Top

Surgical Endoscopy

Published in:

01-11-2019 | Bariatric Surgery | Review Article

Bridging interventions before bariatric surgery in patients with BMI ≥ 50 kg/m²: a systematic review and meta-analysis

Authors: Yung Lee, Jerry T. Dang, Noah Switzer, Roshan Malhan, Daniel W. Birch, Shahzeer Karmali

Published in: Surgical Endoscopy | Issue 11/2019

Abstract

Background

Bariatric surgery on patients with body mass index (BMI) ≥ 50 kg/m², historically known as superobesity, is technically challenging and carries a higher risk of complications. Bridging interventions have been introduced for weight loss before bariatric surgery in this population. This systematic review and meta-analysis aims to assess the efficacy and safety of bridging interventions before bariatric surgery in patients with BMI ≥ 50 kg/m².

Methods

MEDLINE, EMBASE, Web of Science, and Scopus were searched from database inception to September 2018. Studies were eligible for inclusion if they conducted any bridging intervention for weight loss in patients with BMI greater than 50 kg/m² prior to bariatric surgery. Primary outcome was the change in BMI before and after bridging intervention. Secondary outcomes included comorbidity status after bridging interventions and resulting complications. Pooled mean differences (MD) were calculated using random effects meta-analysis.

Results

13 studies including 550 patients met inclusion criteria (mean baseline BMI of 61.26 kg/m²). Bridging interventions included first-step laparoscopic sleeve gastrectomy (LSG), intragastric balloon (IGB), and liquid low-calorie diet program (LLCD). There was a reduction of BMI by 12.8 kg/m² after a bridging intervention (MD 12.8, 95% CI 9.49–16.1, P < 0.0001). Specifically, LSG demonstrated a BMI reduction of 15.2 kg/m² (95% CI 12.9–17.5, P < 0.0001) and preoperative LLCD by 9.8 kg/m² (95% CI 9.82–15.4, P = 0.0006). IGB did not demonstrate significant weight loss prior to bariatric surgery. There was remission or improvement of type 2 diabetes, hypertension, and sleep apnea in 62.8%, 74.6%, and 74.6% of patients, respectively.

Conclusions

First-step LSG and LLCD are both safe and appropriate bridging interventions which can allow for effective weight loss prior to bariatric surgery in patients with BMI greater than 50 kg/m².

Available only for authorised users

Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, Singh GM, Gutierrez HR, Lu Y, Bahalim AN, Farzadfar F, Riley LM, Ezzati M, Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index) (2011) National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants. Lancet 377:557–567. https://doi.org/10.1016/s0140-6736(10)62037-5 CrossRefPubMedPubMedCentral

Sturm R (2007) Increases in morbid obesity in the USA: 2000-2005. Public Health 121:492–496. https://doi.org/10.1016/j.puhe.2007.01.006 CrossRefPubMed

Canadian Institute for Health Information (2014) Bariatric surgery in Canada. Canadian Institute for Health Information, Ottawa

American Society for Metabolic and Bariatric Surgery (2018) Estimate of bariatric surgery numbers, 2011–2017. American Society for Metabolic and Bariatric Surgery, Gainesville

Ponce J, DeMaria EJ, Nguyen NT, Hutter M, Sudan R, Morton JM (2016) American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in 2015 and surgeon workforce in the United States. Surg Obes Relat Dis 12:1637–1639. https://doi.org/10.1016/j.soard.2016.08.488 CrossRefPubMed

Tarnoff M, Kaplan LM, Shikora S (2008) An evidenced-based assessment of preoperative weight loss in bariatric surgery. Obes Surg 18(9):1059–1061. https://doi.org/10.1007/s11695-008-9603-y CrossRefPubMed

Schwartz ML, Drew RL, Chazin-Caldie M (2004) Factors determining conversion from laparoscopic to open Roux-en-Y gastric bypass. Obes Surg 14:1193–1197. https://doi.org/10.1381/0960892042386887 CrossRefPubMed

Lim RB, Blackburn GL, Jones DB (2010) Benchmarking best practices in weight loss surgery. Curr Probl Surg 47:79–174. https://doi.org/10.1067/j.cpsurg.2009.11.003 CrossRefPubMedPubMedCentral

Skrekas G, Lapatsanis D, Stafyla V, Papalambros A (2008) One year after laparoscopic “Tight” sleeve gastrectomy: technique and outcome. Obes Surg 18:810–813. https://doi.org/10.1007/s11695-008-9440-z CrossRefPubMed

10.

Magro DO, Geloneze B, Delfini R, Pareja BC, Callejas F, Pareja JC (2008) Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg 18:648–651. https://doi.org/10.1007/s11695-007-9265-1 CrossRefPubMed

11.

Inge TH, Jenkins TM, Zeller M, Dolan L, Daniels SR, Garcia VF, Brandt ML, Bean J, Gamm K, Xanthakos SA (2010) Baseline BMI is a strong predictor of nadir BMI after adolescent gastric bypass. J Pediatr 156:103–108. https://doi.org/10.1016/j.jpeds.2009.07.028 CrossRefPubMedPubMedCentral

12.

