Laparoscopic gastric bypass: risks vs. benefits up to two years following surgery in super-super obese patients

Jon C Gould, Michael J Garren, Valerie Boll, James R Starling
Surgery 2006, 140 (4): 524-9; discussion 529-31

BACKGROUND: Super-super obesity (body mass index [BMI] >/= 60 kg/m(2)) is thought to be a risk factor for complications and mortality in laparoscopic Roux-en-Y gastric bypass. Excess weight loss has been demonstrated to be diminished compared with less obese patients following surgery. However, we hypothesize that super-super obese patients who undergo laparoscopic gastric bypass can realize major improvements in their health and a good quality of life without a significantly increased risk of complications when compared with less obese patients.

METHODS: From July 2002 to July 2005, University of Wisconsin Health bariatric surgeons performed 288 consecutive laparoscopic Roux-en-Y gastric bypass procedures. Patients were divided into 2 groups: BMI >/= 60 kg/m(2) (n = 28) and BMI < 60 kg/m(2) (n = 260). The groups were compared at defined time intervals during a 2-year period following surgery. Comparison criteria included complications, weight loss, comorbidities, and quality of life.

RESULTS: Both groups had similar morbidity and mortality rates. Excess weight loss was shown to be less, but total pounds lost were greater, for the super-super obese patients at all postoperative time intervals specified for postoperative analysis. Despite this fact, overall health improved to a similar degree in each group of patients following surgery; both groups also had similar Moorehead-Ardelt quality of life scores. Using the Bariatric Analysis and Reporting Outcome System (BAROS) to categorize outcomes, the average result for a patient in either group of patients would be considered "very good" at 1 year following surgery.

CONCLUSIONS: Laparoscopic Roux-en-Y gastric bypass can be accomplished safely even in extremely obese patients. Although excess weight loss in the super-super obese is diminished postoperatively when compared with less obese patients, health is improved and quality of life is good regardless of a patient's preoperative BMI. Therefore, laparoscopic gastric bypass is a good option even in the extremely obese.

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