Super-super obese patients: comparison between sleeve gastrectomy and Roux-en-Y gastric bypass

Raquel G.heredia, MD, PhD, Valeria Valbuena, BS, Crystal Hernandez, BS, Mario Masrur, MD, Kristin Patton, MD, Melissa Murphey DNP. NP-C, Lisa Sanchez-Johnsen PhD., Enrique F Elli, MD. UIC

Introduction: Among the population of obese adults (BMI >30 kg/m2), the super-super obese (BMI >60 kg/m2) present particular challenges for the bariatric surgeon. Surgical management of these patients has been associated with higher morbidity and mortality, unsustainable weight loss goals, and increased surgical risk. Traditionally, two-stage biliopancreatic diversion with duodenal switch has been the procedure of choice for this patient population. However, the benefits and outcomes of single stage sleeve gastrectomy (SG) as well as single stage Roux-en-Y gastric bypass (RYGB) in super-super obese patients have yet to be fully studied.

Materials and Methods: This study is a nonrandomized, controlled, retrospective review of 750 patients who underwent SG or RYGB at the University of Illinois Health and Science System from January 2008 to June 2014. Patients with BMI>60 kg/m2 were selected for our study. Patient demographics, postoperative morbidity and mortality, operating time, length of stay, and excess weight loss (EWL) were reviewed. Statistical analysis was performed comparing aforementioned data related to %EWL at 6, 12, 24, and 36 months follow up in super-super obese patients (BMI>60 kg/m²) for each surgery. Statistical analysis was performed with T-test student and Chi-square test as needed.

Results: Out of 750 patients evaluated, a total of 89 patients (%12) were super-super obese with a mean age at the time of surgery of 39.2 years (standard deviation [SD] ± 10 years). From this group, 77 patients underwent the SG (9 robotic sleeve and 68 laparoscopic sleeve gastrectomy), and 12 underwent RYGB only. The mean preoperative BMI was 64.8 kg/m2 (SD ± 4.0 kg/m2). The mean operative time was 88.4 minutes (SD ± 31.7 minutes) for the SG patients and 219.3 minutes (SD ± 80.2 minutes) for the RYGB patients. There were two complications in the SG group (2.6%) and no complications in the RYGB group, for a total complication rate of 2.2%. The average length of hospital stay was 3.7 days (SD ± 8.4 days) for the SG patients and 3.0 days (SD ± 0.6 days) for the RYGB patients. The mean absolute percent excess weight loss values (SG versus RYGB) were (32% versus 56% P < 0.02) at 6 months, (45% versus 61% P < 0.02) at 12 months, (47% versus 66% P < 0.02) at 24 months, and (41% versus 69% P < 0.04) at 36 months postoperatively. These values were significantly higher in the RYGB group compared to the SG group for each follow up time. There were no statistical differences in postoperative complications or length of stay between the groups.

Conclusions: Sleeve gastrectomy and Roux-en-Y gastric bypass are viable single-stage procedures for the surgical management of super-super obese patients. Single-stage RYGB, however, provides a significantly higher expected weight loss in this patient population compared to single-stage sleeve gastrectomy, which yields acceptable but lower weight loss outcomes.

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