The Effects of Acute Preoperative Weight Loss on Laparoscopic Roux-en-Y Gastric Bypass

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Background:Minimal acute pre-operative weight loss significantly reduces liver size and intra-abdominal adipose tissue. We hypothesize that these changes will reduce intra-operative complications and reduce the difficulty of laparoscopic Roux-en-Y gastric bypass (LRYGBP).Methods:This is a retrospective chart review of consecutive patients who had undergone isolated LRYGBP between July 2003 and March 2005. All patients participated in our institution's medically supervised Weight Management Program before surgery.Results:48 patients (Weight LossGroup) had an average percent loss of excess weight (%EWL) of 4.6; whereas 47 patients (No Weight LossGroup) gained an average of 4.8% of excess weight over an average period of 2.4 and 3 months (P=0.09), respectively. There were no differences between the two groups in age, gender, ASA class, co-morbidities, or BMI at operation. TheWeight LossGroup had less intra-operative blood loss (102 vs 72 ml,P=.03). The surgeon was also less likely to report an enlarged liver in theWeight LossGroup (P=.02). Finally, the operation was less likely to deviate from the standard LRYGBP when patients lost weight (P=.02). No differences were seen in operative time, length of hospital stay, wound infections, or major complications.Conclusion:Acute preoperative weight loss is associated with less intra-operative blood loss and reduces the need for intraoperative deviation from the standard LRYGBP. A larger series with a greater reduction in excess weight is necessary to determine the maximal benefits of acute preoperative weight loss.

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