Effectiveness of Bariatric Surgery in Super-super Obese Patients

Jonathan E Tannebaum, MD, Abraham Krikhely, MD, Mujjahid Abbas, MD, Lindsay Cumella, BS, Prathiba Vemulapalli, MD, Jenny Choi, MD, Diego R Camacho, MD. Montefiore Medical Center.

Introduction: This study aims to add to our understanding of perioperative experience & postoperative outcomes with the super-super obese (BMI≥60). These patients are regarded as high risk for bariatric surgery, but there is limited published data regarding the safety & effectiveness in this population.

Methods and Procedures: This retrospective chart review at a single high volume academic center looks at GBP, SG & adjustable gastric banding (GBa) done from 2008-2012 in super-super obese patients. Experiences and outcomes associated with the different operations were compared. Patient demographics, preoperative risk factors, & intra-operative procedures were noted & compared.
Endpoints of procedure length, postoperative complications, LOS & EWL at 6 months were compared between patients undergoing GBP & SG. Modified Reinhold criteria for success was applied to the results & then adapted for this study. Success was defined as EWL>30% at 6 months. This data was analyzed using x2 analysis. Analysis with Fisher’s exact test was used to compare complication rates between the two groups.

Results: One hundred thirteen patients with BMI≥60 underwent GBa, SG or GBP from 2008-2012. Overall, 76 patients underwent GBP, while 28 underwent SG. Limited GBa group size (n = 8) precluded meaningful comparison & analysis of efficacy of GBa with the super-super obese. At 6 months, 37% RGB patients & 64% SG patients followed up. Of these patients, 78.57% patients achieved greater than 30% EWL at 6 months after RGB. The average operative duration was 2h 06 min +/-55 min. Median length of stay was 2 days (range 2-21 days). After SG, 50.00% patients that followed up achieved greater than 30% EWL at 6 months. The average operative duration was 1h 52 min +/-46 min. Median length of stay was 3 days (range 2-13 days). This difference in EWL was statistically significant (p = 0.0437). Complications included small bowel obstruction, wound infection, anastomotic leak or stricture, pulmonary embolism or upper gastrointestinal bleed. No intraoperative complications were reported. No postoperative pneumonia was reported. For all patients undergoing RGB, 15.79% patients experienced postoperative complications. Reported complications included SBO, (5.26%), wound infection (3.95%), leak (2.63%), stricture (2.63%), UGIB (1.32%) & PE (1.32%). One death was recorded from postoperative cardiac failure after lysis of adhesions for SBO. Postoperative complications were reported in 7.14% of all patients undergoing SG (3.57% SBO, 3.57% PE). No wound infections, leaks, strictures, PE or UGIB were noted.

Conclusions: Bariatric surgery appears to be safe for use in the super-super obese. The overall complication rate of 7-15.79% was comparable to reported rates of 3.2-16% for patients of all BMIs undergoing laparoscopic gastric bypass.
Super-super obese patients undergoing GBP lost more excess body weight at 6 months, but experienced more postoperative complications compared with those undergoing SG.

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