Preoperative Weight Loss in Gastric Bypass

Abstract

Roux-en-Y gastric bypass is one of the most performed bariatric procedures throughout the world, and there is a concern in improving patient selection, in order to achieve better outcomes. One of the proposed mechanisms, which is adopted in many centers, is to recommend preoperative weight loss. This strategy can assess patient's commitment to dietary changes and compliance with the treatment. Also, it has potential to improve postoperative weight loss, to decrease surgical complications, and to reduce liver volume and intra-abdominal fat load, especially in superobese patients. Available published data, however, are controversial to confirm those benefits. Preoperative weight loss can be achieved by different methods, including dietary counseling (including low or very low-calorie diets and meal replacements), physical activities, drugs, and intragastric balloon. The choice should be individualized, with a multidisciplinary approach, and even with no evidence-based recommendation, preoperative weight loss should be attempted and stimulated, by bariatric surgery team.