title: Is Roux-en-Y gastric bypass adequate in the super-obese?
abstract: BACKGROUND
  The outcome after Roux-en-Y gastric bypass (RYGBP) in morbidly obese (MO) (body mass index [BMI] 40-50) was compared with super-obese (SO) (BMI >50) and super-super-obese (SSO) (BMI >60) patients.
  
  
  METHODS
  A prospective study was conducted in 738 consecutive patients who underwent RYGBP. 483 MO were compared with 184 SO and 70 SSO. Study endpoints included: effect on co-morbid conditions, postoperative morbidity and mortality, and long-term results. Statistical analysis utilized SPSS 11.0.
  
  
  RESULTS
  Percentage of males was significantly greater in the SO groups (16.5% vs 13%, P=0.01). Obesity-related conditions were significantly more frequent in the SO groups: sleep apnea (38% vs 17%, P<0.0005), gallstones (23% vs 14%, P=0.013); diabetes (29% vs 17%, P=0.002). Hospital stay was longer in the SO groups (5.7+/-6.1 days vs 4.6+/-2.6 days, P=0.024). Wound infection was more frequent in the SO groups (4.7% vs 1.4%, P=0.019). Postoperative mortality was greater in the SSO and SO groups (1.6% and 1.4%) than MO (0%) (P=0.019). Incisional hernia was more frequent in the SO groups (14.1% vs 8.6%; P=0.041). There was no significant difference in percent of excess weight loss (%EWL) between the three groups. EWL >50% at 5 years was: MO 81.5%, SO 87.5%, SSO 80%. The surgery was effective in treating the co-morbid conditions.
  
  
  CONCLUSIONS
  RYGBP achieved significant durable weight loss and effectively treated co-morbid conditions in SO and SSO patients with acceptable postoperative morbidity and slightly greater mortality than in MO patients.
authors.affiliation: Department of Bariatric Surgery, Hospital Universitario Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. rsanchez@csub.scs.es
authors.forename: Raquel
authors.initials: R
authors.lastname: Sánchez-Santos
authors.forename: Nuria
authors.initials: N
authors.lastname: Vilarrasa
authors.forename: Jorge
authors.initials: J
authors.lastname: Pujol
authors.forename: Pablo
authors.initials: P
authors.lastname: Moreno
authors.forename: Jose
authors.initials: J
authors.lastname: Manuel Francos
authors.forename: Antonio
authors.initials: A
authors.lastname: Rafecas
authors.forename: Carlos
authors.initials: C
authors.lastname: Masdevall
mesh_terms: D015992:Body Mass Index; D001835:Body Weight; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D042882:Gallstones / Q000453:epidemiology; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012891:Sleep Apnea Syndromes / Q000453:epidemiology; D016896:Treatment Outcome; D015431:Weight Loss