Laparoscopic Weight Loss Surgery in the Super-Super Obese Population: A Retrospective Review

Sharique Nazir, MD, Jakub Bartnik, DO, Veshal Malhotra, Salvatore Docimo Jr, DO, MS, George S Ferzli, MD, FACS

Lutheran Medical Center,Brooklyn,New York

INTRODUCTION:
According to recent literature, the prevalence of obesity in the United States was 32.2% among men and 35.5% among women.1 There has also been a marked increase in the prevalence of super obesity (BMI>50 kg/m2) and super-super obesity (BMI>60 kg/m2). Surgery for the super obese and super-super obese presents challenging technical difficulties complexed with the greater incidence of co-morbidities among these patients.2 Despite the super obese and super-super obese being responsible for an increased risk of postoperative morbidity and mortality,3,4 bariatric surgery remains an effective treatment of morbid obesity.5 Surgical interventions such as gastric banding, roux-en-Y gastric bypass, gastric sleeves and duodenal switches are often warranted among this population to help reduce the incidence of comorbidities. We sought to understand the success rates of these procedures in reducing BMI and co-morbidities such as hypertension, diabetes mellitus, gastric reflux, sleep apnea and hypercholesterolemia among the super-super obese.

METHODS:
The records for all patients who underwent weight loss surgery at Lutheran Medical Center from 2006 to 2012 were reviewed. A total of 58 patients with a BMI > 60 kg/m2 who had undergone laparoscopic weight loss surgery were included in the study. The type of surgery, patient demographics, length of stay, change in weight/BMI, reduction of co-morbidities and the number of intraoperative and postoperative complications were determined.

RESULTS:
Analysis revealed the largest excess weight loss occurred with patients who underwent laparoscopic roux-en-Y gastric bypass surgery with 106lbs lost in 6 months, 156 lbs lost in 12 months and 159lbs lost in 24 months post surgery. Further there was a marked reduction of co-morbidities across all types of surgical intervention post-operatively. A reduction of 44% in hypertension, 100% in DM, 100% in GERD, 74% in obstructive sleep apnea, and a 50% reduction in hypercholesterolemia. No significant intraoperative or postoperative complications were noted.

CONCLUSION:
The super-super obese population can safely be treated laparoscopically with minimal extra considerations and a relatively short length of hospital stay. Roux-en-Y gastric bypass demonstrated to have the greatest reduction in postoperative weight loss. However, each bariatric surgical procedure demonstrated a reduction in co-morbidities among the super-super obese.


Session: Poster Presentation

Program Number: P435

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