title: Laparoscopic bariatric surgery for those with body mass index of 70-125 kg/m2.
abstract: BACKGROUND
  Data on laparoscopic bariatric surgery in the extremely obese are limited. Technical difficulties, in addition to the patients' severe weight-related co-morbidities, can compromise the safety of bariatric surgery in these patients. Our objectives were to assess the safety and feasibility of laparoscopic bariatric surgery in extremely obese patients and to compare the outcomes of different surgical approaches at a bariatric surgery center of excellence in an academic medical center.
  
  
  METHODS
  We reviewed our prospectively collected database and identified all patients with a body mass index (BMI) of ≥ 70 kg/m(2) who had undergone bariatric surgery. The data on patient demographics, baseline characteristics, and outcomes of bariatric surgery were retrieved.
  
  
  RESULTS
  A total of 49 patients with a mean BMI of 80.7 kg/m(2) (range 70-125) underwent 61 bariatric procedures. Of the 49 patients, 26 underwent sleeve gastrectomy, 11 gastric bypass, and 12 underwent a 2-stage procedure (sleeve gastrectomy followed by gastric bypass). At a mean follow-up of 17.4 months, the average BMI had decreased to 60.9 kg/m(2) (36% excess weight loss). Overall, the patients who underwent a 2-stage procedure achieved greater percentage of excess weight loss (54.5%) than did those who underwent either single-stage sleeve gastrectomy or gastric bypass (25.4%, P = .002 and 43.8%, P = .519, respectively). Of the 61 cases, 60 (98.4%) were completed laparoscopically. The early complication rate was 16.4% overall; most were minor complications. The late complication rate was 14.8%. A single late mortality occurred in this series.
  
  
  CONCLUSIONS
  Laparoscopic bariatric surgery can be performed safely on patients with a BMI of ≥ 70 kg/m(2). A staged approach might offer better weight loss results.
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. eldars@ccf.org
authors.forename: Shai Meron
authors.initials: SM
authors.lastname: Eldar
authors.forename: Helen M
authors.initials: HM
authors.lastname: Heneghan
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
authors.forename: Haris A
authors.initials: HA
authors.lastname: Khwaja
authors.forename: Manish
authors.initials: M
authors.lastname: Singh
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rogula
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods*; D015992:Body Mass Index; D061887:Conversion to Open Surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult