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



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.


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.


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.


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


Bariatric surgery Super morbid obesity Weight loss 



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.


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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

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