Busetto L, Segato G, De Luca M, Bortolozzi E, MacCari T, Magon A, Inelmen EM, Favretti F, Enzi G (2004) Preoperative weight loss by intragastric balloon in super-obese patientstreated with laparoscopic gastric banding: a case-control study. Obes Surg 14:671–676. https://doi.org/10.1381/096089204323093471 CrossRefPubMed

13.

Zerrweck C, Maunoury V, Caiazzo R, Branche J, Dezfoulian G, Bulois P, Verkindt H, Pigeyre M, Arnalsteen L, Pattou F (2012) Preoperative weight loss with intragastric balloon decreases the risk of significant adverse outcomes of laparoscopic gastric bypass in super-super obese patients. Obes Surg 22:777–782. https://doi.org/10.1007/s11695-011-0571-2 CrossRefPubMed

14.

Khan O, Irukulla S, Sanmugalingam N, Vasilikostas G, Reddy M, Wan A (2013) Simultaneous intra-gastric balloon removal and laparoscopic sleeve gastrectomy for the super-super obese patients—a prospective feasibility study. Obes Surg 23:585–587. https://doi.org/10.1007/s11695-013-0871-9 CrossRefPubMed

15.

Huerta S, Li Z, Anthony T, Livingston EH (2010) Feasibility of a Supervised inpatient low-calorie diet program for massive weight loss prior to RYGB in superobese patients. Obes Surg 20:173–180. https://doi.org/10.1007/s11695-009-0001-x CrossRefPubMed

16.

Collins J, McCloskey C, Titchner R, Goodpaster B, Hoffman M, Hauser D, Wilson M, Eid G (2011) Preoperative weight loss in high-risk superobese bariatric patients: a computed tomography-based analysis. Surg Obes Relat Dis 7:480–485. https://doi.org/10.1016/j.soard.2010.09.026 CrossRefPubMed

17.

Regan JP, Inabnet WB, Gagner M, Pomp A (2003) Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg 13:861–864. https://doi.org/10.1381/096089203322618669 CrossRefPubMed

18.

Silecchia G, Rizzello M, Casella G, Fioriti M, Soricelli E, Basso N (2009) Two-stage laparoscopic biliopancreatic diversion with duodenal switch as treatment of high-risk super-obese patients: analysis of complications. Surg Endosc 23:1032–1037. https://doi.org/10.1007/s00464-008-0113-8 CrossRefPubMed

19.

Silecchia G, Boru C, Pecchia A, Rizzello M, Casella G, Leonetti F, Basso N (2006) Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg 16:1138–1144. https://doi.org/10.1381/096089206778392275 CrossRefPubMed

20.

Iannelli A, Schneck AS, Dahman M, Negri C, Gugenheim J (2009) Two-step laparoscopic duodenal switch for superobesity: a feasibility study. Surg Endosc 23:2385–2389. https://doi.org/10.1007/s00464-009-0363-0 CrossRefPubMed

21.

Dapri G, Cadière GB, Himpens J (2011) Superobese and super-superobese patients: 2-step laparoscopic duodenal switch. Surg Obes Relat Dis 7:703–708. https://doi.org/10.1016/j.soard.2011.09.007 CrossRefPubMed

22.

Alexandrou A, Felekouras E, Giannopoulos A, Tsigris C, Diamantis T (2012) What is the actual fate of super-morbid-obese patients who undergo laparoscopic sleeve gastrectomy as the first step of a two-stage weight-reduction operative strategy? Obes Surg 22:1623–1628. https://doi.org/10.1007/s11695-012-0718-9 CrossRefPubMed

23.

Lewis M, Phillips M, Slavotinek J, Kow L, Thompson C, Toouli J (2006) Change in liver size and fat content after treatment with optifast < SUP > ^®</SUP > very low calorie diet. Obes Surg 16:697–701. https://doi.org/10.1381/096089206777346682 CrossRefPubMed

24.

Fris RJ (2004) Preoperative Low energy diet diminishes liver size. Obes Surg 14:1165–1170. https://doi.org/10.1381/0960892042386977 CrossRefPubMed

25.

Frutos MD, Morales MD, Luján J, Hernández Q, Valero G, Parrilla P (2007) Intragastric balloon reduces liver volume in super-obese patients, facilitating subsequent laparoscopic gastric bypass. Obes Surg 17:150–154. https://doi.org/10.1007/s11695-007-9040-3 CrossRefPubMed

26.

Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73:712–716CrossRefPubMed

27.

Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:135. https://doi.org/10.1186/1471-2288-14-135 CrossRefPubMedPubMedCentral

28.

Higgins J, Green S (2011) 16.1.3.1 Imputing standard deviations. In: Cochrane Handb. Syst. Rev. Interv. https://handbook-5-1.cochrane.org/chapter_16/16_1_3_1imputing_standard_deviations.htm. Accessed 2 Feb 2019

29.

