Abby Navratil, MD, Andrea Schwoerer, MD, Matt Pfister, MD, Keith Gersin, MD, Timothy Kuwada, MD. Carolinas Healthcare System
Background: Medical weight management (MWM) is required pre-operatively by some bariatric centers and insurance companies. Multiple studies evaluating the effect of MWM on weight loss before and after surgery have been published. However, the effect of MWM on preoperative weight loss is often confounded by a disproportionate weight loss during the preoperative “liquid diet”. Furthermore, determination of MWM’s impact on postoperative weight loss and durability of weight maintenance is hampered by relatively short follow up in these studies. The goal of this study was to examine the effect of MWM on pre-operative (controlling for the liquid diet phase) and medium term post-operative follow up.
Methods: An IRB approved, retrospective review was completed on patients who had bariatric surgery by a single bariatric surgeon in a center of excellence from 2012-2014. Patients who underwent a laparoscopic sleeve gastrectomy (LSG) and laparoscopic roux-en-y gastric bypass (LRYGB) were categorized into two groups: those who had four months of pre-operative MWM with a bariatrician and those who did not. Weight loss was evaluated prior to the start of their liquid diet.
Pre-operative and post-operative percentage of excess weight lost (%EWL) was compared between the two cohorts. Specifically, the impact of MWM on weight loss was evaluated from the first surgical visit to the pre-operative visit, as well as %EWL from operation to 1 and 3 years post-operatively.
Results: 246 patients were identified that met inclusion criteria. Of those, 36% had pre-operative MWM. There were 107 LSG and 139 LRYGB performed. The follow-up average was 2.6 years (range 1-4 years). Patients with MWM (LSG and LRYGB) had an average %EWL of 1.7% when re-evaluated at the pre-operative visit, compared to a gain of 0.08% excess weight in the patients without MWM (p=0.054). No difference was found in the change in %EWL post-operatively between the two groups at 1 year (p=0.95 for LRYGB, p=0.68 for LSG) and 3 years (p=0.26 for LRYGB, p=0.73 for LSG).
Conclusion: The patients with MWM did have more weight loss pre-operatively, which may be statistically significant with a larger cohort. This difference was not appreciated in the post-operative period for either surgical procedure (LSG or LRYGB). MWM may have a small effect on pre-operative weight loss, which may reduce operative risk. Additional investigation and longer follow up is needed to determine the effect of MWM and the appropriate role of MWM for bariatric surgery patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78894
Program Number: P557
Presentation Session: Poster (Non CME)
Presentation Type: Poster