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Preoperative Weight Loss via Very Low Caloric Diet (VLCD) and Its Effect on Outcomes After Bariatric Surgery

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Abstract

Introduction

The effect of preoperative weight loss via very low caloric diet (VLCD) on long-term weight loss post-bariatric surgery (BS) is conflicting. We analysed its impact on weight loss and other outcomes post-BS.

Methods

Patients (n = 306) who underwent sleeve gastrectomy or gastric bypass from 2008 to 2018 were studied. VLCD was prescribed for 14 days preoperatively. Patients were followed up for 5 years. Postoperative weight loss was compared in patients with preoperative weight gain or weight loss < 5% (WL < 5%), and weight loss ≥ 5% (WL ≥ 5%). Preoperative WL compared weight before and after VLCD; postoperative WL compared post-VLCD weight and follow-up weight. Total weight loss (TWL) encompassed pre- and postoperative WL.

Results

WL was < 5% in 87.3% and ≥ 5% in 12.7%. There was no significant difference in complication rate, duration of surgery or length of stay, regardless of surgical type. Patients with WL < 5% lost more weight postoperatively compared with WL ≥ 5% for up to 60 months (%postoperative WL at 1 month: WL < 5% = 13.7%, WL ≥ 5% = 10%, p = <0.001; 60 months: WL < 5% = 30.6%, WL ≥ 5% = 23.9%, p = 0.041). However, when TWL and percentage of excess body mass index loss (%EBMIL) were measured, there was no difference beyond 6 months. A predictive multivariable model for 1-year %EBMIL was formed. Significant variables included pre-VLCD BMI and preoperative WL, and the relationship between the two.

Conclusion

Preoperative WL via VLCD was associated with reduced postoperative WL after BS, with no significant effect on complications, long-term TWL or %EBMIL. This challenges the notion that preoperative WL via VLCD should be mandated for better postoperative outcomes.

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Authors and Affiliations

  1. Department of Endocrinology, Singapore General Hospital, Singapore, Singapore

    Sarah Ying Tse Tan, Pooi Ling Loi, Sonali Ganguly, Kwang Wei Tham, Hong Chang Tan & Phong Ching Lee

  2. Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore

    Chin Hong Lim & Weng Hoong Chan

  3. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Nicholas Syn

  4. Department of Dietetics, Singapore General Hospital, Singapore, Singapore

    Hui Mei Wong

Authors
  1. Sarah Ying Tse Tan
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  2. Pooi Ling Loi
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  3. Chin Hong Lim
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  4. Sonali Ganguly
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  7. Hong Chang Tan
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Correspondence to Phong Ching Lee.

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Tan, S.Y.T., Loi, P.L., Lim, C.H. et al. Preoperative Weight Loss via Very Low Caloric Diet (VLCD) and Its Effect on Outcomes After Bariatric Surgery. OBES SURG 30, 2099–2107 (2020). https://doi.org/10.1007/s11695-020-04446-y

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  • DOI: https://doi.org/10.1007/s11695-020-04446-y

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