Extremely High Body Mass Index is not a Contraindication to Laparoscopic Gastric Bypass

Abstract

While patients with a BMI > or =60 are at higher risk for postoperative complications, they are also at higher risk from continued extreme obesity. In our series, 85% of these patients had an uneventful postoperative course and began shedding excess weight. BMI > or =60 should not be a contraindication for LRYGBP.

Is BMI greater than 60 kg/m2 a predictor of higher morbidity after laparoscopic Roux-en-Y gastric bypass?

“…The laparoscopic approach, in contrast to the open procedure, has been shown to have less postoperative pain, decreased impairment of postoperative pulmonary function, shorter length of hospital stay, quicker return to work and other activities of daily living, and a decreased rate and severity of wound infections [4]. While surgeons are becoming more experienced with this procedure over time and are offering it to patients with ever increasing weight, supersuperobese patients (BMI C 60 kg/m 2 ) are still often excluded due to concerns over increased technical difficulty and higher postoperative complication rate [3,8].…”

“…Longer follow-up is required to detect complications that occur after 1 year. Our study shows that laparoscopic Roux-en-Y gastric bypass can be safely performed on the super-supermorbidly obese.Keywords Obesity Á Roux-en-Y gastric bypass Á Laparoscopic Á BMI Á Super-superobese Laparoscopic Roux-en-Y gastric bypass (LapRNYGB) has been shown to be a safe method of surgical weight loss for select individuals [1][2][3]. This procedure is being performed with increasing frequency throughout the USA [3].…”

Staged Laparoscopic Roux-en-Y: A Novel Two-Stage Bariatric Operation as an Alternative in the Super-Obese with Massively Enlarged Liver

“…Although low BMI is a relatively good predictor of a less challenging laparoscopic procedure, a high BMI is not consistently a strong predictor for intraoperative technical difficulty. 4,5 We concur that the best method to determine the technical difficulty of laparoscopic RYGBP is an intraoperative laparoscopic evaluation. In our experience, the primary limiting factor in determining the technical difficulty of laparoscopic RYGBP is the size and thickness of the left lobe of the liver.…”

“…This difficulty in visualization causes a higher morbidity and mortality when bariatric surgery is performed in the super-obese. 4,8 Steps that have been instituted to reduce the size of the left hepatic lobe include implementation of a liquid diet for 2 weeks before the bariatric operation. 9 Compliance and weight loss with such a program, however, is variable and to date, no objective data confirms the use of preoperative efforts to "shrink" the liver.…”

“…4 In an effort to minimize the associated morbidity and mortality with a one-stage RYGBP operation, Regan and colleagues 7 described the two-stage operation which consists of a sleeve gastrectomy (1st stage) followed by an interval RYGBP or duodenal switch. We have been able to perform a onestage laparoscopic RYGBP in the majority of the patients falling into the super-obese category.…”