OBES SURG DOI 10.1007/s11695-013-1157-y
ORIGINAL CONTRIBUTIONS
Laparoscopic Gastric Bypass vs. Sleeve Gastrectomy in the Super Obese Patient: Early Outcomes of an Observational Study Carlos Zerrweck & Elisa M. Sepúlveda & Hernán G. Maydón & Francisco Campos & Antonio G. Spaventa & Verónica Pratti & Itzel Fernández
# Springer Science+Business Media New York 2013
Abstract Background Super obesity [body mass index (BMI) > 50 kg/m2] can yield to higher morbidity/mortality in bariatric surgery, this could be related to patient's characteristics and/or surgeon's experience. In morbid obesity, both techniques proved to have a positive impact and sometimes comparable outcomes during the first 2 years. This has not been clearly analyzed in the super obese patient. Methods Retrospective study comparing the records of 77 consecutive super obese patients (BMI: 50–59.9 kg/m2) submitted to either laparoscopic gastric bypass (LGBP, n=32) or laparoscopic sleeve gastrectomy (LSG, n=45) between 2010 and 2012 at a single institution. The primary objective was to analyze baseline demographics, comorbidities, operative outcomes, and early complications (50 kg/m2] is still subject of debate due to the unique and particularly difficult characteristics of this group, and the technical challenge they represent [1]. Mason et al. [2] first proposed the concept of super obesity based on the observation that patients with a higher degree of obesity often failed to achieve satisfactory weight loss after a vertical banded gastroplasty (VBG). This failure is due to multiple factors and different approaches have been used in order to fulfill a better outcome in this particular group. The usual technical difficulties found in the super obese patient during surgery include the ones related to the size of the patient by itself. Males, in particular, have a higher proportion of central obesity and a longer distance between the xiphoid and the esophagus, and most of the patients have massive hepatomegaly and a thicker visceral and abdominal wall fat layer. Most of the time longer instruments and lenses are needed, requiring greater force to manipulate them increasing operative time and fatigue. On the other hand, super obese patients have a greater incidence of coexisting morbidity that might increase surgical risk [1, 2].
OBES SURG
Laparoscopic gastric bypass (LGBP) continues to be the most widely used bariatric procedure worldwide, but laparoscopic sleeve gastrectomy (LSG) has gained popularity and a rapid expansion has been observed in recent years probably related to the “simplicity” when compared to LGBP, especially in super obesity. Anyway, in this specific population, the efficacy as a definitive procedure is still a matter of debate, and only few studies compared it with other techniques such as LGBP [3–5]. In this study, we compared both surgical groups (LSG vs. LGBP) in a super obese population in order to determine their outcomes and 12-month weight loss.
Methods In this retrospective study, we compared the records of 77 consecutive super obese patients (BMI: 50–59.9 kg/m2) submitted to either LGBP (n=32) or LSG (n=45) from March 2010 to April 2012 at a single institution; data collection was done prospectively. Patients with BMI>60 kg/m2 were systematically submitted to intragastric balloon. The primary objective was to analyze baseline demographics, comorbidities, operative outcomes and early complications (
ORIGINAL CONTRIBUTIONS
Laparoscopic Gastric Bypass vs. Sleeve Gastrectomy in the Super Obese Patient: Early Outcomes of an Observational Study Carlos Zerrweck & Elisa M. Sepúlveda & Hernán G. Maydón & Francisco Campos & Antonio G. Spaventa & Verónica Pratti & Itzel Fernández
# Springer Science+Business Media New York 2013
Abstract Background Super obesity [body mass index (BMI) > 50 kg/m2] can yield to higher morbidity/mortality in bariatric surgery, this could be related to patient's characteristics and/or surgeon's experience. In morbid obesity, both techniques proved to have a positive impact and sometimes comparable outcomes during the first 2 years. This has not been clearly analyzed in the super obese patient. Methods Retrospective study comparing the records of 77 consecutive super obese patients (BMI: 50–59.9 kg/m2) submitted to either laparoscopic gastric bypass (LGBP, n=32) or laparoscopic sleeve gastrectomy (LSG, n=45) between 2010 and 2012 at a single institution. The primary objective was to analyze baseline demographics, comorbidities, operative outcomes, and early complications (50 kg/m2] is still subject of debate due to the unique and particularly difficult characteristics of this group, and the technical challenge they represent [1]. Mason et al. [2] first proposed the concept of super obesity based on the observation that patients with a higher degree of obesity often failed to achieve satisfactory weight loss after a vertical banded gastroplasty (VBG). This failure is due to multiple factors and different approaches have been used in order to fulfill a better outcome in this particular group. The usual technical difficulties found in the super obese patient during surgery include the ones related to the size of the patient by itself. Males, in particular, have a higher proportion of central obesity and a longer distance between the xiphoid and the esophagus, and most of the patients have massive hepatomegaly and a thicker visceral and abdominal wall fat layer. Most of the time longer instruments and lenses are needed, requiring greater force to manipulate them increasing operative time and fatigue. On the other hand, super obese patients have a greater incidence of coexisting morbidity that might increase surgical risk [1, 2].
OBES SURG
Laparoscopic gastric bypass (LGBP) continues to be the most widely used bariatric procedure worldwide, but laparoscopic sleeve gastrectomy (LSG) has gained popularity and a rapid expansion has been observed in recent years probably related to the “simplicity” when compared to LGBP, especially in super obesity. Anyway, in this specific population, the efficacy as a definitive procedure is still a matter of debate, and only few studies compared it with other techniques such as LGBP [3–5]. In this study, we compared both surgical groups (LSG vs. LGBP) in a super obese population in order to determine their outcomes and 12-month weight loss.
Methods In this retrospective study, we compared the records of 77 consecutive super obese patients (BMI: 50–59.9 kg/m2) submitted to either LGBP (n=32) or LSG (n=45) from March 2010 to April 2012 at a single institution; data collection was done prospectively. Patients with BMI>60 kg/m2 were systematically submitted to intragastric balloon. The primary objective was to analyze baseline demographics, comorbidities, operative outcomes and early complications (
