title: One-Stage vs Two-Stage Laparoscopic Roux-en-Y Gastric Bypass in Obese Patients with Body Mass Index >55 Kg/m2; 5-YEAR FOLLOW UP.
abstract: Surgical strategies in patients with BMI > 55 kg/m2are not well established.
  
  
  
  The objective of this study is to compare the long term results and complications of 1- vs. 2-stage laparoscopic "Roux-en-Y″ gastric bypass (LRYGB) for patients with BMI > 55 kg/m2.
  
  
  
  Retrospective review of the complications and outcomes, between January 2007 and January 2010, for patients with a BMI > 55 kg/m2who underwent directly a LRYGB (1-stage) or a LRYGB as a 2nd stage of a laparoscopic sleeve gastrectomy (LSG).
  
  
  
  Twenty-four patients were enrolled (no patient was lost during the 5-year follow-up). In the 1-stage LRYGB group, two patients had grade II complications according to Clavien-Dindo classification. In the 2-stage LRYGB group, complications of the first and the second surgery were summed. There were no differences between the two groups despite being heterogenous (more men with a higher BMI in the 2-stage group). There was a statistically significant difference in the final BMI in 1-stage LRYGB group compared to the 2-stage LRYGB group (34.46 ± 6.29 vs. 40.40 ± 3.47; p = 0.01, respectively) and in percentage of excess of BMI loss (%EBMIL; 69.80 ± 19.96 vs. 54.54 ± 13.93; p = 0.04, respectively).
  
  
  
  In patients with a BMI > 55 kg/m2, both 1- and 2-stage LRYGB give good long-term results. If feasible, a 1-stage LRYGB obtains a better percentage of excess of BMI loss but if not possible, the strategy of initially performing a laparoscopic sleeve gastrectomy followed by a LRYGB is safe and there were no differences in complications.
authors.affiliation: Bariatric and Metabolic Surgery Unit, Hospital Clínico Universitario, Valencia, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Díaz-Tobarra
authors.affiliation: Bariatric and Metabolic Surgery Unit, Hospital Clínico Universitario, Valencia, Spain. cassinello73@hotmail.com.|Servicio Cirugía General y Aparato Digestivo, Hospital Clínico Universitario, Avda Blasco Ibañez, 17, 46010, Valencia, Spain. cassinello73@hotmail.com.
authors.forename: Norberto
authors.initials: N
authors.lastname: Cassinello Fernández
authors.affiliation: Bariatric and Metabolic Surgery Unit, Hospital Clínico Universitario, Valencia, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Jordá Gómez
authors.affiliation: Bariatric and Metabolic Surgery Unit, Hospital Clínico Universitario, Valencia, Spain.
authors.forename: Mohammad Nebih
authors.initials: MN
authors.lastname: Nofal
authors.affiliation: Bariatric and Metabolic Surgery Unit, Hospital Clínico Universitario, Valencia, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Alfonso Ballester
authors.affiliation: Bariatric and Metabolic Surgery Unit, Hospital Clínico Universitario, Valencia, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Ortega Serrano
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Complications; Follow-up; Laparoscopic sleeve gastrectomy; Laparoscopic “roux-en-Y″ gastric bypass; Results; Super-obesity