Short-term outcomes for super-super obese (BMI ≥60 kg/m2) patients undergoing weight loss surgery at a high-volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and open tubular gastric bypass

Non-transectional Open Gastric Bypass as the Definitive Bariatric Procedure for 61 Patients with BMI of 70 and Higher

“…Median operative time of 150 min reported here compares favorably with other reports of open surgery [11] and with laparoscopic gastric bypass in lighter patients with BMI>60 [5,7,10] and is similar to the BMI>70 sub-group of Stephens et al [6] The EBL here also is similar to previous reports. Our LOS of 3 days was equal to, and often better than, LOS for laparoscopic gastric bypass in much lighter patients, which has ranged from 2.0 to 6.6 days [5,6,10,11,24,25]. For example, the SAGES multicenter study reported mean LOS of 3.0 days in 1,954 cases (86% laparoscopic) [25].…”

“…Operative information is listed in Table 2. Medians included incision length 15 cm [12][13][14][15][16][17][18][19][20], abdominal skin-tofascia fat thickness 8 cm [5][6][7][8][9][10][11][12][13], operative time 150 min (100-210), and EBL 100 ml . ICU monitoring was used for 16 (26%), while 45 (74%) were extubated in the OR and brought to the bariatric surgical floor for telemetry monitoring.…”

“…However, for massively obese patients with body mass index (BMI) exceeding 60, the ones most severely disabled by their weight, bariatric surgery, ironically, is technically more difficult and can be more dangerous than it is for less severely obese patients [3][4][5]. While open and laparoscopic gastric bypass and laparoscopic adjustable gastric banding have been performed on patients with BMI >60, technical challenges and post-operative morbidity remain significant [6][7][8][9][10][11][12][13][14][15]. Furthermore, few of these studies have addressed specifically weight loss surgery for the most extremely obese patients with BMI of 70 and above [16,17].…”

Rapid Evidence Review of Bariatric Surgery in Super Obesity (BMI ≥ 50 kg/m2)

“…27 For the comparison of different bariatric surgery types, data were available from one systematic review, 28 two RCTs, 29,30 and 18 retrospective cohorts. [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] The majority of studies involved mostly women aged 35 to 45 years. We rated the systematic review as fair quality, 28 one RCT (in four studies) as low risk of bias, 29,[49][50][51] and one RCT as unclear risk of bias.…”

Laparoscopic Roux-en-Y Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy for the Treatment of Morbid Obesity. A Prospective Study of 117 Patients

“…Among these, the laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most used techniques worldwide because it has proven to be safe and effective in the long term [5,6]. However, this is a technically demanding procedure, with a long learning curve, and with significant morbidity and mortality rates, especially in super-super obese patients (body mass index (BMI) ≥60 kg/m 2 ) [7,8].…”