title: Laparoscopic Roux-en-Y gastric bypass for BMI < 35 kg/m(2): a tailored approach.
abstract: BACKGROUND
  Patients with a body mass index (BMI) < 35 kg/m(2) who are obese, have uncontrolled co-morbidities, and have tried to lose weight with no success do not meet the "traditional" criteria for obesity surgery, and no other treatment is being offered to them.
  
  
  METHODS
  A total of 37 obese patients (30 women and 7 men) had been undergoing clinical treatment with no resolution or improvement of their life-threatening co-morbidities. The mean BMI was 32.5 kg/m(2). Their age ranged from 28 to 45 years. All patients had type 2 diabetes mellitus, hypertension, and lipid disorder. Gastroesophageal reflux disease was present in 7 patients and sleep apnea in 3. These patients underwent the same preoperative evaluation as other patients for gastric bypass. The patients were required to have approval from their primary care physician. All patients provided written informed consent. Laparoscopic Roux-en-Y gastric bypass was performed. After extensive explanation and documentation, the Brazilian insurance companies approved the procedure in 3 cases, and international (non-American) insurance companies approved the procedure in 4 cases.
  
  
  RESULTS
  The follow-up range was 6-48 months. The mean excess weight loss was 81%. Thirty-six patients had total remission of their co-morbidities. One patient still had mild hypertension, but with a reduction in the number of antihypertensive drugs used. No surgery-related complications occurred.
  
  
  CONCLUSIONS
  Obese patients with a BMI of <35 kg/m(2) and severe co-morbidities can benefit from laparoscopic Roux-en-Y gastric bypass. This treatment option should be offered to this group of patients.
authors.affiliation: Center for the Surgical Treatment of Morbid Obesity, Hospital São Camilo, São Paulo, Brazil. rvcohen@attglobal.net
authors.forename: Ricardo
authors.initials: R
authors.lastname: Cohen
authors.forename: Jose S
authors.initials: JS
authors.lastname: Pinheiro
authors.forename: Jose L
authors.initials: JL
authors.lastname: Correa
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Schiavon
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D006973:Hypertension / Q000150:complications; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000601:surgery*; D012891:Sleep Apnea Syndromes / Q000150:complications; D016896:Treatment Outcome