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Surgical Endoscopy
Published in: Surgical Endoscopy 6/2015

Open Access 01-06-2015

Early postoperative weight loss predicts maximal weight loss after sleeve gastrectomy and Roux-en-Y gastric bypass

Authors: Sean Manning, Andrea Pucci, Nicholas C. Carter, Mohamed Elkalaawy, Giorgia Querci, Silvia Magno, Anna Tamberi, Nicholas Finer, Alberic G. Fiennes, Majid Hashemi, Andrew D. Jenkinson, Marco Anselmino, Ferruccio Santini, Marco Adamo, Rachel L. Batterham

Published in: Surgical Endoscopy | Issue 6/2015

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Abstract

Background

Previous studies show that ‘poor responders’ to Roux-en-Y gastric bypass (RYGBP) may be identified on the basis of early postoperative weight loss. Early identification of poor responders could allow earlier provision of postoperative behavioural and/or intensive lifestyle interventions and enhance their maximal weight loss. Our aim was to investigate whether early postoperative weight loss predicts the maximal weight loss response after RYGBP and sleeve gastrectomy (SG).

Methods

We undertook a retrospective cross-sectional study of 1,456 adults who underwent either RYGBP (n = 918) or SG (n = 538) as a primary procedure in one of two European centres. Postoperative weight loss was expressed as weight loss velocity (WLV) and percentage weight loss. Linear regression analyses were performed to determine the association of early postoperative weight loss with maximal %WL, including adjustment for baseline variables.

Results

There was marked variability in maximal %WL following both RYGBP (mean 32.9 %, range 4.1–60.9 %) and SG (mean 26.2 %, range 1.1–58.3 %). WLV 3–6 months postoperatively was more strongly associated with maximal %WL (r 2 = 0.32 for RYGBP and r 2 = 0.26 for SG, P < 0.001 for both) than either WLV 0–6 weeks or 6 weeks to 3 months postoperatively (r 2 = 0.14 and 0.10 for RYGBP, respectively; r 2 = 0.18 and 0.21 for SG, respectively; P < 0.001 for all). Multiple linear regression analysis, including baseline variables of age, sex, preoperative BMI, type 2 diabetes, ethnicity, and bariatric centre, revealed that 3–6 month WLV was an independent predictor of maximal %WL in both SG and RYGBP groups (standardised β-coefficients 0.51 and 0.52, respectively; P < 0.001 for both).

Conclusions

There is a marked variability in weight loss response following RYGBP and SG. Early postoperative weight loss can be used to identify patients whose predicted weight loss trajectories are suboptimal. Early targeting of poor responders with more intensive postoperative lifestyle and behavioural support could potentially enhance their weight loss response.
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Metadata
Title
Early postoperative weight loss predicts maximal weight loss after sleeve gastrectomy and Roux-en-Y gastric bypass
Authors
Sean Manning
Andrea Pucci
Nicholas C. Carter
Mohamed Elkalaawy
Giorgia Querci
Silvia Magno
Anna Tamberi
Nicholas Finer
Alberic G. Fiennes
Majid Hashemi
Andrew D. Jenkinson
Marco Anselmino
Ferruccio Santini
Marco Adamo
Rachel L. Batterham
Publication date
01-06-2015
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 6/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3829-7

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