Laparoscopic Sleeve Gastrectomy As Stand-alone Procedure vs. Laparoscopic Roux-en-y Gastric Bypass in the Super OR Super Super Obese Patient

Sungsoo Park, MD, Abraham Abdemur, MD, Jianjun Yang, MD, Emanuele LoMenzo, MD, FACS, Samuel Szomstein, MD, FACS, Raul J Rosenthal, MD, FACS. Cleveland Clinic FLorida

BACKGROUND:

Super obesity [body mass index (BMI) >50 kg/m2] and super super obesity (BMI>60 kg/m2) can lead to higher morbidity/mortality after bariatric surgery. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the “gold standard” for Super obesity. Laparoscopic sleeve gastrectomy (LSG) is a relatively new procedure and was initially described as a first-step procedure followed by LRYGB in Super obesity. The efficacy of LSG as a stand-alone procedure for super obesity remains unknown.

METHODS:

We retrospectively reviewed the records of 584 consecutive super or super super obese patients who underwent to either LRYGB (n=487, 67.6% female, 32.4% male) or LSG group (n=97, 48.5% female, 51.5% male) from July,2002 to Aug.2013. The primary objective was to analyze baseline demographics, comorbidities, operative outcomes, and major complications need for reinterventions. Secondarily, weight loss and % excess weight loss (%EWL) was also described and compared during the six months.

RESULTS:

Both groups had comparable mean age, mean weight, BMI, comorbidities except ratio of female vs. male (2.56 for LRYGB vs. 0.94 for LSG, P=0.001).No conversions to open and no death occurred. There is no difference with operative time [105.4±33.6 min (60-225min). for LRYGB vs.105.3±40.5 min(48-220min) for LSG; p=0.583].Weight loss and %EWL at 12 months after surgery were similar in both groups [%EWL, 60.5± 29.1(17-140.6)% for LRYGB vs. 58.4±34.5(17.3-242)% for LSG, P=0.485 ].Remission rate of Hypertension and type II-DM were comparable in both groups(Hypertension 72.7% for LRYGB vs.75.0% LSG, P =0.786; II-DM,78.0% for LRYGB vs.66.7% for LSG, P = 0.371;). Remission rate of GERD in LRYGB group was higher than LSG group (71.5% vs.11.1%, P=0.001).There are more major complications which need reinterventions in LRYGB than in LSG group(26/487 vs. 1/97, P=0.001).

CONCLUSION:

LSG as a standalone procedure is safe and feasible for super or super super obesity with excellent short-term effects and less morbidities. But more studies with a long-term follow-up are needed to validate its benefits.

Keywords: obesity; Bariatric surgery; Laparoscopic sleeve gastrectomy; Laparoscopic Roux-en-Y gastric bypass ;