Patients With Severe Obesity Are Made Eligible for Complex Abdominal Wall Repair After Preoptimization With GLP-1 Agonists: Results of a Bicentric Pilot Study.
Benoit Romain, Vincent Pfirsch, Simone Manfredelli, Thomas Leroi, Fadi Salman, Ouidad Sami, Diane Westerfeld-Ruillier, Séverine Ledoux, David Moszkowicz
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引用次数: 0
Abstract
Background: Incisional hernia repairs (IHRs) are not recommended in patients with severe obesity (BMI ≥ 35 kg/m2). Weight loss is challenging, but new medications, such as glucagon-like peptide-1 receptor agonists (GLP-1 agonists), have recently attracted increased attention for their potential weight loss advantages. The aim was to analyze the preliminary results about the safety and weight loss efficiency of the use of GLP-1 agonists in the context of prehabilitation prior to complex IHR.
Methods: All patients planned for IHR with a BMI ≥ 35 kg/m2 and treated with preoperative GLP-1 agonists were included in the experimental group and compared with a comparable historical surgical cohort treated with a conventional tailored nutritional preoperative management. Weight loss in the experimental group and perioperative and postoperative outcomes were compared between the two groups. The success rate of GLP1 agonists was defined as a weight loss that enables the patient to fall within the recommended limits of a BMI ≤ 35 kg/m2 before an IHR.
Results: Fifty-two patients in the control group were compared to 24 with GLP-1 agonists. The distribution of GLP-1 agonists was as follows: semaglutide (n = 12; 50%), dulaglutide (n = 7; 29.2%), and liraglutide (n = 5; 20.8%). The mean initial BMI was 40.1 ± 3.6 kg/m2 kg/m2. The average percentage of weight loss was 11.3 ± 7.4% with GLP-1 agonists (maximum weight loss was observed with semaglutide 2.4 mg/wk). The success rate of GLP1 agonists (defined as BMI ≤ 35 kg/m2 before IHR) was reached for 15/24 patients (62.5%). Postoperative total complication rate was lower in the group with GLP-1 agonists (59.6% in the control group vs. 45.8% in GLP-1 and p = 0.2).
Conclusion: This study demonstrated the efficacy of GLP-1 agonists in the optimization of patients with obesity, allowing two thirds of the patients to benefit from IHR, with a tendency for lower morbidity.
期刊介绍：
World Journal of Surgery is the official publication of the International Society of Surgery/Societe Internationale de Chirurgie (iss-sic.com). Under the editorship of Dr. Julie Ann Sosa, World Journal of Surgery provides an in-depth, international forum for the most authoritative information on major clinical problems in the fields of clinical and experimental surgery, surgical education, and socioeconomic aspects of surgical care. Contributions are reviewed and selected by a group of distinguished surgeons from across the world who make up the Editorial Board.
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