Faut-il encourager la perte de poids avant la chirurgie bariatrique ?

Bariatric surgery is recognized as a modality in its own right for the treatment of severe obesity but also of its comorbidities. Many centers of bariatric surgery encourage or even impose on their patients a weight loss before surgery. The purpose of this paper is to review the rationale of this practice and to propose a practical attitude in the expectation of conclusive data. The analysis of the current literature does not make it possible to conclude unequivocally about the value of preoperative weight loss in the context of bariatric surgery. There is thus currently no sufficient argument to consider that weight loss is a systematic prerequisite for bariatric surgery. The only benefit demonstrated is the reduction in liver size. It remains however to be demonstrated by randomized prospective studies that the reduction in hepatic volume caused by preoperative weight loss is accompanied by a reduction in per- and postoperative complications without any risk of undernutrition.