title: Single-stage laparoscopic sleeve gastrectomy: safety and efficacy in the super-obese.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) is increasingly used as a single-stage bariatric procedure. However, its safety and efficacy in super-obese patients (body mass index [BMI] > 50 kg/m(2)) is less well defined. This series reports on 400 consecutive patients who underwent LSG at our institution, to evaluate safety and efficacy in the super-obese.
  
  
  METHODS
  We performed a retrospective review of prospectively collected data on 400 consecutive patients who underwent LSG at our institution. We analyzed baseline demographic data, median length of hospital stay, complications, length of follow-up, weight loss, and comorbidity resolution. We graded complications according to the Clavien-Dindo classification system. We classified patients as super-obese and non-super-obese and compared outcomes between groups. We used the two-tailed t-test and Fisher's exact test as necessary.
  
  
  RESULTS
  There were 400 patients, 291 of whom were female (73%). The mean age was 44 y (standard deviation [SD] ± 9 y). The mean preoperative weight and BMI were 140 kg (SD ± 31 kg) and 49 kg/m(2) (SD ± 9 kg/m(2)), respectively. There were 67 complications (16%) in total. The major complication rate was 7.2%, with one recorded death. The median length of hospital stay was 3 d, and the mean follow-up period was 1 y. A total of 170 patients (43%) were super-obese, with a mean preoperative BMI of 56 kg/m(2) (SD ± 5 kg/m(2)). The mean absolute weight loss (59 versus 36.7 kg; P < 0.01) and percentage excess weight loss (58.9% versus 45.9%; P < 0.01) was significantly higher in the super-obese. The mean postoperative BMI for super-obese patients was 38.9 kg/m(2). There was no difference between groups in the incidence of major complications (8.2% versus 6.5%; P = 0.56).
  
  
  CONCLUSIONS
  Laparoscopic sleeve gastrectomy is safe and effective in the super-obese, with acceptable weight loss and no increase in the major complication rate.
authors.affiliation: Department of Surgery, South Auckland Clinical School, Middlemore Hospital, University of Auckland, Private Bag 93311, Otahuhu, Auckland, New Zealand. daniel.lemanu@middlemore.co.nz
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Lemanu
authors.forename: Sanket
authors.initials: S
authors.lastname: Srinivasa
authors.forename: Primal P
authors.initials: PP
authors.lastname: Singh
authors.forename: Andrew D
authors.initials: AD
authors.lastname: MacCormick
authors.forename: Stephanie
authors.initials: S
authors.lastname: Ulmer
authors.forename: Jon
authors.initials: J
authors.lastname: Morrow
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Hill
authors.forename: Richard
authors.initials: R
authors.lastname: Babor
authors.forename: Habib
authors.initials: H
authors.lastname: Rahman
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies