A prospective evaluation of a variant of biliopancreatic diversion with Roux-en-Y reconstruction in mega-obese patients (BMI > or = 70 kg/m(2)).
BACKGROUND
Super-obese patients with BMI > or = 70 kg/m(2) present a special subgroup among the obese population due to the higher incidence of severe comorbidities and increased technical difficulties in perioperative management. The optimal surgical approach still remains controversial.


METHODS
From January 2002 to October 2007, 68 super-obese patients with BMI > or = 70 kg/m(2) (75.7 +/- 5.61) and various comorbidities (mean 1.45 +/- 1, range 0-5), underwent a variant of biliopancreatic diversion with Roux-en-Y reconstruction (BPD-RYGBP) at our institution. The mean age was 39.6 +/- 9.5 years, and the excess weight was 146.1 +/- 24.5 kg. The safety and the effectiveness of the procedure were prospectively evaluated.


RESULTS
Thirty-one patients have completed their second postoperative year. Mean BMI after 2 years follow-up was 35 +/- 5.33 kg/m(2) (p < 0.001) and mean %EWL was 79.9% (range 57.17-149.89). Significant improvement in preexisting comorbidities was also observed (mean 0.95 +/- 0.1, range 0-2; p < 0.001). Early major postoperative complications included one case of acute renal failure (1.47%), three anastomotic leaks (4.41%), four pulmonary embolisms (5.88%), one hemorrhage requiring reoperation (1.47%), and three cases of pneumonia (4.41%), resulting in a total morbidity rate of 8.82% and a mortality rate of 8.82%. Late complications included small bowel obstruction in four patients (5.88%), pulmonary embolism in one patient (1.47%), severe hypoalbuminemia requiring artificial nutrition support in six patients (8.82%), and incisional hernia in 23 patients (33.8%). Late morbidity was 41.1%, and there was no late mortality.


CONCLUSIONS
BPD-RYGBP appears to be an effective procedure in patients with BMI > or = 70 kg/m(2) providing adequate weight loss and improvement of co-existing comorbidies after 2 years. Nevertheless, it is associated with higher morbidity and mortality rates compared to patients with BMI < 70 kg/m(2) undergoing the same surgical procedure.
Spyropoulos
Charalambos
C
Department of Surgery, School of Medicine, University of Patras, Platia Voriou Ipirou 5, Patras, 264, Greece.
Bakellas
George
G
Skroubis
George
G
Kehagias
Ioannis
I
Mead
Nancy
N
Vagenas
Konstantinos
K
Kalfarentzos
Fotis
F
D000328:Adult; D015904:Biliopancreatic Diversion / Q000009:adverse effects / Q000379:methods*; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss