title: Sleeve gastrectomy as a bridge to a second bariatric procedure in superobese patients--a single institution experience.
abstract: BACKGROUND
  The surgical treatment of superobese patients (body mass index ≥50 kg/m(2)) with significant co-morbidities remains a challenge. We evaluated our outcomes after initial laparoscopic sleeve gastrectomy (LSG) in the superobese undergoing staged procedures in the setting of a university hospital in the United Kingdom.
  
  
  METHODS
  The data from patients with a body mass index of ≥50 kg/m(2) undergoing LSG as a part of a staged procedure from 2005 to 2008 were extracted from our database. The patient parameters were analyzed, along with the morbidity, length of stay, and weight loss after the initial procedure.
  
  
  RESULTS
  A total of 61 patients with a body mass index of ≥50 kg/m(2) (median 60, range 50-81.5) underwent LSG as a part of a staged procedure during the study period. The median age was 46 years (range 24-61.5), and 41 were women. Obesity-related co-morbidities were present in different combinations in 51 patients (83.6%). All the procedures were completed laparoscopically, barring 1. The median hospital stay was 4 days (interquartile range 3-4). Complications occurred in 6 patients (9.8%), and 3 required repeat laparoscopy for complications. No patient died. The median percentage of excess weight loss was 31% at 6 months (interquartile range 26-40) and 39% at 1 year (interquartile range 34-51). Diabetes, obstructive sleep apnea and hypertension had resolved in 90%, 100%, and 61% of the patients, respectively. Of the 61 patients, 41 went on to undergo a second-stage procedure, of whom 1 underwent laparoscopic Roux-en-Y gastric bypass, 5 underwent repeat LSG, and the rest underwent laparoscopic duodenal switch.
  
  
  CONCLUSIONS
  LSG is safe and effective for initial weight loss in the superobese undergoing 2-stage procedures.
authors.affiliation: Homerton University Hospital, Homerton Row, London, United Kingdom. docsamrat@yahoo.com
authors.forename: Samrat
authors.initials: S
authors.lastname: Mukherjee
authors.forename: Kalpana
authors.initials: K
authors.lastname: Devalia
authors.forename: Mehtab G
authors.initials: MG
authors.lastname: Rahman
authors.forename: Kesava R
authors.initials: KR
authors.lastname: Mannur
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D015431:Weight Loss / Q000502:physiology; D055815:Young Adult