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


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.


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.


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).


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 ;

Table 1. Demographics LRYGB and LSG group
LRYGB group(n=487)LSG group(n=97)P value
mean age44.7±12.1 (20-71)years42.1±11.5 (22-65) yearsP = 0.365
mean weight358.9±74.7 (210-875)Lb346.2±62.8 (210-453)LbP= 0.512

58.0±13.9 (50-112)kg/m2

57.4±4.9 (50-74)kg/m2P = 0.468

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