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Outcomes of Bariatric Surgery in Super Super Morbidly Obese Patients

Raelina S Howell, MD, Harika Boinpally, MD, Elizabeth Carruthers, MSN, RN, Keneth Hall, MD, FACS, FASMBS, Jun Levine, MD, Armando Castro, MD, Patrizio Petrone, MD, Collin Em Brathwaite, MD, FACS, FASMBS. NYU Winthrop Hospital

Introduction: Increased body mass index (BMI) is associated with poor bariatric surgical outcomes. The risks of bariatric surgery in the super super morbidly obese (BMI ≥60 mg/kg2) merit further investigation. This study examines short-term outcomes of bariatric surgical procedures in this population.

Methods: Our prospectively-maintained database was retrospectively reviewed for patients with BMI ≥60 mg/kg2 who underwent bariatric surgery at our Center of Excellence over a 13-year period ending June 2018. Demographic data was summarized using descriptive statistics for quantitative variables, and frequencies and percentages for categorical variables. Statistical analyses were made using Chi-Square.

Results: Two hundred fourteen procedures were performed on 207 patients over the 13-year period. Excluded were four aborted procedures, one internal hernia repair, and one lap band removal. Four laparoscopic sleeve gastrectomies (LSG) were aborted due to extensive adhesions (n=3), and respiratory distress prior to incision (n=1). Two hundred eight cases were eligible for inclusion. One hundred thirty-six patients were female (65.4%). Mean age was 43 years (range 17-68), BMI 65.9 mg/kg2 (60-95), and weight 411 pounds (range 265-639). Co-morbidities included obstructive sleep apnea (n=154; 74%), hypertension (n=125; 60%), gastroesophageal reflux disease (n=94; 45%), osteoarthritis (n=91; 44%), and diabetes mellitus (n=65; 31.3%). There were 97 roux-en-y gastric bypasses (46%), 88 LSG (42%) and 23 adjustable gastric bands (11%). These included primary (n=181; 87%), conversion (n=20; 9.6%), and revision (n=7; 3.4%) procedures. Technique was primarily minimally-invasive (75% laparoscopic, 24% robotic, and 1% open). Complications were graded according to the Clavien-Dindo classification system: 1 grade I, 1 grade II, 3 grade IIIa, 3 grade IIIb, and 3 grade IVa. Thirty-day events included: 11 complications (5.3%; including 1 leak [0.5%] and 1 deep vein thrombosis [0.5%]), six readmissions (3%), and four reoperations (1.9%), which involved repair of staple-line leak (n=1), repair of incisional hernias (n=1), uterine dilation and curettage for vaginal bleeding (n=1), and cholecystectomy for biliary colic (n=1). There were no mortalities. Complications occurred in 14.8% of conversion/revision cases and 3.9% in primary cases (p=0.0395) with no difference in complications between laparoscopic (4.5%) and robotic (6.1%) modalities (p=0.7051).

Conclusion: Super super morbidly obese patients may undergo bariatric surgery safely, with no mortalities using minimally-invasive techniques. Revision procedures may increase the risk.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 95354

Program Number: P139

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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