title: Operative experience and follow-up in a cohort of patients with a BMI > or =70 kg/m2.
abstract: BACKGROUND
  Roux-en-Y gastric bypass (RYGBP) has been found to be a safe and effective operation for the morbidly obese whether performed open or laparoscopically. Weight loss has been substantial and sustained. Less is known about those at the extremes of obesity, with BMI > or =70 kg/m2 with regard to safety and efficacy. This study is a retrospective review of a cohort of such patients, to examine operative experience and response to surgical treatment.
  
  
  METHODS
  A cohort of 34 patients who underwent open RYGBP at one institution was retrospectively reviewed. All operations were performed by a single surgeon. Operative outcome was examined, including early mortality, morbidity, need for intensive (ICU) care and hospital length of stay (LOS). Percent of excess weight lost (EWL) and percent reduction of BMI after at least 1 year of follow-up were determined. Late mortality was assessed.
  
  
  RESULTS
  There were 22 females and 12 males with mean age 42.0 + 8.1 years and mean BMI 78.3 + 8.5 kg/m2. Obstructive sleep apnea (OSA) was found in 19/34 (58%) and hypoventilation syndrome of obesity (HSO) in 11/34 (32%). There was 1 early death (3 months) from renal failure. 7 patients (21%) developed complications, 3 major (pulmonary embolus, wound dehiscence) and 4 minor (wound infection). 16 patients (47%) required ICU, and 12 (35%) required extended mechanical ventilation. Hospital LOS was 10.3 +/- 10.4 days for all patients. There were 4 late deaths (12%) from 7 to 36 months after RYGBP. Mean percent EWL was 61 +/- 17 and mean percent reduction in BMI was 44 +/- 11. For those followed at least 36 months, weight loss was sustained in 12/14 patients.
  
  
  CONCLUSIONS
  RYGBP can be performed safely, even at the extremes of weight. While technically challenging, there were no instances of intra-abdominal sepsis. Postoperative complications were few. Need for ICU and hospital LOS is greater, reflecting the incidence of pre-existing pulmonary problems. Weight loss is significant and appears to be sustained in most patients. Late deaths have been noted and deserve careful scrutiny.
authors.affiliation: Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA. thelling@carondelet.com
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Helling
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D015431:Weight Loss