Surgical management of super-super obese patients: Roux-en-Y gastric bypass versus sleeve gastrectomy.
BACKGROUND
Among morbidly obese adult patients (BMI >40 kg/m(2)), those who are super-super obese (BMI >60 kg/m(2)) present particular challenges for bariatric surgeons. Surgical management of super-super obese (SSO) patients has been associated with higher morbidity and mortality and increased surgical risk. The optimal surgical management of these patients is controversial. The aim of this study was to compare perioperative outcomes, percent excess weight loss (%EWL), and percent weight loss (%WL) in super-super obese patients who underwent either SG or RYGB.


METHODS
This study was a nonrandomized, controlled, retrospective review of 89 SSO patients who underwent SG or RYGB at the University of Illinois Hospital and Health Sciences System from January 2008 to June 2014. Patient demographics, pre-surgical comorbidities, perioperative parameters, post-operative complications (leak, conversion to open surgery, and 30-day mortality), and post-operative outcome months were examined.


RESULTS
Seventy-seven patients underwent SG (nine robotic sleeve and 68 laparoscopic sleeve gastrectomy), and 12 underwent RYGB. The mean pre-operative BMI was 63.4 kg/m(2) (SD = 3.7 kg/m(2)). The mean operative time was 88.4 min (SD = 31.7) for the SG patients and 219.2 min (SD = 80.2) for the RYGB patients. There were no significant differences in complications or length of hospitalization between the groups. There were significant differences in %EWL and %WL at 12- and 24-month follow-up between groups (p's < 0.05).


CONCLUSIONS
Based on the results from this sample of patients, SG and RYGB appear to be viable procedures for the surgical management of super-super obese patients. RYGB, however, provides a significantly higher %EWL and %WL at 12 and 24 months compared to SG, which in turn, yields acceptable but lower %EWL and %WL.
University of Illinois at Chicago College of Medicine, 840 South Wood Street 435 E, Chicago, IL, 60612, USA. rgheredi@uic.edu.
Raquel
http://orcid.org/0000-0002-9406-2848
R
Gonzalez-Heredia
University of Illinois at Chicago College of Medicine, 840 South Wood Street 435 E, Chicago, IL, 60612, USA.
Lisa
L
Sanchez-Johnsen
University of Illinois at Chicago College of Medicine, 840 South Wood Street 435 E, Chicago, IL, 60612, USA.
Valeria S M
VS
Valbuena
University of Illinois at Chicago College of Medicine, 840 South Wood Street 435 E, Chicago, IL, 60612, USA.
Mario
M
Masrur
University of Illinois at Chicago College of Medicine, 840 South Wood Street 435 E, Chicago, IL, 60612, USA.
Melissa
M
Murphey
University of Illinois at Chicago College of Medicine, 840 South Wood Street 435 E, Chicago, IL, 60612, USA.
Enrique
E
Elli
D000328:Adult; D015897:Comorbidity; D005260:Female; D005743:Gastrectomy / Q000379:methods; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D015431:Weight Loss
Bariatric surgery; Robotic-assisted; Roux-en-Y gastric bypass; Sleeve gastrectomy; Super–super obese