American Society of Bariatric Plastic Surgeons (ASBPS)

Contact Us |  
[Back to News]

Laparoscopic Bariatric Tx Possible in Super Obese

Laparoscopic Bariatric Tx Possible in Super Obese
Good 30-day mortality outcomes for sleeve gastrectomy and gastric bypass for BMI ≥60

by Ed Susman, Contributing Writer, MedPage Today
November 02, 2017
This article is a collaboration between MedPage Today® and: Medpage Today
Action Points
NATIONAL HARBOR, Maryland – Performing laparoscopic bariatric surgery seemed to be feasible and safe in patients classified as super-super obese (BMI ≥60), researchers reported here.
For either laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB), there was no significant difference in 30-day mortality between the groups (0.1% for LSG vs 0.2% for LRYGB, adjusted odds ratio 0.40, 95% CI0.10-0.65, P=0.21), according to Reza Fazl Alizadeh, MD, of the University of California Irvine, and colleagues.

"Conventionally, Roux-en-Y gastric bypass is associated with higher morbidity and mortality in the patients with super-super obesity ... In an effort to reduce the surgical morbidity, laparoscopic sleeve gastrectomy was originally advocated as a staged procedure in this high-risk patient population," they explained in a presentation at the annual Obesity Week meeting.
Alizadeh's group accessed the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, and identified 8,320 patients with a BMI ≥ 60. About 65% of these patients were treated with LSG while 35% were treated with the LRYGB.
They used database terminology codes to identify the super-super obese patients. They excluded patients who were treated in the emergency department and those who underwent a revision procedure. Multivariate logistic regression model was utilized to analyze the outcomes of LSG versus LRYGB.
The authors reported that compared with patients who underwent LRYGB, patients who underwent LSG had significantly shorter mean operative time (83 minutes vs 125 minutes, P<0.01) and lower mean length of stay (2 days vs 3 days, P<0.01).
Also, compared with LRYGB patients, those who underwent LSG have significantly lower overall morbidity (2.7% vs 5.1%, adjusted OR 0.52, 95% CI0.41-0.66, P<0.01) and serious morbidity (1.3% vs 2.9%, adjusted OR0.46, 95% CI0.33-0.63, P<0.01).

In addition, patients in the LSG group had lower rates of the following versus LRYGB patients:
Postoperative cardiac complications: 0.04% vs 0.2% (adjusted OR 0.21, P=0.08)
Respiratory complications: 0.5% vs 1.2% (adjusted OR 0.40, P=0.001)
Surgical site infections: 1.2% vs 2.8% (adjusted OR0.44, P<0.01)
Finally, there was no significant difference in anastomotic leak between the two groups (0.3% vs 0.5%, adjusted OR 0.55, 95% CI 0.26-1.17, P=0.12).
"Laparoscopic sleeve gastrectomy is the predominant operation being performed in patients with super-super obesity and it is associated with significant lower 30-day risk-adjusted overall morbidity, serious morbidity and shorter length of stay compared with LRYGB," the authors noted. "The contemporary 30-day mortality for laparoscopic Roux-en-Y gastric bypass at accredited centers is similar to that of laparoscopic sleeve gastrectomy."
"We talk about safety in doing these procedures in this type of patient and this study is all about safety," commented Obesity Week session moderator Edward Lin, DO, of Emory Bariatrics at Emory University School of Medicine in Atlanta." Both of these procedures appear to have been safely performed in these very obese patients."
Lin asked the authors if the patients were able to maintain weight loss over the long term, up to 6 months or a year. Alizadeh said that information was not immediately discernable from the database, and the only outcomes readily available were at 30 days.

The researcher did find that patients who underwent the sleeve procedure were more likely to have preoperatively lower rates of diabetes, hypertension, chronic obstructive pulmonary disease or sleep apnea.
Alizadeh said that the findings would indicate to him that he wold more likely recommend that patients in his practice undergo the sleeve technology. "It seems safer and has fewer complications and has less health care utilization."

[Back to News]