Skip to main content

Advertisement

Log in

Weight loss outcomes and complications from bariatric surgery in the super super obese

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Bariatric surgery has been established as the most effective long-term treatment for morbid obesity.

Methods

We performed a retrospective review of SSO patients treated at our institute between 2008 and 2013 who underwent a laparoscopic gastric bypass (LGBP) or sleeve gastrectomy (LSG). The primary end point for this study was excess weight loss (EWL) at 1, 3, 6, and 12 months. Secondary end points included procedure length (PL), length of stay (LOS), diabetes management and postoperative complications.

Results

We identified 135 SSO patients who underwent bariatric surgery (93 LGBP, 42 LSG) at our institute from 2008 to 2013 with a median follow-up of 49 months. The incidence of EWL > 30 % for patients in the LGBP group was 3.9, 29.0, 72.2 and 94.6 % at 1, 3, 6 and 12 months, respectively, while the incidence of EWL > 30 % in patients in the LSG group was 4.2, 25.0, 59.1 and 100 % at 1, 3, 6 and 12 months, respectively. PL was 124 ± 49 min for the LGBP group and 98 + 51 min for the LSG group (p < 0.005). LOS was on average 3.0 days (range 1–21) for the LGBP group and 3.4 days (range 1–13) for the LSG group (p = 0.41). Patients experienced a decrease in their hemoglobin A1C level by 10 % for the LGBP group and 9 % for the LSG group at 1 year (p = 0.89). Postoperative complications were seen in 15.1 % of LGBP patients and 4.8 % of LSG patients.

Conclusions

Bariatric surgery is feasible in the SSO patients with comparable EWL outcomes and postoperative complications to historical non-SSO patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

Abbreviations

SSO:

Super super obese

SO:

Super obese

BMI:

Body mass index

EWL:

Estimated weight loss

PL:

Procedure length

LOS:

Length of stay

SBO:

Small bowel obstruction

PE:

Pulmonary embolism

UGIB:

Upper gastrointestinal bleed

Hgb A1C:

Hemoglobin A1C

References

  1. O’Brien PE, MacDonald L, Anderson M, Brennan L, Brown WA (2012) Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature. Ann Surg 257(1):87–94

    Article  Google Scholar 

  2. Jackson TD, Hutter MM (2012) Morbidity and effectiveness of laparoscopic sleeve gastrectomy, adjustable gastric band, and gastric bypass for morbid obesity. Adv Surg 46:255–268

    Article  PubMed  Google Scholar 

  3. Lynch J, Belgaumkar A (2012) Bariatric surgery is effective and safe in patients over 55: a systematic review and meta-analysis. Obes Surg 22(9):1507–1516

    Article  PubMed  Google Scholar 

  4. Ahn SM, Pomp A, Rubino F (2010) Metabolic surgery for type 2 diabetes. Ann N Y Acad Sci 1212:E37–E45

    Article  PubMed  Google Scholar 

  5. Tutuian R (2011) Obesity and GERD: pathophysiology and effect of bariatric surgery. Curr Gastroenterol Rep 13(3):205–212

    Article  PubMed  Google Scholar 

  6. Kubik JF, Gill RS, Laffin M, Karmali S (2013) The impact of bariatric surgery on psychological health. J Obes. 2013:837989

    Article  PubMed  PubMed Central  Google Scholar 

  7. Savastano S, Di Somma C, Pivonello R, Tarantino G, Orio F, Nedi V, Colao A (2013) Endocrine changes (beyond diabetes) after bariatric surgery in adult life. J Endocrinol Invest 36(4):267–279

    CAS  PubMed  Google Scholar 

  8. Brzozowska MM, Sainsbury A, Eisman JA, Baldock PA, Center JR (2013) Bariatric surgery, bone loss, obesity and possible mechanisms. Obes Rev 14(1):52–67

    Article  CAS  PubMed  Google Scholar 

  9. Tuomilehto H, Seppä J, Uusitupa M (2013) Obesity and obstructive sleep apnea–clinical significance of weight loss. Sleep Med Rev 17(5):321–329

