Total weight loss after laparoscopic Roux-en-Y gastric bypass is influenced by preoperative weight loss: can we predict the outcome?

BACKGROUND

Preoperative weight loss (WL) is associated with higher postoperative WL at 1- to 2-year follow-up in patients who undergo laparoscopic Roux-en-Y gastric bypass (LRYGB).

OBJECTIVE

To evaluate the possible association between preoperative and postoperative WL at 3-year follow-up and identify risk factors for insufficient WL.

SETTING

A single-center prospective cohort study in the Netherlands.

METHODS

Patients undergoing primary LRYGB and laparoscopic conversion from band to bypass (redo LRYGB) were instructed to lose weight preoperatively. Follow-up data were collected 1, 2, and 3 years postoperatively. WL was described as percentage total weight loss (%TWL) and percentage excess body mass index (BMI) loss. Patients were divided into 2 groups: group A lost any amount of weight; group B did not lose any weight or gained weight preoperatively.

RESULTS

Group A consisted of 230 patients (median preoperative %TWL, 4.8%), and group B consisted of 46 patients (median preoperative %TWL, -1.3%). Median BMI at intake was 44.1 kg/m. Baseline characteristics were similar. The %TWL and BMI for group A and B in the patients who underwent primary LRYGB at 1, 2, and 3 years was 32.2% (BMI, 28.6 kg/m) versus 23.9% (BMI, 32.2 kg/m), 31.8% (BMI, 28.9 kg/m) versus 25.2% (BMI, 31.9 kg/m), and 33.3% (BMI, 29.7 kg/m) versus 21.9% (BMI, 34 kg/m), respectively, all P < .05. In patients who underwent redo LRYGB no clinically significant differences in postoperative BMI were found.

CONCLUSIONS

Preoperative WL in primary patients who undergo LRYGB can be useful to identify those at risk of inadequate postoperative WL. In patients who undergo redo LRYGB different risk factors should be considered for prediction of inadequate postoperative WL.