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Obesity Surgery

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01-07-2018 | Original Contributions

Perioperative Short-Term Outcome in Super-Super-Obese Patients Undergoing Bariatric Surgery

Authors: Anna Duprée, Alexander Tarek El Gammal, Stefan Wolter, Silvana Urbanek, Nina Sauer, Oliver Mann, Philipp Busch

Published in: Obesity Surgery | Issue 7/2018

Abstract

Background

Prevalence of obesity is increasing with a pandemic magnitude worldwide. Incidence of super-super-obesity (> 60 kg/m²) is expanding by the same means. While bariatric surgery is the only approach with proven long-term results, surgical outcome in super-super-obesity is still discussed controversially.

Objective

This retrospective study examined bariatric surgery patients’ short-term outcome in relation to their degree of obesity.

Setting

Data collection was performed in a German university medical center between March 2010 and November 2013.

Methods

This study analyzes a cohort of 715 patients in a single institution. Patients were subdivided into three groups, obese (≤ 49.9 kg/m²), super-obese (≥ 50 kg/m²), and super-super-obese (≥ 60 kg/m²), and evaluated regarding perioperative outcome.

Results

Three hundred eighty-one patients were included into obese (O); 225 patients, into super-obese (SO); and 109 patients, into super-super-obese (SSO) cohort. There were no significant differences regarding patient characteristics including quantity of comorbidities and perioperative outcome. BMI was significantly lower in patients with complications, compared to patients without complications (p < 0.05), whereas patients’ age was significantly higher (p < 0.05) in complication cohort. One SSO patient died of a septic multiorgan failure. Thus, the 30-day overall mortality was 0.14%. The BMI showed an inverse correlation to the patients’ age at surgery (p < 0.05).

Conclusion

Super-super-obesity should not be considered as a limiting factor for bariatric surgery outcome; however, the patients’ age, surgeries prior to the bariatric procedure, and comorbidities must be considered prior to bariatric surgical treatment.

WHO. Obesity and overweight Fact sheet No 311 Updated August 2014 2014 [cited 2014 15.11.14]; Available from: http://www.who.int/mediacentre/factsheets/fs311/en/.

WHO. Obesity: preventing and managing the global epidemic; Report of a WHO Consultation (WHO Technical Report Series 894). 2000 [cited 2015]; Available from: http://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/.

Kakarla VR, Nandipati K, Lalla M, et al. Are laparoscopic bariatric procedures safe in superobese (BMI >/=50 kg/m2) patients? An NSQIP data analysis. Surg Obes Relat Dis. 201;7(4):452–8. https://doi.org/10.1016/j.soard.2010.10.009.

Dapri G, Cadiere GB, Himpens J. Superobese and super-superobese patients: 2-step laparoscopic duodenal switch. Surg Obes Relat Dis. 2011;7(6):703–8. https://doi.org/10.1016/j.soard.2011.09.007.CrossRefPubMed

van Rutte PW, Smulders JF, de Zoete JP, et al. Outcome of sleeve gastrectomy as a primary bariatric procedure. Br J Surg. 2014;101(6):661–8. https://doi.org/10.1002/bjs.9447.CrossRefPubMed

Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014;370(21):2002–13. https://doi.org/10.1056/NEJMoa1401329.CrossRefPubMedPubMedCentral

Carlsson LM, Peltonen M, Ahlin S, et al. Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med. 2012;367(8):695–704. https://doi.org/10.1056/NEJMoa1112082.CrossRefPubMed

Aberle J, Freier A, Busch P, et al. Treatment with sibutramine prior to Roux-en-Y gastric bypass leads to an improvement of metabolic parameters and to a reduction of liver size and operative time. Obes Surg. 2009;19(11):1504–7. https://doi.org/10.1007/s11695-009-9940-5.CrossRefPubMed

Busetto L, Segato G, De Luca M, et al. Preoperative weight loss by intragastric balloon in super-obese patients treated with laparoscopic gastric banding: a case-control study. Obes Surg. 2004;14(5):671–6. https://doi.org/10.1381/096089204323093471.CrossRefPubMed

10.

Zerrweck C, Maunoury V, Caiazzo R, et al. Preoperative weight loss with intragastric balloon decreases the risk of significant adverse outcomes of laparoscopic gastric bypass in super-super obese patients. Obes Surg. 2012;22(5):777–82. https://doi.org/10.1007/s11695-011-0571-2.CrossRefPubMed

11.

Artuso D, Wayne M, Kaul A, et al. Extremely high body mass index is not a contraindication to laparoscopic gastric bypass. Obes Surg. 2004;14(6):750–4. https://doi.org/10.1381/0960892041590764.CrossRefPubMed

12.

