Christopher J. Larson

Number of weight loss attempts and maximum weight loss before Roux-en-Y laparoscopic gastric bypass surgery are not predictive of postoperative weight loss

BACKGROUND Many insurance companies have mandated that bariatric surgery candidates already satisfying the National Institutes of Health criteria make an additional attempt at medically supervised weight loss. The objective of this study was to determine whether a correlation exists between the number of weight loss attempts (WLAs) or maximal preoperative weight loss (MWL) and the percentage of excess weight loss (%EWL) after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. METHODS The WLAs and MWL data were collected by bariatric medical record review. The postoperative %EWL was obtained by retrospective review of a prospectively enrolled bariatric database. Patients whose records contained 1 year of follow-up data and either the WLAs or MWL were included in the study. The data were analyzed using Pearson correlations and odds ratios. RESULTS From September 2001 to 2006, 530 patients underwent LRYGB. Of these, 384 met the study criteria (82.6% were women). The mean WLAs was 4.3+/-1.8. The mean MWL was 46.6+/-31.2 lb (21.2+/-14.2 kg). At surgery, the mean patient age was 43.3+/-9.3 years, and the mean body mass index was 48.0+/-5.9 kg/m2. At 1 year after LRYGB, the mean body mass index was 30.2+/-5.0 kg/m2, and the mean %EWL was 72.3%+/-15.3%. Statistical analysis revealed no correlations between the %EWL at 1 year after LRYGB and the WLAs (R2=.011) or MWL (R2=.005). CONCLUSION Neither the WLAs nor the MWL correlated with the %EWL at 1 year after LRYGB. Our results showed no evidence that the WLAs or MWL before surgery correlates with the %EWL in patients undergoing LRYGB.

Effects of standardized care plan on length of stay in patients undergoing laparoscopic Roux-en-Y gastric bypass for morbid obesity

tients and observed nutritional deficiencies. Methods: A survey was conducted via e-mail of ASBS surgeons who perform the DS procedure and of surgeons who attended the DS meeting of the 2004 ASBS conference in San Diego. The survey addressed nutritional guidelines given to patients, nutritional parameters measured postoperatively and nutritional deficiencies observed. Results: There were seventeen responses to the survey. Percent of the respondents recommending supplements ‘below’ RDI values were as follows: 44% recommended less than the RDI for calcium; 76% for iron; 24% for vitamins D and A (water-soluble); and 71% for vitamins E and K. More than half of respondents failed to recommend adequate fluid intake ( 64 oz) and only 29% recommended protein in amounts 80 g. Among the respondents, 27% reported vitamin D deficiencies post-DS; 18% reported vitamin A deficits; 41% low calcium; 29% low iron; and 35% protein deficiencies. Conclusions: Inadequate nutritional guidelines provided to patients undergoing the DS procedure may account for some of the nutritional deficiencies of the procedure. Standard nutritional supplementation guidelines should be developed for the DS procedure. PII: S1550-7289(05)00231-5