title: Preoperative weight loss with intragastric balloon decreases the risk of significant adverse outcomes of laparoscopic gastric bypass in super-super obese patients.
abstract: BACKGROUND
  Extreme obesity increases morbi-mortality in bariatric surgery. We previously showed that significant weight loss can be obtained within 3 months in super-super obese patients (BMI > 60 kg/m(2)) with an intragastric balloon (IGB). Here, we explored the potential benefit of preoperative IGB on the outcome of laparoscopic gastric bypass (LGBP) in super-super obese patients.
  
  
  METHODS
  In this case-control study, we compared the records of 60 consecutive super-super obese patients (66.5 ± 3.4 kg/m(2)) submitted to a LGBP between 2004 and 2009, with preoperative IGB (n = 23, cases) or without (n = 37, controls). We analyzed the clinical outcome of surgery and a composite end point of significant adverse events defined as the presence of at least one of the following conditions: conversion to laparotomy, intensive care unit stay for more than 2 days, and overall hospital stay superior to 2 weeks.
  
  
  RESULTS
  All baseline clinical and biological characteristics were homogenous between both groups. IGB was maintained during 155 ± 62 days and induced a loss of 5.5 ± 1.3 kg/m(2) (11.2 ± 3.2% of excess body mass index) at the time of LGBP, associated with a decrease in systolic blood pressure and gamma-glutamyl transpeptidase level (p < 0.05 vs. baseline). Operative time was lower in the IGB group (146 ± 47 vs. 201 ± 81 min in controls; p < 0.01). Significant adverse events occurred less frequently after LGBP in the IGB group (2 vs. 13 in controls; p < 0.05). All patients were alive at 1 year and overall weight loss was similar in both groups (52.4 ± 17.3 vs. 50.3 ± 12.7 percent of excess BMI loss in controls; NS).
  
  
  CONCLUSIONS
  IGB prior to LGBP in super-super obese patients significantly reduced excess BMI. It was associated with a shorter operative time and a lower overall risk of significant adverse outcomes.
authors.affiliation: Department of Digestive and Endocrine Surgery, Lille University Hospital, Lille, France.
authors.forename: Carlos
authors.initials: C
authors.lastname: Zerrweck
authors.forename: Vincent
authors.initials: V
authors.lastname: Maunoury
authors.forename: Robert
authors.initials: R
authors.lastname: Caiazzo
authors.forename: Julien
authors.initials: J
authors.lastname: Branche
authors.forename: Guélareh
authors.initials: G
authors.lastname: Dezfoulian
authors.forename: Philippe
authors.initials: P
authors.lastname: Bulois
authors.forename: Helene
authors.initials: H
authors.lastname: Verkindt
authors.forename: Marie
authors.initials: M
authors.lastname: Pigeyre
authors.forename: Laurent
authors.initials: L
authors.lastname: Arnalsteen
authors.forename: François
authors.initials: F
authors.lastname: Pattou
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016022:Case-Control Studies; D003422:Critical Care; D005260:Female; D015905:Gastric Balloon; D015391:Gastroplasty / Q000379:methods* / Q000534:rehabilitation; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008499:Medical Records; D009767:Obesity, Morbid / Q000601:surgery*; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods*; D016896:Treatment Outcome; D015431:Weight Loss