Bariatric Surgery in the Super-Super Obese: Outcomes of Weight Loss and Effects on Medical Co-morbidities

Maureen V Hill, MD¹, Ian C Bostock, MD, MS¹, Sarah E Billmeier, MD, MPH¹, Escar Kusema², Maureen Quigley, APRN¹, Gina L Adrales, MD, MPH, FACS¹. ¹Dartmouth Hitchcock Medical Center, ²Dartmouth Geisel School of Medicine

Introduction: Laparoscopic roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (LSG) have both been shown to be safe and effective in achieving excess weight loss (EWL) in the super-super obese (SSO) (BMI>60). Our purpose was to examine the efficacy in terms of medical co-morbidity resolution in addition to weight loss.

Methods and Procedures: A retrospective review was performed of all bariatric surgical patients with a BMI >60 treated at our institution between June 2009 and January 2015.  The primary end point was %EWL at each follow up interval (1, 4, 8, 12 months and 2 years). Secondary endpoints were resolution of medical comorbidities (diabetes, hypertension, obstructive sleep apnea (OSA), CPAP use, and GERD). Resolution of diabetes and hypertension was defined by cessation of all associated medications with continued normal fasting blood glucose levels and blood pressure, respectively. GERD resolution was defined as lack of symptoms off medication, and OSA resolution was defined as titration and cessation of CPAP use (if applicable) with no continued symptoms. The statistical analysis was performed using student T test, and a p value <0.05 was considered statistically significant with a confidence interval of 95%. For categorical variables, an analysis to determine frequencies, proportions, and Chi2 was also performed.

Results: Fifty nine SSO patients were identified for which we had follow up information on 55.  Forty seven underwent RYGB and 12 underwent LSG. Mean BMI was 68.15 (±6.96 SD). The average %EWL at each follow up interval for patients undergoing RYGB or LSG at 1, 4, 8 12 months and 2 years respectively were 21.1%, 29.2%, 45.0%, 46.9% and 50.9%. There was a significant decrease in the incidence of hypertension (69.5% vs. 40.7%, p<0.05), OSA (88.1% vs. 62.7%, p<0.05), and CPAP use (84.7% vs. 54.2%, p<0.05) on follow up. There was a trend towards resolution of diabetes (52.5% vs. 22%, p=0.06).

Conclusion: Bariatric surgery is effective in achieving both weight loss and in improving medical comorbidities in the super-super obese. This may have implications in reducing healthcare resource utilization by this challenging patient population.