What is the Actual Fate of Super-Morbid-Obese Patients Who Undergo Laparoscopic Sleeve Gastrectomy as the First Step of a Two-Stage Weight-Reduction Operative Strategy?

Abstract

The overall success-rate of the two-stage treatment plan for the treatment of super-morbid obesity has not yet been assessed. We reviewed the long-term results of 41 treated super-morbid-obese patients. Mean initial BMI was 59.5 ± 3.5kg/m(2). Twelve patients (29.3%) achieved after only LSG a BMI <35kg/m(2) (mean 31.9 ± 2). They have lost 78.7 ± 11.8% of excess body weight (EBW). The remaining 28 patients lost 48.1 ± 11.9% of EBW and achieved a mean BMI of 44.2 ± 4.3kg/m(2), thus requiring the second stage. Ten of them (24.4% of the total or 35.7% of those in need), were submitted to laparoscopic Roux-en-Y gastric bypass (LRYGBP). They lost 71.9 ± 4.3% of EBW and have a mean BMI of 33.6 ± 2.7kg/m(2). The 18 remaining patients have a BMI of 42 ± 3.6kg/m(2) and they still suffer from morbid obesity. They have lost 48.5 ± 8.7% of EBW. The mean rate of EBW loss for all the available 39 patients after either LSG or both LSG and LRYGBP has been 63.2 ± 16.5% after a mean follow-up of 42.8 ± 19.5months. Out of 41 patients, 1 died, 1 was lost to follow-up, 21 (51.2%) achieved "healthy" BMIs and 18 (44%) still require LRYGBP. The rate of cure of morbid obesity was 51.2%. A remaining 44% of super-morbid obese patients still need the completion LRYGBP but have not undergone it. Half of these patients have lost >50% of their EBW. The two-stage strategy is an effective treatment plan for super-morbid obesity. A less patient-dependent strategy may be needed for a subset of patients.