Laparoscopic Roux-en-Y Gastric Bypass in the "Megaobese"

Abstract

Hypothesis: Laparoscopic Roux-en-Y gastric bypass is a safe and effective procedure in patients with a body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) of 70 or greater. Design: A retrospective analysis of patients with a BMI of 70 or greater who underwent laparoscopic Rouxen-Y gastric bypass by a single surgeon. Setting: A university-affiliated community hospital in Allentown, Pa. Patients: A nonconsecutive series of 9 patients with a BMI of 70 or greater who met traditional criteria for a bariatric procedure. Intervention: Laparoscopic approach to Roux-en-Y gastric bypass with stapled anastomoses. Results: Patient medical records were reviewed for length of stay, complications, operative time, comorbidities, and weight loss. Seven patients were women and 2 were men. Comorbidities included dyspnea on exertion, peripheral edema, arthritis, sleep apnea, hypertension, diabetes mellitus, asthma, hypothyroidism, gastroesophageal reflux disease, peptic ulcer disease, and heart disease. Eight of 9 procedures were successfully completed laparoscopically. One patient was converted to an open procedure. One patient developed a marginal ulcer postoperatively. No other complications occurred. Operative time ranged from 122 to 330 minutes (mean, 203 minutes). Length of stay averaged 1.2 days. Overall weight loss was 49% of excess body weight at 1 year after surgery. Conclusion: Laparoscopic Roux-en-Y gastric bypass is safe and effective in patients with a BMI of 70 or greater.

Obesity surgery: Evidence-based guidelines of the European Association for Endoscopic Surgery (EAES)

“…Numerous technical modifications have been proposed relating to gastric pouch construction, gastro-jejunal anastomosis, and length of alimentary and biliopancreatic limbs. RYGB usually results in 60% to 70% EWL [75,101,138,173,222,273], but the procedure is much better accepted in the United States (about 70% of all procedures) as compared to Europe [332].…”

Spectrum and Risk Factors of Complications After Gastric Bypass

“…5 Several studies have shown that bariatric surgery can be accomplished safely in super obese patients. 54,55 However, higher BMI should still be an important consideration in patient selection, as it correlates with a higher prevalence of comorbidities, longer operative times, and higher rates of conversion to open procedures. 56 In conclusion, presence of diabetes, open surgery, and early surgeon experience are associated with increased risk of complications after GBP.…”

A Prospective Evaluation of a Variant of Biliopancreatic Diversion with Roux-en-Y Reconstruction in Mega-obese Patients (BMI ≥ 70 kg/m2)

“…Further subdivision of obesity into different groups according to BMI has become necessary for risk stratification purposes and long-term survival estimates. Patients with BMI>70 kg/m 2 present a challenging subgroup of the obese population because of limitations on diagnostic work-up and higher prevalence of perioperative complications [7,8]. The presence of severe accompanying comorbidities such as hypoventilation syndrome, sleep apnea, severe hypertension, insulin-dependent diabetes mellitus type II, deep vein thrombosis, and severe venous stasis disease, puts these patients at significantly higher risk for increased postoperative morbidity and mortality [4].…”

“…Few studies have been published regarding the optimal perioperative management of these patients [6][7][8], while the most advantageous surgical approach still remains controversial. The major hazard when operating on these patients is the lack of sufficient pulmonary and cardiovascular reserve necessary to survive the difficulty of the operation and, in particular, any complication that may occur.…”