It has been suggested that a preoperative weight loss of 10% of excess body weight, be a key component of the pre-operative preparation process. It can demonstrate motivation and commitment to surgery, reduce liver size and abdominal adiposity as well reducing operating time and length of stay (LOS). It is has also been demonstrated to be associated with greater weight loss 3 years post operatively than in those patients who had not achieved a reduction in their excess weight of 10%. The aim of the study is to examine whether it is possible for patients awaiting surgery to lose 10% of their excess body weight (EBW) using diet alone and to measure the influence this has on operating time, hospital stay and the degree of weight lost 6 months post surgery.
Patients and Methods
37 patients (8 men and 29 women) were studied over a 14-month period. The median age, starting weight and body mass index with, ranges in brackets, were 44 yr (19 to 65 yr), 133kg (90 to 279 kg) and 49kg/m2 (37 to 79Kg/m2), respectively. 16 patients underwent gastric banding, 17 Roux en Y gastric bypass and 4-sleeve gastrectomy. Each patient was asked to lose 10% of their EBW prior to surgery. Each was offered expert dietary advice and a 3-week preoperative diet of 1000 kcals per day.
65% of patients were able to lose the target 10% loss of EBW. There was no statistical different between those who achieved the target and those who did not, in terms of age, sex, start weight, BMI or surgery type.
Median time in the operating theatre for those with and without 10% EBW loss were (2 hr 40 min (1 to 2.40) vs 2 hr 45 min (2.10 to 3) for gastric banding, (36kg, (2.15 to 6), 5 hr vs 7hr (5.15.to 8) for gastric bypass and (3 hr vs 4 hr 30 min (3.15 to 8) for sleeve gastrectomy.
The median lengths of stay with and without 10% EBW loss were 2 days (1 to 5) vs 2.5 (2 to 3) for gastric banding, 4 days (3 to 27) vs 6 days (6 to 7) for gastric bypass and 3 days (3) vs 4 days (4) for sleeve gastrectomy respectively.
Weigh loss at 6 months was greater in those who had a achieved 10% EBW prior to surgery than those who did not (P 0.004), (29kg (15 to 38Kg), EBW loss 47%, vs 14 Kg (8 to 29 Kg) EBW loss 24%, for gastric banding, (36 Kg, (18 to 71 Kg), EBW loss 58%, vs 42 Kg (40 to 45 Kg) EBW loss 50 % for gastric bypass and (89 kg, EBW loss 46%, vs 4 Kg EBW loss 21%, (25 to 57 Kg) for sleeve gastrectomy, respectively.
The majority of patients (65%) were able to achieve the target of 10% EBW loss through the use of sensible healthy dieting combined with a strict 4-week period of liver shrinking diet. Indeed, some patients were able to lose substantially more. Pre-operative weight loss of at least 10% EBW was related to greater weight loss at 6 months for all patients (but was especially important in those undergoing gastric banding), shorter in theatre times for patients undergoing gastric bypass and sleeve gastrectomy and reduced length of stay for patients undergoing gastric bypass.
Program Number: P034