Original articleOutcomes of Roux-en-Y gastric bypass in the super obese: comparison of body mass index 50–60 kg/m2 and≥60 kg/m2 with the morbidly obese☆
Section snippets
Methods
After institutional review board approval and according to the Health Insurance Portability and Accountability Act guidelines, we performed a retrospective chart review of a prospectively maintained database of 2717 patients who underwent RYGB between January 1, 2004 and November 30, 2013. Most cases were done laparoscopically, except in 87 cases in 2004 done as open and 48 cases in 2013 done as robot-assisted laparoscopic. A total of 1555 patients were identified as having a BMI 40–50 kg/m2,
Results
Of 1555 morbidly obese patients with a BMI 40–50 kg/m2, 1294 were female and 261 were male. Patients had a mean age of 42.3±11.0 years (range, 18–70), and a mean preoperative BMI of 44.6±7.7 kg/m2 (range, 40.0–49.9).
Of 891 super-obese patients, 661 (74.2%) had a preoperative BMI between 50–60 kg/m2 and 230 (25.8%) had a BMI≥60 kg/m2. The BMI 50–60 kg/m2 group consisted 522 female and 139 male patients with a mean age of 42.1±10.8 years (range, 17–66) and a mean preoperative BMI of 54.1±2.7 kg/m2
Discussion
Prevalence of obesity in the United States has increased dramatically during the period of 1976 through 2000 [1]. Smaller changes were noted between 1999 and 2010, and overall, the percentage of obese population was 35% in U.S. adults during the 2009–2010 period. However, there is change in the distribution of the BMI. Flegal et al. [18] reported increased skewness with a greater shift in the upper part of the distribution, and so the heaviest subgroup was heavier than prior studies in 2000.
Conclusion
The readmission and reoperation rates were similar in the BMI 40–50, 50–60, and≥60 kg/m2 groups. Super-obese and super-super-obese patients are not at greater risk for surgical complications compared with those with lower BMIs.
Disclosures
Muhammad Jawad, Andre F. Teixeira, and Rena C. Moon received an honorarium as a consultant for Ethicon Endosurgery. The other authors have no commercial associations that might be a conflict of interest in relation to this article. Andre F. Teixeira received an honorarium as a consultant for Intuitive Surgical. None of these might be a conflict of interest in relation to this article.
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Cited by (19)
Conversion of gastric sleeve to Roux-en-Y gastric bypass: overall outcomes and predictors of below-average weight loss
2023, Surgery for Obesity and Related DiseasesCitation Excerpt :A BMI >40 kg/m2 at the time of conversion surgery was also found to be associated with below-average %EWL at 1 year. This does not come as a surprise as previous studies on primary RYGB outcomes have found that higher BMI patients will experience relatively lower weight loss [33,34]. Numerous factors could explain this finding.
Outcomes of bariatric surgery in extreme obesity: results from the United Kingdom National Bariatric Surgery Registry for patients with a body mass index >70 kg/m<sup>2</sup>
2021, Surgery for Obesity and Related DiseasesCitation Excerpt :We found that BMS has an acceptable perioperative profile and very good medium-term clinical outcomes. Regarding the safety of primary BMS in patients with extreme obesity, our findings of low complication and reoperation rates are corroborated by studies of patients with super obesity (BMI ≥50 kg/m2) or super-super obesity (BMI ≥60 kg/m2) [6,8]. It is worth noting that 3 reported postoperative deaths constituted 1% mortality rate in this cohort of patients, which is higher than the .1% currently recorded in NBSR for all BMS in the UK [10,16].
Perioperative outcomes of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in super-obese and super-super-obese patients: a national database analysis
2019, Surgery for Obesity and Related DiseasesCitation Excerpt :After adjustment, only LSG was associated with a modest increase in readmission. Others also found that LRYGB was not associated with increased readmission after adjustment for covariates [13,14]. The readmission rate for SO and SSO undergoing LRYGB in our study (5.63%–6.91%) was lower than that of previous studies (9.2%–11.7%) [13,14].
Comment on: Two-stage approach is still the gold standard for super-super obese patients (SSO) undergoing bariatric surgery
2019, Surgery for Obesity and Related DiseasesOutcomes of Roux-en-Y gastric bypass versus sleeve gastrectomy in super-super-obese patients (BMI ≥60 kg/m <sup>2</sup> ): 6-year follow-up at a single university
2019, Surgery for Obesity and Related Diseases
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The abstract of this manuscript was accepted for poster presentation at the 2015 ASMBS annual meeting in Los Angeles, CA.