Importance of Preoperative Weight Loss in Bariatric Surgery

Francisco Schlottmann, Marina Spano, Romina Reino, Martin Galvarini, Jose Alvarez Gallesio, Rudolf Buxhoeveden. Hospital Aleman of Buenos aires

Introduction: Due to the progress in bariatric surgery the number of complex patients who undergo this procedure has increased. Multiple attempts have been made to determine risk factors for postoperative complications. In this context, several authors stated that the higher the preoperative weight loss, the lower the postoperative complication rate. Therefore, many centers require a minimum 10% weight loss before surgery. The aim of this study was to evaluate the relationship between the percentage preoperative weight lost and perioperative complications in bariatric surgery.

Methods and procedures: A retrospective study based on a prospectively loaded database was performed.  A consecutive series of patients undergoing laparoscopic bariatric surgery between 2008 and 2015 were included. The sample was divided into two groups according to the percentage preoperative weight loss. G1: weight loss < 10% and G2: weight loss > 10%. Surgical variables and early postoperative complications (<30 days) were evaluated in both groups.

Results: A total of 120 patients were included. Ninety-four patients belonged to G1 (78.3%) and 26 patients to G2 (21.7%). There were no significant differences in gender, age, BMI and ASA score between groups. Gastric bypass and gastric sleeve were performed in 85 % and 15 % in G1 and 73 % and 27 % in G2, respectively (p= NS). Length of stay was 2.3 (2-5) days in G1 and 2.4 (2-4) days in G2 (p= NS). Clavien I-II complications occurred in 16 patients in G1 (17%) and in 7 patients in G2 (26%) (p= NS). Clavien III-IV complications were identified in three patients in G1 (3.2%) and in none of the patients in G2 (p= NS). There was no mortality in this series.

Conclusions: Although preoperative weight loss in bariatric surgery would be beneficial for patients, no statistically significant difference was found between those with a decrease of < 10% and those with a decrease greater than 10%.