Fernandez Jr AZ, DeMaria EJ, Tichansky DS, et al. Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc. 2004;18(2):193–7. https://doi.org/10.1007/s00464-003-8926-y.CrossRefPubMed

13.

Fernandez Jr AZ, Demaria EJ, Tichansky DS, et al. Multivariate analysis of risk factors for death following gastric bypass for treatment of morbid obesity. Ann Surg. 2004;239(5):698–702. discussion -3CrossRef

14.

Villamere J, Gebhart A, Vu S, et al. Body mass index is predictive of higher in-hospital mortality in patients undergoing laparoscopic gastric bypass but not laparoscopic sleeve gastrectomy or gastric banding. Am Surg. 2014;80(10):1039–43.PubMed

15.

Kushnir L, Dunnican WJ, Benedetto B, et al. Is BMI greater than 60 kg/m(2) a predictor of higher morbidity after laparoscopic Roux-en-Y gastric bypass? Surg Endosc. 2010;24(1):94–7. https://doi.org/10.1007/s00464-009-0552-x.CrossRefPubMed

16.

Taylor JD, Leitman IM, Hon P, et al. Outcome and complications of gastric bypass in super-super obesity versus morbid obesity. Obes Surg. 2006;16(1):16–8. https://doi.org/10.1381/096089206775222087.CrossRefPubMed

17.

Dresel A, Kuhn JA, McCarty TM. Laparoscopic Roux-en-Y gastric bypass in morbidly obese and super morbidly obese patients. Am J Surg. 2004;187(2):230–2; discussion 2. https://doi.org/10.1016/j.amjsurg.2003.08.017.CrossRefPubMed

18.

Farkas DT, Vemulapalli P, Haider A, et al. Laparoscopic Roux-en-Y gastric bypass is safe and effective in patients with a BMI > or =60. Obes Surg. 2005;15(4):486–93. https://doi.org/10.1381/0960892053723466.CrossRefPubMed

19.

Sanchez-Santos R, Vilarrasa N, Pujol J, et al. Is Roux-en-Y gastric bypass adequate in the super-obese? Obes Surg. 2006;16(4):478–83. https://doi.org/10.1381/096089206776327224.CrossRefPubMed

20.

Qin C, Luo B, Aggarwal A, et al. Advanced Age as an independent predictor of perioperative risk after laparoscopic sleeve gastrectomy (LSG). Obes Surg. 2015;25(3):406–12. https://doi.org/10.1007/s11695-014-1462-0.CrossRefPubMed

21.

Varela JE, Wilson SE, Nguyen NT. Outcomes of bariatric surgery in the elderly. Am Surg. 2006;72(10):865–9.PubMed

22.

Dorman RB, Abraham AA, Al-Refaie WB, et al. Bariatric surgery outcomes in the elderly: an ACS NSQIP study. J Gastroint Surg. 2012;16(1):35–44. discussionCrossRef

23.

Gebhart A, Young MT, Nguyen NT. Bariatric surgery in the elderly: 2009–2013. Surg Obes Relat Dis. 2015;11(2):393–8. https://doi.org/10.1016/j.soard.2014.04.014.CrossRefPubMed

24.

Ramirez A, Roy M, Hidalgo JE, et al. Outcomes of bariatric surgery in patients >70 years old. Surg Obes Relat Dis. 2012;8(4):458–62.CrossRef

25.

Stroh C, Kockerling F, Volker L, et al. Results of more than 11,800 sleeve gastrectomies: data analysis of the German Bariatric Surgery Registry. Ann Surg. 2016;263(5):949–55. https://doi.org/10.1097/SLA.0000000000001559.CrossRefPubMed

26.

Rosenthal RJ, International Sleeve Gastrectomy Expert P, Diaz AA, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19. https://doi.org/10.1016/j.soard.2011.10.019.CrossRefPubMed

27.

Milone L, Strong V, Gagner M. Laparoscopic sleeve gastrectomy is superior to endoscopic intragastric balloon as a first stage procedure for super-obese patients (BMI > or =50). Obes Surg. 2005;15(5):612–7. https://doi.org/10.1381/0960892053923833.CrossRefPubMed

Title: Perioperative Short-Term Outcome in Super-Super-Obese Patients Undergoing Bariatric Surgery
Authors: Anna Duprée
Alexander Tarek El Gammal
Stefan Wolter
Silvana Urbanek
Nina Sauer
Oliver Mann
Philipp Busch
Publication date: 01-07-2018
Publisher: Springer US
Published in: Obesity Surgery / Issue 7/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-018-3118-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Perioperative Short-Term Outcome in Super-Super-Obese Patients Undergoing Bariatric Surgery

Abstract

Background

Objective

Setting

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Setting

Methods

Results

Conclusion

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