Laparoscopic Roux-en- Y gastric bypass in patients with body mass index >70 kg/m 2

Abstract

Background Sparse published data support the optimal surgical management of megaobesity (body mass index >70 kg/m 2). The purpose of the present study was to compare laparoscopic Roux-en- Y gastric bypass (LRYGB) and open Roux-en- Y gastric bypass (ORYGB) in megaobese patients. Methods We conducted a retrospective review of 89 consecutive patients with a body mass index >70 kg/m 2 who underwent LRYGB or ORYGB from January 2003 to May 2007 at the Ohio State University Medical Center. Results LRYGB was performed in 37 patients, with 3 conversions to open surgery, and 52 underwent ORYGB. No statistically significant demographic or preoperative co-morbidity differences were discerned. The mean intraoperative blood loss was lower in the LRYGB group (54 mL versus 211 mL; P < .0001). The median length of stay for both LRYGB and ORYGB groups was 4 days. One patient in the open group died. The postoperative complications were statistically equivalent between the 2 groups. The hernia rate for the LRYGB group was 3% and was 19% in the ORYGB group ( P = .02). The patients who underwent LRYGB had greater excess body weight loss at 3 (22.7% versus 17.5%, P = .02) and 6 (37.5% versus 30.5%, P = .03) months. However, the average excess body weight loss at 12 and 24 months was similar (48% and 60%, respectively). Conclusion LRYGB is a technically feasible and safe surgical approach in the megaobese. The intraoperative blood loss was less with LRYGB than with ORYGB. The overall mortality and complications were not different, with the exception of hernia frequency, which was significantly greater after ORYGB. The percentage of excess body weight loss at 3 and 6 months was better for the LRYGB group. In both groups of patients, the 12- and 24-month excess body weight loss were similar.