Best to lose some weight before weight-loss surgery

[MsJacquiiC]

Having weight-loss surgery? Shedding a few pounds before the surgery might reduce your risk of having surgical complications, a new study hints.

Some surgeons who perform weight-loss surgery mandate that certain high-risk patients lose some weight before having the surgery

A look back at the medical records of 881 patients who had weight-loss surgery found that the more weight patients lost before surgery, the less likely they were to suffer post-op complications, such as infections, blood clots, and kidney problems.

Preoperative weight changes varied among the 881 patients, ranging from modest weight gain to weight loss of more than 10 percent of excess body weight.

The post-surgery complication rate was nearly twofold higher in patients who gained weight before surgery relative to those who lost weight before surgery, Dr. Peter N. Benotti of the Saint Francis Medical Center in Trenton, New Jersey and colleagues report in the Archives of Surgery.

All of the patients had undergone open or "keyhole" Roux-en-Y gastric bypass surgery. With this procedure, staples are used to create a pouch in the stomach that can hold only a small amount of food at a time; then, a portion of the small intestine is attached to the pouch so that food bypasses the rest of the stomach and part of the small intestine.

Patients who had the more-invasive open surgery were at increased risk of post-op complications, regardless of whether they gained or lost weight before the surgery, the researchers found.

The popularity of weight-loss surgery has increased in recent years and so too have the numbers of patients seeking surgery who are older and sicker, the researchers note.

As more of these high-risk patients seek out surgical weight-loss options, doctors are facing a need to identify risk factors and help prepare patients for successful surgery. The current study, the researchers say, suggests that pre-surgery weight loss may be one step that will help those having weight-loss surgery to achieve a more favorable outcome.

Some surgeons who perform weight-loss surgery mandate that certain high-risk patients lose some weight before having the surgery, Benotti and colleagues note. However, others believe that mandated pre-surgery weight loss "may be a deterrent to surgery." In addition, the long term effect of shedding a few pounds before weight-loss surgery is also unclear.

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In a telephone interview with Reuters Health, Benotti said patients need to know that weight-loss surgery "is not a definitive treatment." A healthy diet, lifestyle change, and behavior modification are essential for maintaining weight loss after surgery, the researcher said.

"Surgery is a carrot; it provides motivation for people knowing they will have help," Benotti said.



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Roux-en-Y Gastric Bypass A type of gastric bypass procedure which combines restrictive and malabsorption techniques - meaning, it reduces the amount of food a patient can comfortably eat (restriction), and also reduces the amount of calories that can be digested in the small intestine (malabsorption). This combination of bariatric methods leads to greater weight loss and the roux-en-y procedure is seen as one of the best ways to treat clinically severe obesity. See WLS Videos for animated surgery technique.

Surgical Staples Surgical staples are specialized staples used in surgery in place of sutures to close skin wounds. Stapling is much faster than suturing by hand, and also more accurate and consistent. In bariatric surgery, staples are primarily used because staple lines are less likely to leak blood, air or bowel contents. In skin closure, dermal adhesives (skin glues) are also an increasingly common alternative. The technique of stapling for surgery is said to have been influenced by the Roman use of ants for wound closure.

Pouch Most bariatric surgeries restricts the amount of food a patient can eat by reducing the size of the stomach by gastric banding, stapling or removal. What results is known as the gastric pouch.