[Gastric bypass in the surgical treatment of the morbid obesity and super obesity: comparative study].
BACKGROUND
Gastric Bypass (GB) constitutes the surgical treatment of election of morbid obesity (BMI < 50) at the present time, however doubts exist about its effectiveness in super obesity patients (BMI > 50).


OBJECTIVE
The purpose of this work is one of to analyze the results of loss of weight of the first 52 open GB of our series, and to compare the losses of weight in morbid obesity (MO) and super obesity (SO), to determine if the superobese patient looses enough weight with this technique or if it would be more indicated another technique more malabsorptive, like some authors recommend.


METHODS
Retrospective study of the first 52 patients operated of open GB pathway. The weight loss of 32 patients' with MO are compared with the weight loss of 20 patients with super obesity after five year follow-up. The parameters analyzed are: age, sex, height, initial weight, current weight, initial BMI, current BMI, % BMI lost, % overweight lost, incidence of incisional hernia, acceptable oral tolerance and metabolic alterations. The malabsorptive procedure associated in patients with super obesity was a 200 cm Roux-en-Y and a patients with BMI between 40 and 50 was a 150 cm Roux-en-Y. The results are compared by means of the X2 and Mann Whitney statistical test.


RESULTS
The age, the sex and the stature are homogeneous in the two groups. In the group of MO the initial weight was of 121.5 kg; initial BMI, 45; current BMI; 28.9, the median loss of weight in 5 years was of 48 kg; the percentage loss of the excess of BMI is of 80% and the percentage loss of the excess of weight is of 74.6%. In the group of SO the initial weight was of 142.,7 kg; initial BMI, 54.9; current BMI, 34.,9; the median loss of weight in 5 years was of 54 kg; the percentage loss of the excess of BMI was of 65,3% and the percentage loss of the excess of weight was of 63.2%. The analysis of the results ponders shows that it exists statistically significant differences (P < 0.05) among the two groups, however the rate of success, according to the classic parameter of loss of more than 50% of the excess of weight, was superior to 90% in both groups. The results of the study about the presence of incisional postoperative hernia, alimentary tolerance and metabolic alterations, indicate that it doesn't exist differences statistically significant between both groups.


CONCLUSIONS
GB is an effective surgical technique in patients with morbid obesity and with super obesity, provided that in these patients is realized a procedure more malabsorptive. There are not differences between both groups, in morbidity, improvement in the associate disease, alimentary tolerance and necessity of nutritional supplements.
Carvajal-Balaguera
J
J
Servicio de Cirugía General y Digestiva, Hospital Central de la Cruz Roja San José y Santa Adela de Madrid, España. josuecarvajal@yahoo.es
García-Almenta
M Martín
MM
Oliart Delgado de Torres
S
S
Camuñias-Segovia
J
J
Peña-Gamarra
L
L
Fernández
I P
IP
Gómez-Maestro
P
P
Prieto Sánchez
A
A
Viso-Ciudad
S
S
Cerquella-Hernández
C Ma
CM
D000328:Adult; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D015431:Weight Loss