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.
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
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
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
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
Ahn SM, Pomp A, Rubino F (2010) Metabolic surgery for type 2 diabetes. Ann N Y Acad Sci 1212:E37–E45
Tutuian R (2011) Obesity and GERD: pathophysiology and effect of bariatric surgery. Curr Gastroenterol Rep 13(3):205–212
Kubik JF, Gill RS, Laffin M, Karmali S (2013) The impact of bariatric surgery on psychological health. J Obes. 2013:837989
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
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
Tuomilehto H, Seppä J, Uusitupa M (2013) Obesity and obstructive sleep apnea–clinical significance of weight loss. Sleep Med Rev 17(5):321–329
Sheiner E, Willis K, Yogev Y (2013) Bariatric surgery: impact on pregnancy outcomes. Curr Diab Rep. 13(1):19–26
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
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
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
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
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
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
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
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
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
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
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
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
Schwartz A, Etchechoury L, Collet D (2013) Outcome after laparoscopic gastric bypass for super-super obese patients. J Visc Surg. 150(2):145–149
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
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
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
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
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
Sucandy I, Antanavicius G, Bonanni F Jr (2013) Outcome analysis of early laparoscopic sleeve gastrectomy experience. JSLS. 17(4):602–606
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
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
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
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
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
Author information
Authors and Affiliations
Corresponding author
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
About this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-015-4509-y