Superobese and super-superobese patients: 2-step laparoscopic duodenal switch.

Morbidity and mortality after bariatric surgery in superobese (body mass index [BMI] >50 but <60 kg/m2) and super-superobese (BMI >60 kg/m2) patients can allegedly be reduced by performing surgery in 2 steps. We report a retrospective study gathered from a prospective database for superobese and super-superobese patients who underwent laparoscopic biliopancreatic diversion/duodenal switch (LBPD/DS) after laparoscopic sleeve gastrectomy (LSG) as the first step. From October 2004 to June 2010, 31 patients underwent LBPD/DS after LSG. The mean age was 45.8 ± 10.1 years (range 21-64). The mean interval between the 2 procedures was 13.9 ± 8.4 months (range 6-37). At LSG, the mean weight and BMI was 168.8 ± 35.4 kg (range 127-255) and 58.3 ± 6.7 kg/m2 (range 50-74.5). At LBPD/DS, the mean weight, BMI, and percentage of excess weight loss was 136.3 ± 32.6 kg (range 92-220), 47.1 ± 7.2 kg/m(2) (range 37.8-64.3), and 31.6% ± 12.2% (range -11.7 to +54.6). At LSG, 26 patients had 43 obesity co-morbidities. Three co-morbidities (6.9%) resolved in 3 patients before the second step of LBPD/DS was performed. The mean operative time was 175.5 ± 60.6 minutes (range 75-285). There were no deaths or conversions to open surgery. Four patients had early complications (1 anastomotic leak, 1 small bowel perforation, 1 case of renal insufficiency, and 1 case of pneumonia). The mean hospital stay was 6.6 ± 8 days (range 3-35). All patients, with the exception of 3, were followed up for a mean of 28.8 ± 21.4 months (range 4-71). At follow-up, the mean weight, BMI, and percentage of excess weight loss (compared with the pre-LSG weight) was 99.4 ± 23.7 kg (range 62-150), 34.5 ± 5.8 kg/m2 (range 24.9-46.3), and 54.8% ± 16% (range 18.9-84.8). A total of 22 obesity co-morbidities (51.1%) resolved in 14 patients. Three patients presented with late complications (1 ventral hernia, 1 case of protein deficiency, 1 anastomotic stenosis). In the treatment of superobese and super-superobese patients with 2-step LBPD/DS, we experienced no deaths and achieved acceptable morbidity, considering the high operative risk in this group. This procedure is effective for both weight loss and resolution of co-morbidities.

Dapri G ，Cadière GB ，Himpens J 《-》

Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients.

Silecchia G ，Boru C ，Pecchia A ，Rizzello M ，Casella G ，Leonetti F ，Basso N ... -  《OBESITY SURGERY》

Laparoscopic sleeve gastrectomy is superior to endoscopic intragastric balloon as a first stage procedure for super-obese patients (BMI > or =50).

Milone L ，Strong V ，Gagner M 《OBESITY SURGERY》

Sleeve gastrectomy as a bridge to a second bariatric procedure in superobese patients--a single institution experience.

The surgical treatment of superobese patients (body mass index ≥50 kg/m(2)) with significant co-morbidities remains a challenge. We evaluated our outcomes after initial laparoscopic sleeve gastrectomy (LSG) in the superobese undergoing staged procedures in the setting of a university hospital in the United Kingdom. The data from patients with a body mass index of ≥50 kg/m(2) undergoing LSG as a part of a staged procedure from 2005 to 2008 were extracted from our database. The patient parameters were analyzed, along with the morbidity, length of stay, and weight loss after the initial procedure. A total of 61 patients with a body mass index of ≥50 kg/m(2) (median 60, range 50-81.5) underwent LSG as a part of a staged procedure during the study period. The median age was 46 years (range 24-61.5), and 41 were women. Obesity-related co-morbidities were present in different combinations in 51 patients (83.6%). All the procedures were completed laparoscopically, barring 1. The median hospital stay was 4 days (interquartile range 3-4). Complications occurred in 6 patients (9.8%), and 3 required repeat laparoscopy for complications. No patient died. The median percentage of excess weight loss was 31% at 6 months (interquartile range 26-40) and 39% at 1 year (interquartile range 34-51). Diabetes, obstructive sleep apnea and hypertension had resolved in 90%, 100%, and 61% of the patients, respectively. Of the 61 patients, 41 went on to undergo a second-stage procedure, of whom 1 underwent laparoscopic Roux-en-Y gastric bypass, 5 underwent repeat LSG, and the rest underwent laparoscopic duodenal switch. LSG is safe and effective for initial weight loss in the superobese undergoing 2-stage procedures.

Mukherjee S ，Devalia K ，Rahman MG ，Mannur KR ... -  《-》

Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients.

Ren CJ ，Patterson E ，Gagner M 《OBESITY SURGERY》