    Article  PubMed  Google Scholar 

  10. Sheiner E, Willis K, Yogev Y (2013) Bariatric surgery: impact on pregnancy outcomes. Curr Diab Rep. 13(1):19–26

    Article  PubMed  Google Scholar 

  11. Joshi GP, Ahmad S, Riad W, Eckert S, Chung F (2013) Selection of obese patients undergoing ambulatory surgery: a systematic review of the literature. Anesth Analg 117(5):1082–1091

    Article  PubMed  Google Scholar 

  12. Ahmed S, Morrow E, Morton J (2010) Perioperative considerations when operating on the very obese: tricks of the trade. Minerva Chir 65(6):667–675

    CAS  PubMed  Google Scholar 

  13. Leykin Y, Pellis T, Del Mestro E, Marzano B, Fanti G, Brodsky JB (2006) Anesthetic management of morbidly obese and super-morbidly obese patients undergoing bariatric operations: hospital course and outcomes. Obes Surg 16(12):1563–1569

    Article  PubMed  Google Scholar 

  14. Zerrweck C, Sepúlveda EM, Maydón HG, Campos F, Spaventa AG, Pratti V, Fernández I (2014) Laparoscopic gastric bypass vs. sleeve gastrectomy in the super obese patient: early outcomes of an observational study. Obes Surg 24(5):712–717

    Article  PubMed  Google Scholar 

  15. Kushnir L, Dunnican WJ, Benedetto B, Wang W, Dolce C, Lopez S, Singh TP (2010) Is BMI greater than 60 kg/m(2) a predictor of higher morbidity after laparoscopic Roux-en-Y gastric bypass? Surg Endosc 24(1):94–97

    Article  CAS  PubMed  Google Scholar 

  16. Farkas DT, Vemulapalli P, Haider A, Lopes JM, Gibbs KE, Teixeira JA (2005) Laparoscopic Roux-en-Y gastric bypass is safe and effective in patients with a BMI > or = 60. Obes Surg 15(4):486–493

    Article  PubMed  Google Scholar 

  17. Gould JC, Garren MJ, Boll V, Starling JR (2006) Laparoscopic gastric bypass: risks vs. benefits up to two years following surgery in super-super obese patients. Surgery. 140(4):524–529

    Article  PubMed  Google Scholar 

  18. Abeles D, Kim JJ, Tarnoff ME, Shah S, Shikora SA (2009) Primary laparoscopic gastric bypass can be performed safely in patients with BMI > or = 60. J Am Coll Surg 208(2):236–240

    Article  PubMed  Google Scholar 

  19. Tichansky DS, DeMaria EJ, Fernandez AZ, Kellum JM, Wolfe LG, Meador JG, Sugerman HJ (2005) Postoperative complications are not increased in super-super obese patients who undergo laparoscopic Roux-en-Y gastric bypass. Surg Endosc 19(7):939–941

    Article  CAS  PubMed  Google Scholar 

  20. Nguyen NT, Longoria M, Gelfand DV, Sabio A, Wilson SE (2005) Staged laparoscopic Roux-en-Y: a novel two-stage bariatric operation as an alternative in the super-obese with massively enlarged liver. Obes Surg 15(7):1077–1081

    Article  PubMed  Google Scholar 

  21. de Menezes Ettinger JE, Azaro E, Mello CA, Fahel E (2005) Critical analysis of the staged laparoscopic Roux-en-Y: a two-stage operation to diminish the size of the liver in super-obese patients. Obes Surg 15(9):1358–1360

    Article  PubMed  Google Scholar 

  22. Stephens DJ, Saunders JK, Belsley S, Trivedi A, Ewing DR, Iannace V, Capella RF, Wasielewski A, Moran S, Schmidt HJ, Ballantyne GH (2008) Short-term outcomes for super-super obese (BMI > or = 60 kg/m2) patients undergoing weight loss surgery at a high-volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and open tubular gastric bypass. Surg Obes Relat Dis. 4(3):408–415

