title: Primary laparoscopic gastric bypass can be performed safely in patients with BMI >or= 60.
abstract: BACKGROUND
  Several studies suggest patients with a body mass index (BMI; calculated as kg/m(2)) >or= 60 have a greater operative risk and so advocate a staged approach to bariatric procedures. This requires two separate operations and all associated risks. At our institution, we do not perform staged bariatric operations for these patients; we execute a single-stage laparoscopic Roux-en-Y gastric bypass (LGBP). Here, we analyze our experience in this population with a single-stage LGBP.
  
  
  METHODS
  Ninety-five patients with a BMI >or= 60 were compared with 1,311 patients with BMI < 60 undergoing LGBP from December 2001 to May 2007. Data recorded included age, BMI, estimated blood loss, operating time, length of stay, and complications within the first 30 days after operation. Analyses of the data were performed using unpaired Student's t-test, with p < 0.05 as significant.
  
  
  RESULTS
  There were no statistically significant differences in age (42.6 versus 42.8 years), estimated blood loss (68.5 versus 69.5 mL), length of stay (3.1 versus 3.1 days), overall complications (12.7% versus 13.7%), or 30-day mortality (0.2% versus 0%) for patients with BMI < 60 as compared with patients with BMI >or= 60. The difference in operating time between the 2 groups was statistically significant (111 versus 118.7 minutes; p = 0.02) but likely reflected the learning curve.
  
  
  CONCLUSIONS
  In our experience, there were no differences in the incidence of complications or mortality for patients with a BMI >or= 60 undergoing LGBP as compared with those with a BMI < 60. These high-risk patients can safely undergo a single-stage LGBP.
authors.affiliation: Department of Surgery, Center for Minimally Invasive Obesity Surgery, Tufts Medical Center, Boston, MA, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Abeles
authors.forename: Julie J
authors.initials: JJ
authors.lastname: Kim
authors.forename: Michael E
authors.initials: ME
authors.lastname: Tarnoff
authors.forename: Sajani
authors.initials: S
authors.lastname: Shah
authors.forename: Scott A
authors.initials: SA
authors.lastname: Shikora
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000473:pathology / Q000601:surgery*