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

Kushnir, Leon; Dunnican, Ward; Benedetto, Bernard; Wang, W.; Dolce, Charles J.; Lopez, Sandra; Singh, Tejinder P.

doi:10.1007/s00464-009-0552-x

Cited by 25 publications

(9 citation statements)

References 12 publications

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“…There was no higher complication index in surgeries for patients with a BMI≥60, coinciding with the report by Kushnir 44 . Bennet, in a study of mortality in bariatric surgery, found that mortality is related to age, and male sex, not nding a relationship with the increase in BMI as in our study 45 .…”

Section: Discussionsupporting

confidence: 90%

Bariatric Surgery in Super-Superobese Patients Maintains Metabolic Improvement Beyond The Failure in Expected Weight Loss.

Susmallian

Raziel

Babis

et al. 2021

Preprint

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Background Extreme obesity leads to increased health risks and perioperative complications. The results of bariatric surgery in patients with super-super obesity (SSO) are presented in this study. Methods From April 2008 to August 2019, 60 patients with SSO underwent bariatric surgery. Their weight loss and surgical outcome were analyzed. The mean follow-up time was 7.2 years. Results At baseline, the mean age was 41.5 years old, the mean BMI was 63.8 kg/m2, 80% of the patients suffered from co-morbidities, and 23.33% were revisional surgeries. Weight loss continued for up to two years after surgery. The percentage of EBW lost at two years was 62.27%, from two to five years: 61.48%, from five to 10 years: 36.82% and after ten years it was 31.89%, the differences in weight change over the time is significative (P<.001). The mean BMI at last visit (Mean 7.2 years) was 45.1 kg/m2 and 48.33% of the patients failed to lose at least 50% of EBW. Patients with fatty liver, diabetes, sleep apnea and hyperlipidemia had a remission or improvement in more than 70% of the cases. There were 5% perioperative complications, one perioperative death (1.67%) and other patient died in a motor vehicle accident, overall mortality 3.33%. Conclusion In the long term, almost half of the patients failed to lose 50% of their EBW. However, the metabolic effects of bariatric surgery were maintained during the follow-up time with a high remission of comorbidities. Revisional bariatric surgery increased the risk of mortality.

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Section: Discussionsupporting

confidence: 90%

Bariatric Surgery in Super-Superobese Patients Maintains Metabolic Improvement Beyond The Failure in Expected Weight Loss.

Susmallian

Raziel

Babis

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…In fact, the influence of pre-surgical weight on surgical morbidity is also uncertain. Retrospective recent studies, conducted in the maturity stage of laparoscopic surgery did not find that the evolution and morbidity related with IGB was different in super-obese patients (BMI > 60) compared to morbidly-obese patients with a BMI > 60 (34)(35)(36).…”

Section: Discussionmentioning

confidence: 88%

“…As stated in other similar studies (35), it is often difficult to achieve enough statistical power in these type of studies. Therefore, in order to achieve statistical significance in the postsurgical morbidity of group H, the sample size of the study should have been increased to 364 patients (182 patients in each arm), which can only be attainable in multicenter studies.…”

Section: Discussionmentioning

confidence: 92%

Usefulness of an intra-gastric balloon before bariatric surgery

et al. 2017

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Introduction: There are only few reports regarding the use of intragastric-balloons (IGB ® ) to achieve weight loss and subsequently decrease surgical complications. In this study, we try to assess whether presurgery weight loss using IGB decreases the postsurgical mortality after bariatric surgery.Material and methods: This is a prospective case-control study. We matched 1:1 by gender, age (± 10 y-o) and type of surgery (sleeve resection [LSG] or gastric bypass [LGBP]), matching cases (A) and controls (H, from a historic cohort). Morbidly obese patients with an indication for bariatric surgery were included in the study. Cases (A) were recruited from an ongoing clinical trial, and the controls (H) came from a historic cohort prior to the start of the clinic trial. The presurgical weight loss in group A was reached by IGB combined with diet, versus only diet in group H.Results: We included 58 patients, 65.5% women, 69% LGBP/31% LSG. The mean age of group A was 42 and 43.4 years old for group H. ASA III of 24.1% group A vs 58.6% group H, p = 0.012. The mean total weight loss (TWL) before surgery was greater in group A (16.2 kg, SD 9.75) than in group H (1.2 kg, SD 6.4), p < 0.0001. The % of EWL before surgery was 23.5 (SD 11.6) in group A vs 2.4 (SD 8) in group H, p < 0.001. Hospital stay was seven days for group A, and eight days for group H, p = 0.285. The rate of unsuccessful IGB treatment to accomplish the scheduled weight loss was 34.5%. The balloon morbidity was 17.2% (6.9% severe). All in all, morbidity (due to bariatric surgery and IGB) was 41% in both groups. Postsurgical morbidity moderate-severe was 20.3% in group A (6.9% severe) and 27.3% in group H (17.2% severe) without statistical significance. One patient died in group H (mortality rate, 3.44%).Conclusion: Preoperative IGB treatment in morbid obesity has not been found to be effective at decreasing postsurgical morbidity LSG and LGBP, despite the fact that it acheives a greater weight loss than diet and exercise.

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“…However, even US-based hospitals face a number of challenges when super-obese patients are admitted to the intensive-care unit. One report suggested that, among patients undergoing laparoscopic gastric operations, the rates of postoperative mortality and morbidity in patients with BMI values of >60 are not higher than those of patients with lower BMI values ( 11 ). However, there have been no reports concerning the mortality and morbidity rates of patients with BMI values of >80 (super-super-super obese); this degree of obesity might lead to severe disturbance of the microcirculation disturbance in the fatty tissue, which may be complicated by infection ( 12 , 13 ).…”

Section: Discussionmentioning

confidence: 99%

A Fatal Case of Super-super Obesity (BMI >80) in a Patient with a Necrotic Soft Tissue Infection

et al. 2018

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A 35-year-old man (height, 169 cm; body weight, 240 kg; BMI, 84) visited the Department of Dermatology due to left leg pain and swelling. Focused enhanced computed tomography (CT) of the left leg ruled out complications of deep venous thrombosis. Surgical exploration of the left leg resulted in a diagnosis of necrotic soft tissue infection, but amputation was ruled out due to his weight. The patient ultimately died of multiple organ failure on the fourth day of hospitalization. A culture of the surgical material revealed Streptococcus dysgalactiae. The present case suggests that super-obese patients should be aggressively treated before lethal complications occur.

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

Cited by 25 publications

References 12 publications

Bariatric Surgery in Super-Superobese Patients Maintains Metabolic Improvement Beyond The Failure in Expected Weight Loss.

Bariatric Surgery in Super-Superobese Patients Maintains Metabolic Improvement Beyond The Failure in Expected Weight Loss.

Usefulness of an intra-gastric balloon before bariatric surgery

A Fatal Case of Super-super Obesity (BMI >80) in a Patient with a Necrotic Soft Tissue Infection

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