    Article  PubMed  Google Scholar 

  23. Schwartz A, Etchechoury L, Collet D (2013) Outcome after laparoscopic gastric bypass for super-super obese patients. J Visc Surg. 150(2):145–149

    Article  CAS  PubMed  Google Scholar 

  24. Taylor JD, Leitman IM, Hon P, Horowitz M, Panagopoulos G (2006) Outcome and complications of gastric bypass in super-super obesity versus morbid obesity. Obes Surg 16(1):16–18

    Article  PubMed  Google Scholar 

  25. Date RS, Walton SJ, Ryan N, Rahman SN, Henley NC (2013) Is selection bias toward super obese patients in the rationing of metabolic surgery justified?–A pilot study from the United Kingdom. Surg Obes Relat Dis. 9(6):981–986

    Article  PubMed  Google Scholar 

  26. Wang C, Yang W, Yang J (2014) Surgical results of laparoscopic Roux-en-Y gastric bypass in super obese patients with BMI ≥ 60 in China. Surg Laparosc Endosc Percutan Tech. 24(6):e216–e220

    PubMed  Google Scholar 

  27. Sánchez-Santos R, Vilarrasa N, Pujol J, Moreno P, Manuel Francos J, Rafecas A, Masdevall C (2006) Is Roux-en-Y gastric bypass adequate in the super-obese? Obes Surg 16(4):478–483

    Article  PubMed  Google Scholar 

  28. Magee CJ, Barry J, Arumugasamy M, Javed S, Macadam R, Kerrigan DD (2011) Laparoscopic sleeve gastrectomy for high-risk patients: weight loss and comorbidity improvement–short-term results. Obes Surg 21(5):547–550

    Article  PubMed  Google Scholar 

  29. Sucandy I, Antanavicius G, Bonanni F Jr (2013) Outcome analysis of early laparoscopic sleeve gastrectomy experience. JSLS. 17(4):602–606

    Article  PubMed  PubMed Central  Google Scholar 

  30. Lemanu DP, Srinivasa S, Singh PP, MacCormick AD, Ulmer S, Morrow J, Hill AG, Babor R, Rahman H (2012) Single-stage laparoscopic sleeve gastrectomy: safety and efficacy in the super-obese. J Surg Res 177(1):49–54

    Article  PubMed  Google Scholar 

  31. Sarhan M, Choi JJ, Al Sawwaf M, Murtaza G, Getty JL, Ahmed L (2011) Is weight loss better sustained with long-limb gastric bypass in the super-obese? Obes Surg 21(9):1337–1343

    Article  PubMed  Google Scholar 

  32. Giordano S, Tolonen P, Victorzon M (2015) Laparoscopic Roux-en-Y gastric bypass versus laparoscopic adjustable gastric banding in the super-obese: peri-operative and early outcomes. Scand J Surg. 104(1):5–9

    Article  CAS  PubMed  Google Scholar 

  33. Mehaffey JH, LaPar DJ, Turrentine FE, Miller MS, Hallowell PT, Schirmer BD (2015) Outcomes of laparoscopic Roux-en-Y gastric bypass in super-super-obese patients. Surg Obes Relat Dis 11(4):814–819

    Article  PubMed  Google Scholar 

  34. Thereaux J, Czernichow S, Corigliano N, Poitou C, Oppert JM, Bouillot JL (2015) Five-year outcomes of gastric bypass for super-super-obesity (BMI ≥ 60 kg/m2): a case matched study. Surg Obes Relat Dis. 11(1):32–37

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Oscar K. Serrano.

Ethics declarations

Disclosures

Oscar K. Serrano, MD, MBA, Jonathan E. Tannebaum, MD, Lindsay Cumella, BS, Jenny Choi, MD, Pratibha Vemulapalli, MD, W. Scott Melvin, MD, Diego R. Camacho, MD, report no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Serrano, O.K., Tannebaum, J.E., Cumella, L. et al. Weight loss outcomes and complications from bariatric surgery in the super super obese. Surg Endosc 30, 2505–2511 (2016). https://doi.org/10.1007/s00464-015-4509-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4509-y

Keywords

Navigation