title: Laparoscopic sleeve gastrectomy is superior to endoscopic intragastric balloon as a first stage procedure for super-obese patients (BMI > or =50).
abstract: BACKGROUND
  The treatment of patients with a BMI > or =50 kg/m2 is still controversial. Given the many co-morbidities and oftentimes fragile health of super-obese patients, surgeons experienced in bariatrics often advocate a less invasive first stage operation for these patients. This allows them enough weight loss to support a more major second-stage operation such as a gastric bypass or a biliopancreatic diversion/duodenal switch. Thus, the aim of this study was to compare laparoscopic sleeve gastrectomy (LSG) and the BioEnterics intragastric balloon (BIB) as a first-stage procedure for effective initial weight loss before more definitive surgery.
  
  
  METHODS
  20 patients (13 males and 7 females) who underwent LSG from May 2001 to December 2002 were compared with 57 patients (33 males and 24 females) obtained as historical controls from two large series who underwent BIB. Patients were evaluated at 6 months in terms of: weight, BMI, percent of excess weight loss (%EWL) and change in BMI.
  
  
  RESULTS
  There were no differences between groups for age, weight and BMI. There were no complications for patients under-going the LSG. For patients undergoing BIB, 4 patients (7%) had the balloon removed due to intolerance. The mean weight loss for patients undergoing LSG and BIB at 6 months was 45.5 vs 22.3 kg respectively, and the %EWL was 35 for LSG vs 24 for BIB. BMI decreased respectively from 69 to 53 for the LSG group and from 59 to 51 for the BIB group. Weight loss decreased co-morbidities in 90% of patients after both procedures.
  
  
  CONCLUSIONS
  Patients undergoing a LSG showed a faster and greater weight loss than those using a BIB at 6 months. Moreover, LSG is a safe procedure, with reproducible results, in contrast to the BIB which was tolerated by 93% of patients. The results indicate that both mean weight loss and %EWL were better in the LSG group, and that BMI decreased substantially more in the LSG group as well. Although the BIB procedure shows efficacy in reducing weight, the LSG group does so faster and to a greater amount, thus suggesting that this may be a superior procedure as a first stage for super-obesity.
authors.affiliation: Department of Surgery, New York Presbyterian Hospital, Weill College of Medicine of Cornell University, New York, NY 10021, USA.
authors.forename: Luca
authors.initials: L
authors.lastname: Milone
authors.forename: Vivian
authors.initials: V
authors.lastname: Strong
authors.forename: Michel
authors.initials: M
authors.lastname: Gagner
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015905:Gastric Balloon; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D015431:Weight Loss