The study
A look at the medical records of 881 patients who had weight-loss surgery found that the more weight patients lost before surgery, the less likely they were to suffer post-op complications, such as infections, blood clots, and kidney problems.

Preoperative weight changes varied among the 881 patients, ranging from modest weight gain to weight loss of more than 10% of excess body weight.

The post-surgery complication rate was nearly two-fold higher in patients who gained weight before surgery relative to those who lost weight before surgery, Dr Peter N Benotti of the Saint Francis Medical Center in Trenton, New Jersey and colleagues report.

All of the patients had undergone open or 'keyhole' Roux-en-Y gastric bypass surgery. With this procedure, staples are used to create a pouch in the stomach that can hold only a small amount of food at a time; then, a portion of the small intestine is attached to the pouch so that food bypasses the rest of the stomach and part of the small intestine.

Patients who had the more-invasive open surgery were at increased risk of post-op complications, regardless of whether they gained or lost weight before the surgery, the researchers found.

More demand for weight-loss surgery
The popularity of weight-loss surgery has increased in recent years and so too have the numbers of patients seeking surgery who are older and sicker, the researchers note.

As more of these high-risk patients seek out surgical weight-loss options, doctors are facing a need to identify risk factors and help prepare patients for successful surgery. The current study, the researchers say, suggests that pre-surgery weight-loss may be one step that will help those having weight-loss surgery to achieve a more favorable outcome.

Benotti said patients need to know that weight-loss surgery "is not a definitive treatment." A healthy diet, lifestyle change, and behaviour modification are essential for maintaining weight-loss after surgery, the researcher said.

Surgery is a carrot; it provides motivation for people knowing they will have help," Benotti said.

Pic: Rob Owen-Wahl