Milone L, Strong V, Gagner M (2005) Laparoscopic sleeve gastrectomy is superior to endoscopic intragastric balloon as a first stage procedure for super-obese patients (BMI ≥ 50). Obes Surg 15:612–617. https://doi.org/10.1381/0960892053923833 CrossRefPubMed

30.

Coffin B, Maunoury V, Pattou F, Hébuterne X, Schneider S, Coupaye M, Ledoux S, Iglicki F, Huten N, Alfaiate T, Hajage D, Msika S (2017) Impact of intragastric balloon before laparoscopic gastric bypass on patients with super obesity: a randomized multicenter study. Obes Surg 27(4):902–909. https://doi.org/10.1007/s11695-016-2383-x CrossRefPubMed

31.

Moura D, Oliveira J, De Moura EGH, Bernardo W, Neto MG, Campos J, Popov VB, Thompson C (2016) Effectiveness of intragastric balloon for obesity: a systematic review and meta-analysis based on randomized control trials. Surg Obes Relat Dis 12(2):420–429. https://doi.org/10.1016/j.soard.2015.10.077 CrossRefPubMed

32.

Brethauer SA, Hammel JP, Schauer PR (2009) Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. SOARD 5:469–475. https://doi.org/10.1016/j.soard.2009.05.011 CrossRef

33.

Van Nieuwenhove Y, Dambrauskas Z, Campillo-Soto A, van Dielen F, Wiezer R, Janssen I, Kramer M, Thorell A (2011) Preoperative very low-calorie diet and operative outcome after laparoscopic gastric bypass. Arch Surg 146:1300. https://doi.org/10.1001/archsurg.2011.273 CrossRefPubMed

34.

Arterburn DE, Courcoulas AP (2014) Bariatric surgery for obesity and metabolic conditions in adults. BMJ 349:g3961. https://doi.org/10.1136/BMJ.G3961 CrossRefPubMedPubMedCentral

35.

Nelson DW, Blair KS, Martin MJ (2012) Analysis of obesity-related outcomes and bariatric failure rates with the duodenal switch vs gastric bypass for morbid obesity. Arch Surg 147:847. https://doi.org/10.1001/archsurg.2012.1654 CrossRefPubMed

36.

Lee Y, Ellenbogen Y, Doumouras AG, Gmora S, Anvari M, Hong D (2019) Single- or double-anastomosis duodenal switch versus Roux-en-Y gastric bypass as a revisional procedure for sleeve gastrectomy: a systematic review and meta-analysis. Surg Obes Relat Dis 1:2. https://doi.org/10.1016/j.soard.2019.01.022 CrossRef

37.

Turner PL, Saager L, Dalton J, Abd-Elsayed A, Roberman D, Melara P, Kurz A, Turan A (2011) A nomogram for predicting surgical complications in bariatric surgery patients. Obes Surg 21:655–662. https://doi.org/10.1007/s11695-010-0325-6 CrossRefPubMed

38.

Hariri K, Guevara D, Dong M, Kini SU, Herron DM, Fernandez-Ranvier G (2018) Is bariatric surgery effective for co-morbidity resolution in the super-obese patients? Surg Obes Relat Dis 14:1261–1268. https://doi.org/10.1016/j.soard.2018.05.015 CrossRefPubMed

39.

Spielman AB, Kanders B, Kienholz M, Blackburn GL (1992) The cost of losing: an analysis of commercial weight-loss programs in a metropolitan area. J Am Coll Nutr 11:36–41. https://doi.org/10.1080/07315724.1992.10718194 CrossRefPubMed

40.

Creange C, Lin E, Ren-Fielding C, Lofton H (2016) Use of liraglutide for weight loss in patients with prior bariatric surgery. Surg Obes Relat Dis 12:S157. https://doi.org/10.1016/j.soard.2016.08.281 CrossRef

Title: Bridging interventions before bariatric surgery in patients with BMI ≥ 50 kg/m2: a systematic review and meta-analysis
Authors: Yung Lee
Jerry T. Dang
Noah Switzer
Roshan Malhan
Daniel W. Birch
Shahzeer Karmali
Publication date: 01-11-2019
Publisher: Springer US
Keywords: Bariatric Surgery
Bariatric Surgery
Published in: Surgical Endoscopy / Issue 11/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-07027-y

At a glance: The STEP trials

Springer Medicine

Bridging interventions before bariatric surgery in patients with BMI ≥ 50 kg/m²: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2019

Comparison of outcome and cost between the open, laparoscopic, and robotic surgical treatments for colon cancer: a propensity score-matched analysis using nationwide hospital record database

Hierarchical task analysis for identification of interrelationships between ergonomic, external disruption, and internal disruption in complex laparoscopic procedures

Evaluation of hyperspectral imaging (HSI) for the measurement of ischemic conditioning effects of the gastric conduit during esophagectomy

Electrical lower esophageal sphincter augmentation in patients with GERD and severe ineffective esophageal motility—a safety and efficacy study

After laparoscopic liver resection for colorectal liver metastases, age does not influence morbi-mortality

Three-dimensional versus two-dimensional high-definition laparoscopy in cholecystectomy: a prospective randomized controlled study