title: Laparoscopic gastric bypass vs. sleeve gastrectomy in the super obese patient: early outcomes of an observational study.
abstract: BACKGROUND
  Super obesity [body mass index (BMI) > 50 kg/m2] can yield to higher morbidity/mortality in bariatric surgery, this could be related to patient's characteristics and/or surgeon's experience. In morbid obesity, both techniques proved to have a positive impact and sometimes comparable outcomes during the first 2 years. This has not been clearly analyzed in the super obese patient.
  
  
  METHODS
  Retrospective study comparing the records of 77 consecutive super obese patients (BMI: 50-59.9 kg/m2) submitted to either laparoscopic gastric bypass (LGBP, n = 32) or laparoscopic sleeve gastrectomy (LSG, n = 45) between 2010 and 2012 at a single institution. The primary objective was to analyze baseline demographics, comorbidities, operative outcomes, and early complications (<30 days). Secondarily, weight loss [BMI and % excess weight loss (%EWL)] was also described and compared during the first year.
  
  
  RESULTS
  Female sex comprised 72.7 % of all cases. Both groups had comparable BMI (52.7 ± 2.1 kg/m2 for LGBP vs. 53.87 ± 2.8 kg/m2 for LSG; p = 0.087) and homogeneous baseline characteristics. Operative time was lower for the LSG group (113.1 ± 35.3 vs. 186.9 ± 39 min for LGBP; p ≤ 0.001). Overall, early complications were observed in 16.8% of patients (LGBP 9% vs. LSG 22%; p = 0.217). There were four major complications (two in each group), with two reinterventions. Weight loss (%EWL) at 6, 9, and 12 months was significantly higher in the LGBP group (51.6 ± 12.9%, 56.5 ± 13%, 63.9 ± 13.3%, respectively) than in the LSG group (40 ± 12.8%, 45.1 ± 15.5%, 43.9 ± 10.4%, respectively).
  
  
  CONCLUSIONS
  Just like in morbid obesity, LGBP and LSG are effective and safe procedures in super obese patients. LGBP had better weight loss at 1 year.
authors.affiliation: The Obesity Clinic at Hospital General "Dr. Rubén Leñero", Mexico City, Mexico, zerrweck@yahoo.com.
authors.forename: Carlos
authors.initials: C
authors.lastname: Zerrweck
authors.forename: Elisa M
authors.initials: EM
authors.lastname: Sepúlveda
authors.forename: Hernán G
authors.initials: HG
authors.lastname: Maydón
authors.forename: Francisco
authors.initials: F
authors.lastname: Campos
authors.forename: Antonio G
authors.initials: AG
authors.lastname: Spaventa
authors.forename: Verónica
authors.initials: V
authors.lastname: Pratti
authors.forename: Itzel
authors.initials: I
authors.lastname: Fernández
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D005743:Gastrectomy; D015905:Gastric Balloon; D015390:Gastric Bypass; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss