Effect of Preoperative Weight Loss and Baseline Comorbidity on Short-Term Complications and Reoperations After Laparoscopic Roux-en-Y Gastric Bypass in 2,067 Patients

• Published in: Obesity surgery 2021-06, Vol.31 (6), p.2444-2452
• Main Authors: Wiggins, Tom, Pournaras, Dimitri J., Priestman, Elena, Osborne, Alan, Titcomb, Daniel R., Finlay, Ian, Hopkins, James, Hollyman, Marianne, Mason, Matthew, Noble, Hamish, Mahon, David, Welbourn, Richard
• Format: Article
• Language: English
• Subjects: Gastrointestinal surgery; Medicine; Medicine & Public Health; Original Contributions; Surgery
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-021-05331-y

Purpose Decreasing popularity of Roux-en-Y gastric bypass (RYGB) in bariatric-metabolic surgery may be due to higher perceived peri-operative complications. There are few studies on whether preoperative weight loss can reduce complications or reoperations following RYGB. We investigated this using a standardised operative technique. Materials and Methods Retrospective single-centre study of RYGB from 2004 to 2019 using a prospective database. Preoperative behavioural management included intentional weight loss. Maximum preoperative weight, weight on the day of operation, and Obesity-Surgery Mortality Risk Score (OS-MRS) class were recorded. Short-term outcomes (post-operative stay, 30-day complication and reoperation rates) were analysed. Results In 2,067 RYGB patients (1,901 primary and 166 revisional), median preoperative total body weight loss (TWL) was 6.2% (IQR: 2.5–10.7%). The median age was 46 (interquartile range (IQR) 38–54) and 80.4% were female ( n =1,661). For primary surgery, the median body mass index (BMI) was 47.6 kg/m 2 (IQR: 43.1–53.3). Excluding the 100-procedure learning curve, the complication rate for primary cases was 4.4% and reoperation rate of 2.8% and one peri-operative mortality (0.06%). OS-MRS ≥2 (class B or C) predicted higher risk of complications (6.1%) compared to those with a score