title: LapBand System in super-superobese patients (>60 kg/m(2)): 4-year results.
abstract: BACKGROUND
  Bariatric surgery in superobese (BMI > 50 kg/m(2)) and super-superobese (BMI > 60 kg/m(2)) patients can be a formidable technical and therapeutic challenge because these patients often present multiple medical, surgical, and anesthetic risks. Only a few dedicated reports on different surgical options in this kind of patient population are available. The aim of this study is the evaluation of laparoscopic adjustable gastric banding (LAGB) results in an unselected populations of super-superobese patients operated during the last 4 years.
  
  
  METHODS
  Super-superobese (BMI > 60 kg/m(2)) patients who underwent LAGB were recruited from the prospective database of our institution. LapBand System (Allergan, Irvine, CA, USA) was positioned in all cases via pars flaccida, 1-2 cm below the gastroesophageal junction and fixed anteriorly with three non-absorbable stitches. The band was not filled at the time of surgery. Operative time, co-morbidities, laparotomic conversion, intra- and postoperative complications, mortality, and weight-loss-related parameters were considered. Data were expressed as mean +/- standard deviation, except as otherwise indicated.
  
  
  RESULTS
  From January 2003 to December 2006, 823 patients underwent a bariatric surgical procedure, 95 of whom (11.5%) were BMI > 60 kg/m(2) (59 F/ 36 M; mean BMI, 62.5 +/- 4.2; range, 60.1-77 kg/m(2); mean age 38.5 +/- 13.5, range 18-61 years old). Mortality, intraoperative, and 30-day major complications were absent. One or more preoperative co-morbidities were diagnosed in 90 of 95 (94.7%) patients. After 1 year, co-morbidity-free patients increased from five of 95 (5.3%) to 27 of 95 (28%; p < 0.001). Patients with three or more co-morbidities decreased from 62 of 95 (65.3%) to 0 (p < 0.001). Mean BMI was 43.6 in 95 of 95, 37.9 in 55 of 55, 29.1 in 11 of 11, and 28.9 in five of five patients at 12, 24, 36, and 48 months, respectively. At the same time, %EWL was 53.6, 69.7, 81.3, and 82.1 and %EBL was 50, 66, 90, and 91.
  
  
  CONCLUSIONS
  LAGB can be considered an appropriate bariatric surgical option in super-superobese patients both for low morbidity rate and weight loss. The end-point of BMI < 30 can be achieved with a multidisciplinary follow-up. Additional studies with more patients and longer follow-up are needed to confirm these observations.
authors.affiliation: Ninetta Rosano Institute, Casa di Cura Tricarico, Via Capo Tirone n.12.20, 87021 Belvedere Marittimo (CS), Italy. fioretorchia@virgilio.it
authors.forename: Fiore
authors.initials: F
authors.lastname: Torchia
authors.forename: Vincenza
authors.initials: V
authors.lastname: Mancuso
authors.forename: Simona
authors.initials: S
authors.lastname: Civitelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Maro
authors.forename: Pasquale
authors.initials: P
authors.lastname: Cariello
authors.forename: Pasquale Tricarico
authors.initials: PT
authors.lastname: Rosano
authors.forename: Giuseppe Ciriaco
authors.initials: GC
authors.lastname: Sionne
authors.forename: Michele
authors.initials: M
authors.lastname: Lorenzo
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Cascardo
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000295:instrumentation*; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult