title: Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity.
abstract: BACKGROUND
  We evaluated the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) for super morbid obesity in patients with an initial body mass index (BMI) of <50 or > or =50.
  
  
  METHODS
  Between October 2005 and January 2008, we performed LSG in 30 patients. There were 20 males and 10 females with a mean age of 38 years. Mean initial body weight and BMI were 139 kg and 49.1 kg/m(2), respectively. Sleeve gastrectomy was carried out using a linear stapler from the greater curvature of the antrum 5 cm proximal from the pyloric ring up to the angle of His alongside a 45-Fr. bougie.
  
  
  RESULTS
  Laparoscopic procedures were performed successfully in all patients. The mean operation time was 92 min, and blood loss was minimal. The BMI change and weight loss at the 1-, 3-, 6-, 9-, 12-, and 18-month follow-up points of patients with an initial BMI of <50 and > or =50 were 34.2 and 57.4, 32.1 and 53.7, 29.6 and 50.8, 29.5 and 51.2, 27.8 and 52.2, and 29.7 and 45.5 kg/m(2) and 96.8 and 172.2, 89.5 and 157.0, 83.4 and 144.8, 84.0 and 145.4, 78.0 and 153.4, and 84.5 and 119.5 kg, respectively. The patients with a BMI of <50 obtained good outcomes, but weight loss reached a plateau at 9 months after surgery in patients with a BMI of > or =50. Postoperative complications included leakage, bleeding, stricture, and peritonitis in one patient each. There was no surgical mortality. Most of the co-morbidities improved after surgery.
  
  
  CONCLUSIONS
  Sleeve gastrectomy is a feasible and safe treatment for super morbid obesity, but evaluation of long-term outcome is necessary to determine whether it is a durable procedure in terms of effectiveness. We expect that patients with a BMI of <50 are good candidates for LSG as a definitive treatment, and, if those with a BMI of > or =50 hope for further weight loss, a second-step procedure may be required.
authors.affiliation: Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan. tagaya@dokkyomed.ac.jp
authors.forename: Nobumi
authors.initials: N
authors.lastname: Tagaya
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kasama
authors.forename: Rie
authors.initials: R
authors.lastname: Kikkawa
authors.forename: Eiji
authors.initials: E
authors.lastname: Kanahira
authors.forename: Akiko
authors.initials: A
authors.lastname: Umezawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Oshiro
authors.forename: Yuka
authors.initials: Y
authors.lastname: Negishi
authors.forename: Yoshimochi
authors.initials: Y
authors.lastname: Kurokawa
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Nakazato
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kubota
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000473:pathology / Q000601:surgery*; D012720:Severity of Illness Index; D017792:Surgical Stapling; D016896:Treatment Outcome; D015431:Weight Loss