Advertisement

Obesity Surgery

, Volume 27, Issue 10, pp 2537–2545 | Cite as

A Comparison of the Bariatric Procedures that Are Performed in the Treatment of Super Morbid Obesity

  • Kohei Uno
  • Yosuke SekiEmail author
  • Kazunori Kasama
  • Kotaro Wakamatsu
  • Akiko Umezawa
  • Katsuhiko Yanaga
  • Yoshimochi Kurokawa
Original Contributions

Abstract

Background

We have experienced numerous cases of super morbid obesity (SMO), defined by a BMI of ≥50 kg/m2, in which laparoscopic sleeve gastrectomy (LSG) was not able to achieve a sufficient weight loss effect. However, the most appropriate procedure for the treatment of SMO has not yet been established.

Methods

The subjects included 248 successive patients who underwent surgery at our hospital from June 2006 to December 2012. We divided the subjects into an SMO group (BMI, 50 to <70 kg/m2) and a morbid obesity (MO) group (BMI, 35 to <50 kg/m2). The subjects underwent LSG, LSG with duodenojejunal bypass (LSG/DJB), or laparoscopic Roux-en-Y gastric bypass (LRYGB). The weight loss effects, safety of surgery, and metabolic profile changes were compared.

Results

Sixty-two subjects were classified into the SMO group (25%). The percent excess weight loss (%EWL) after LSG among the patients in the SMO group was not significantly different from that of patients who underwent other procedures. LSG was associated with a significantly lower success rate in terms of weight loss (%EWL ≥ 50%), in comparison to the weight loss at 1 year after LRYGB and at 2 years after LSG/DJB and LRYGB. Among the patients in the MO group, the %EWL and the rate of successful weight loss did not differ to a statistically significant extent.

Conclusion

This study demonstrated that in patients with SMO, LSG/DJB and LRYGB can achieve superior weight loss effects in comparison to LSG.

Keywords

Bariatric surgery Super morbid obesity Weight loss 

Notes

Acknowledgments

The authors declare that they have no acknowledgment.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in our study involving human participants were in accordance with the ethical standards of the institutional and/or Japanese national research committees and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in our study.

Grant Information

The authors declare that they have no grant information.

References

  1. 1.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25:1822–32.CrossRefPubMedGoogle Scholar
  2. 2.
    Haruta H, Kasama K, Ohta M, et al. Long-term outcomes of bariatric and metabolic surgery in Japan: results of a multi-institutional survey. Obes Surg. 2016; doi: 10.1007/s11695-016-2361-3.Google Scholar
  3. 3.
    Kasama K, Tagaya N, Kanehira E, et al. Laparoscopic sleeve gastrectomy with duodenojejunal bypass: technique and preliminary results. Obes Surg. 2009;19:1341–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Tagaya N, Kasama K, Kikkawa R, et al. Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity. Obes Surg. 2009;19:1371–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Thereaux J, Corigliano N, Poitou C, et al. Comparison of results after one year between sleeve gastrectomy and gastric bypass in patients with BMI Z 50 kg/m2. Surg Obes Relat Dis. 2015;11:785–90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25771441 CrossRefPubMedGoogle Scholar
  6. 6.
    Zerrweck C, Sepúlveda EM, Maydón HG, et al. Laparoscopic gastric bypass vs. sleeve gastrectomy in the super obese patient: early outcomes of an observational study. Obes. Surg. 2014;24:712–7.Google Scholar
  7. 7.
    Peterli R, Borbély Y, Kern B, et al. Early results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Ann Surg. 2013;258:690–5. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3888472&tool=pmcentrez&rendertype=abstract CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Zhang N, Maffei A, Cerabona T, et al. Reduction in obesity-related comorbidities: is gastric bypass better than sleeve gastrectomy? Surg Endosc Other Interv Tech. 2013;27:1273–80.CrossRefGoogle Scholar
  9. 9.
    Keidar A, Hershkop KJ, Marko L, et al. Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes: a randomised trial. Diabetologia. 2013;56:1914–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Kehagias I, Karamanakos SN, Argentou M-I, et al. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI < 50 kg/m2. Obes Surg. 2011;21:1650–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Topart P, Becouarn G, Ritz P. Weight loss is more sustained after biliopancreatic diversion with duodenal switch than Roux-en-Y gastric bypass in superobese patients. Surg Obes Relat Dis. 2013;9:526–30. doi: 10.1016/j.soard.2012.02.006.CrossRefPubMedGoogle Scholar
  12. 12.
    Prachand VN, DaVee RT, Alverdy JC. Duodenal switch provides superior weight loss in the super-obese (BMI ≥50kg/m2) compared with gastric bypass. Ann Surg. 2006;244:611–9.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Søvik TT, Taha O, Aasheim ET, et al. Randomized clinical trial of laparoscopic gastric bypass versus laparoscopic duodenal switch for superobesity. Br J Surg. 2010;97:160–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Rezvani M, Sucandy I, Klar A, et al. Is laparoscopic single-stage biliopancreatic diversion with duodenal switch safe in super morbidly obese patients? Surg Obes Relat Dis. 2014;10:427–30. doi: 10.1016/j.soard.2013.10.004.CrossRefPubMedGoogle Scholar
  15. 15.
    Dresel A, Kuhn JA, McCarty TM. Laparoscopic Roux-en-Y gastric bypass in morbidly obese and super morbidly obese patients. Am J Surg. 2004;187:230–2.CrossRefPubMedGoogle Scholar
  16. 16.
    Melissas J. IFSO guidelines for safety, quality, and excellence in bariatric surgery. Obes Surg. 2008;18:497–500.CrossRefPubMedGoogle Scholar
  17. 17.
    Benotti P, Wood GC, Winegar DA, et al. Risk factors associated with mortality after Roux-en-Y gastric bypass surgery. Ann Surg. 2014;259:123–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23470583\nhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4075503 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Kohei Uno
    • 1
    • 2
  • Yosuke Seki
    • 1
    Email author
  • Kazunori Kasama
    • 1
  • Kotaro Wakamatsu
    • 1
  • Akiko Umezawa
    • 1
  • Katsuhiko Yanaga
    • 2
  • Yoshimochi Kurokawa
    • 1
  1. 1.Weight Loss and Metabolic Surgery CenterYotsuya Medical CubeTokyoJapan
  2. 2.Department of SurgeryJikei University School of MedicineTokyoJapan

Personalised recommendations