

ERAS protocols have been safely implemented in bariatric patients to improve patient outcomes, reduce length of stay and lead to fewer postoperative complications. Bariatric Surgery is becoming increasingly prevalent and patients are usually advised to lose weight pre-operatively but the effects of this on perioperative complications when evaluated within an ERAS protocol have not yet been studied. Current ERAS Society guidelines for use in Bariatric Surgery state that preoperative weight loss as “strong” recommendation grade; but this is often overlooked due to barriers to its implementation.

What this paper adds:

This was a multicentre study looking at prospectively collected data on 909 bariatric patients undergoing laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB), using ERAS protocols, in two hospitals in Poland. They aimed to look at factors affecting preoperative weight loss and the effects weight loss had on short term outcomes. They separated patients into those who lost <5% of body weight and those >5% body weight pre-operatively. They found that factors associated with increased weight loss were presence of diabetes mellitus (p=0.027) and obstructive sleep apnoea (p=0.007). Steatohepatitis was more common (p <0.001) in those who lost < 5% and in male patients (p=0.02). The median operative times were significantly lower in patients who lost > 5% body weight (LSG p<0.001, LRYGB p=0.010). Patients who lost > 5% body weight went on to have higher median total weight loss on follow up (p=0.009). There was no difference in post-operative complication rates between to the two groups. Randomised studies looking into the effects of pre-operative weight loss are needed but this small study shows that preoperative weight loss can lead to reduced surgical times and greater overall weight loss after bariatric surgery. However not losing weight preoperatively did not increase complications postoperatively, showing the importance of a good ERAS programme.

Katie Wimble, Guildford