Article Abstract

Gastric bypass is safe and effective for the super-super-obese patient

Authors: Vadim Meytes, Grace C. Chang, Mazen Iskandar, George Ferzli


Background: Obesity in the United States is on the rise with a growing percentage of patients being diagnosed as super-super-obese (SSO) defined as patients with a body mass index (BMI) ≥60 kg/m². This patient population is at high risk of mortality due to associated comor-bidities. In patients with BMI ≤49 kg/m², the Roux en-Y gastric bypass (RYGB) is considered the ‘gold standard’ surgical treatment for BMI reduction. However, there are limited studies to extrapolate that into SSO patients and some surgeons advocate for a staged approach. The goal of this study is to analyze the safety and efficacy of RYGB surgery in the SSO population.
Methods: Between September 2004 to April 2015, 78 SSO patients underwent RYGB surgery at NYU Lutheran Medical Center. A retrospective study was performed to analyze re-duction of preoperative comorbidities, postoperative outcomes and complications, total percentage of excess weight loss (%EWL) and patient follow up.
Results: Thirty six patients were males and 42 were females with a mean age of 37±10. The mean BMI was 65±4.8 kg/m² and 12 (15.3%) had a BMI ≥70 kg/m². The average OR time was 123±50 minutes, estimated blood loss (EBL) was 10±7.9 mL, and the average length of stay was 75±38 hours. None of the patients were converted to open surgery and 66 (83.5%) had no postoperative complications. For patients with complications, all were Clavien-Dindo grade 1–2 and did not require any invasive interventions. Of the 46 patients who followed up within 6 months, 45 (98.7%) had a decrease in %EWL with an average of 26%±14%. Thirty six (78.3%) of these follow up patients had preoperative comorbidities and 15 (41.7%) had significant improvement or even complete resolution post-surgery.
Conclusions: In our experience, the RYGB is a safe and effective single stage surgical treatment for SSO patients. These patients start to achieve a significant BMI reduction as well as improvement or resolution of their comorbidities without significantly high complication rate however, longer follow up is needed. Follow up in general within this patient population is a nationwide problem and is something that needs to be more consistent in order to better track the postoperative course of the SSO patient.