The first survey addressing patients with BMI over 50: a survey of 789 bariatric surgeons

Abstract

Background Bariatric surgery in patients with BMI over 50 kg/m2 is a challenging task. The aim of this study was to address main issues regarding perioperative management of these patients by using a worldwide survey. Methods An online 48-item questionnaire-based survey on perioperative management of patients with a BMI superior to 50 kg/m2 was ideated by 15 bariatric surgeons from 9 different countries. The questionnaire was emailed to all members of the International Federation of Surgery for Obesity (IFSO). Responses were collected and analyzed by the authors. Results 789 bariatric surgeons from 73 countries participated in the survey. Most surgeons (89.9%) believed that metabolic/bariatric surgery (MBS) on patients with BMI over 50 kg/m2 should only be performed by expert bariatric surgeons. Half of the participants (55.3%) believed that weight loss must be encouraged before surgery and 42.6% of surgeons recommended an excess weight loss of at least 10%. However, only 3.6% of surgeons recommended the insertion of an Intragastric Balloon as bridge therapy before surgery. Sleeve Gastrectomy (SG) was considered the best choice for patients younger than 18 or older than 65 years old. SG and One Anastomosis Gastric Bypass were the most common procedures for individuals between 18 and 65 years. Half of the surgeons believed that a 2-stage approach should be offered to patients with BMI > 50 kg/m2, with SG being the first step. Postoperative thromboprophylaxis was recommended for 2 and 4 weeks by 37.8% and 37.7% of participants, respectively. Conclusion This survey demonstrated worldwide variations in bariatric surgery practice regarding patients with a BMI superior to 50 kg/m2. Careful analysis of these results is useful for identifying several areas for future research and consensus building.

Robot-assisted vs laparoscopic bariatric procedures in super-obese patients: clinical and economic outcomes

“…Such data are probably due to the minor impact of the patient’s complexity on the robotic approach when compared to laparoscopy. Indeed, robotic procedures allow to overcome SO and SSO patients-related surgical difficulties, due to the aforementioned advantages of robotic technology [ 28 , 38 ].…”

Early safety outcomes of laparoscopic one anastomosis gastric bypass in patients with class III, IV, and V obesity

“…A survey of 789 MBS surgeons worldwide regarding selection of surgery and management of patients with class IV obesity found that identifying the safest effective procedure for high-BMI patients was a primary challenge. 25 With respect to OAGB, a recent systematic review by Parmar et al that directly compared OAGB to SG and RYGB in class IV and V obesity concluded that the safety of OAGB was equivalent to that of the other two procedures. 16 Still, the existing evidence conflicts on the topic of perioperative complications in higher-BMI patients after OAGB, SG, and RYGB.…”

“…A survey of 789 MBS surgeons worldwide regarding selection of surgery and management of patients with class IV obesity found that identifying the safest effective procedure for high‐BMI patients was a primary challenge 25 . With respect to OAGB, a recent systematic review by Parmar et al.…”

One anastomosis gastric bypass as a one-stage bariatric surgical procedure in patients with BMI ≥ 50 kg/m2

“…According to the first survey of bariatric surgeons about patients with BMI ≥ 50 kg/m 2 , about 53% of participants recommended one-stage procedure and 47% of them recommended a two-stage approach with SG as the first step for these patients 13 . Also, some authors have recommended two-stage procedures in patients with BMI ≥ 50 kg/m 2 , including sleeve gastrectomy (SG) as a first-stage procedure and RYGB or BPD-DS as the second-stage procedure in order to decrease complications in these patients 14 , 15 .…”