title: Is BMI greater than 60 kg/m(2) a predictor of higher morbidity after laparoscopic Roux-en-Y gastric bypass?
abstract: BACKGROUND
  It has been hypothesized that patients who are super-super morbidly obese, defined as having a body mass index (BMI) of 60 kg/m(2) or higher, have an increased rate of postoperative complications. As surgical techniques and operator experience with Roux-en-Y gastric bypass improved with time, the selection criteria have expanded to include the super-super morbidly obese. We hypothesize that a higher BMI does not predict a higher postoperative complication rate.
  
  
  METHODS
  The prospectively collected database for our Accredited Bariatric Program was queried for all laparoscopic Roux-en-Y gastric bypass procedures performed between January 2004 and July 2006. All cases were performed by a single surgeon at a tertiary-care center. Average postoperative follow-up time was 1 year. Patients were stratified into two groups: BMI < 60 kg/m(2) and BMI >or= 60 kg/m(2). The number of postoperative complications was compared between the two groups using a chi-square method with Yates correction.
  
  
  RESULTS
  One hundred and sixty-nine patients with adequate follow-up data were identified during the study period. Of these, 148 patients had BMI < 60 kg/m(2) (group 1) and 21 had BMI >or= 60 kg/m(2) (group 2). There were 28 (19%) total complications in group 1, and 4 (19%) total complications in group 2. There was no statistical difference between the two groups (p = 0.98). Stricture rate was 10% in group 1 and 5% in group 2.
  
  
  CONCLUSIONS
  Patients with BMI >or= 60 kg/m(2) do not have a higher postoperative morbidity compared with other patients undergoing laparoscopic Roux-en-Y gastric bypass. The stricture rate is less in patients with BMI >or= 60 kg/m(2) compared with other patients. Longer follow-up is required to detect complications that occur after 1 year. Our study shows that laparoscopic Roux-en-Y gastric bypass can be safely performed on the super-supermorbidly obese.
authors.affiliation: Department of General Surgery, Albany Medical Center, Albany, NY 12208, USA. KushniL@mail.amc.edu
authors.forename: L
authors.initials: L
authors.lastname: Kushnir
authors.forename: W J
authors.initials: WJ
authors.lastname: Dunnican
authors.forename: B
authors.initials: B
authors.lastname: Benedetto
authors.forename: W
authors.initials: W
authors.lastname: Wang
authors.forename: C
authors.initials: C
authors.lastname: Dolce
authors.forename: S
authors.initials: S
authors.lastname: Lopez
authors.forename: T P
authors.initials: TP
authors.lastname: Singh
mesh_terms: D000328:Adult; D015992:Body Mass Index; D019992:Databases as Topic; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology