Super-super obesity : early outcome after laparoscopic sleeve gastrectomy and gastric bypass in observational study

Rapheephat Tanompetsanga, MD, Pondech Vichajarn, MD, Narong Boonyagard, Jakrapan Wittayapairoch, Krit Kitisin, Suppa-ut Pungpapong, AsstProf, Chadin Tharavej, AssocProf, Patpong Navicharern, AssocProf, Suthep Udomsawaengsup, assocProf. King Chulalongkorn Memorial Hospital

Introduction

Morbid obesity is the second most common cause of preventable death in worldwide. Bariatric surgery has been proven the effectiveness in weight reducing  and comorbidity resolution. However performing bariatric surgery in super-super obesity (BMI >60 kg/m2) is very difficult because of huge liver and large volume of visceral fat. There has been no conclusion of best technique for these patient. Therefore this study was designed for evaluation the outcome of bariatric surgery in super-super obesity.

Patient and methods

Observational study comparing data of 68 super-super obesity(BMI>60 kg/m2) submitted to laparoscopic sleeve gastrectomy(LSG,n=50) and laparoscopic Roux en Y gastric bypass(LRYGB,n=18) between 2005 – 2015 at King Chulalongkorn Memorial Hospital. The primary objective was to analyze baseline demographics data, body mass index(BMI),% excess weight(%EWL), comorbidity and post operative complication. Secondarily, BMI and %EWL was analyzed and compared between both operation(LSG vs LRYGB) in first year

Result

There was 46 male and 22 female undergoing to do bariatric surgery. Mean of age was 31+1 years(range 11-53 years) and the most associated co-morbidity in those patients was OSA(82%) and HT(57%). Both group were comparable of BMI (70.31+8.0 kg/m2 in LSG and 69.46+6.5 kg/m2 in LRYGB;p=0.685).There were 2 cases of major complications( post operative bleeding in 1 patient and another one was post operative leakage) that have to urgent reintervention. No mortality in this study. %EWL in duration of 1,3,6,9,12 months was not difference between LSG and LRYGB ;15.7+5.61 vs 18.5+9.83 kg/m2(p=0.189) at 1 month,25.6+7.2 vs 26.56+11 kg/m2(p=0.712) at 3 months, 34.94+9.1 vs 39.3+12.76 kg/m2 (p=0.185) at 6month, 42.19+10.56 vs 43.45+8.19 kg/m2(p=0.733) at 9 months and 46.1+12.6 vs 52.41+16.06 kg/m2(p=0.192) at 12 months

Conclusion

Both LSG and LRYGB was safe and effectiveness to achieve %EWL in patient with super-super obesity when comparing in first year . LSG is more simple and comfortable than LRYGB for bariatric surgeons to do operation in patient with difficult situation of these heavy weigh patient such as huge liver and large volume of visceral fat. However long term follow up data of %EWL and resolution of comorbidity in both operation has been needed.