title: Outcomes of laparoscopic Roux-en-Y gastric bypass in super-super-obese patients.
abstract: BACKGROUND
  There is limited outcome data for super-super-obese (SSO) patients, those with Body Mass Index (BMI) ≥ 60 kg/m(2), who seek surgical treatment with Laparoscopic Roux-en-Y Gastric Bypass (LRYGB). A large single center LRYGB experience was reviewed to compare the safety and efficacy of LRYGB in SSO patients to the standard obese population undergoing this procedure.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database and an Institutional Review Board approved prospective database was used to identify all patients undergoing LRYGB by multiple surgeons at a single institution between 1/1/1994 and 11/15/2013. Preoperative co-morbidities, postoperative complications, 30-day outcomes, and weight loss at yearly intervals were analyzed to determine difference between SSO patients and NonSSO patients (BMI < 60 kg/m(2)).
  
  
  RESULTS
  Of the 2009 patients undergoing LRYGB over the past 20 years; 328 had BMI ≥ 60 kg/m(2). Preoperative co-morbidities, conversion to open, and length of stay were significantly increased among SSO patients; however there was no significant difference in postoperative outcomes or complications. Percent reduction of excess BMI beyond 12 months was significantly improved among NonSSO patients with less than 30% follow-up beyond 2 years.
  
  
  CONCLUSIONS
  LRYGB appears well tolerated for super-super-obese patients with BMI ≥ 60 kg/m(2) in experienced centers. These patients still have significant reduction in excess BMI despite being less than NonSSO patients undergoing RYGB. The ACS NSQIP database provides excellent tracking of institutional progress with bariatric surgical outcomes to facilitate the improvement of best practice techniques.
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia. Electronic address: jhm9t@virginia.edu.
authors.forename: J Hunter
authors.initials: JH
authors.lastname: Mehaffey
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Damien J
authors.initials: DJ
authors.lastname: LaPar
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Florence E
authors.initials: FE
authors.lastname: Turrentine
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Miller
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Hallowell
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Schirmer
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Bariatric surgery; Gastric bypass; Obesity surgery; Super-super-obese