Laparoscopic Bariatric Surgery in Super-obese Patients (BMI&gt;50) is Safe and Effective: A Review of 332 Patients

Parikh, Manish; Shen, Roy; Weiner, Matt; Siegel, Niccole; Ren, Christine

doi:10.1381/0960892054222632

Cited by 119 publications

(69 citation statements)

References 13 publications

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“…1,3,4,16,17 Around two thirds of body weight loss is attributable to fat mass loss, and the significant reduction of waist circumference is an indirect indicator of visceral fat loss. This explains the improvement of morbidity indices related to body weight excess and metabolic syndrome: systolic and diastolic blood pressure, blood glucose after oral glucose load, triglycerides, HDL cholesterol and fasting plasma insulin concentrations.…”

Section: Discussionmentioning

confidence: 99%

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Resting energy expenditure and fuel metabolism following laparoscopic adjustable gastric banding in severely obese women: relationships with excess weight lost

et al. 2006

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Background: Although adjustable gastric banding is increasingly proposed for massively obese patients, little is known about the modifications of resting metabolic rate and substrate oxidation or about metabolic determinants of weight loss following this type of bariatric surgery. Objectives: To evaluate the relationships between excess weight loss, resting metabolic rate (RMR) and substrate oxidation, and to identify metabolic predictive factors of weight loss after adjustable gastric banding. Subjects: Seventy-three obese nondiabetic women aged 39.1710.4 years (18.4-64.8). Design: Resting metabolic rate and substrate oxidation (indirect calorimetry), body composition (bio-impedance), lipid profile and insulin sensitivity indexes were assessed before and after (13.376.0 months, range 6.0-31.1) adjustable gastric banding. Patients were classified according to postsurgery time: group A (6-12 months, n ¼ 39); group B (12-18 months, n ¼ 21); group C (418 months, n ¼ 13). Metabolic parameters associated with the percentage of excess weight lost (EWL) 1 year after surgery were analyzed in univariate and multivariate regressions. Results: Mean weight loss was 26.2711.4 kg. Mean fat mass loss was 17.378.1 kg. All biological parameters associated with excess weight improved after surgery. Excess weight lost at 1 year was 45.9717.1% in group A, 47.4717.1% in group B and 51.4718.5% in group C (P ¼ NS). Resting metabolic rate/fat-free mass (FFM) slightly decreased (28.973.26 vs 30.372.8, Po0.00001) and RMR/body weight slightly increased (18.572.8 vs 17.371.9, Po0.00001) after surgery. Respiratory quotient (0.8170.06 vs 0.8270.05) and FFM-adjusted lipid oxidation (1.1070.41 vs 1.0570.33 mg/min/kg FFM) were not significantly modified after surgery. In multiple linear regression analysis, difference in RMR/body weight, difference in energy sparing, baseline BMI and postsurgery time, were significantly and independently correlated with EWL (total R 2 ¼ 72.5%). Conclusions: Adjustable gastric banding promotes gradual but sustained weight loss and is associated with long-term conservation of lipid oxidation and energy expenditure. The individual variability in energy sparing mechanisms predicts weight loss during the first year after surgery.

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Section: Discussionmentioning

confidence: 99%

“…As a consequence, the rate of weight loss is usually slower than that obtained after vertical gastroplasty 24 or bypass. 17 Thus, the triggering of compensatory mechanisms opposing weight loss by energy sparing might be blunted.…”

Section: 23mentioning

confidence: 99%

Resting energy expenditure and fuel metabolism following laparoscopic adjustable gastric banding in severely obese women: relationships with excess weight lost

et al. 2006

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“…Furthermore, there is no real consensus concerning the best surgical procedure for super-obesity (16). this fragile population has benefited from different bariatric procedures: studies on sleeve gastrectomy, duodenal switch, gastric banding, and roux-en-Y gastric bypass have all reported relatively safe outcomes (20,21). Although evidence suggests that LAGB is not the most effective bariatric procedure concerning WL (6), it is still popular, with a worldwide prevalence of 17.8% in 2011 (5).…”

Section: Methodsmentioning

confidence: 99%

Laparoscopic Roux-En-Y Gastric Bypass Versus Laparoscopic Adjustable Gastric Banding in the Super-Obese: Peri-Operative and Early Outcomes

2015

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Introduction: Controversy exists between laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding in super-obese patients. Methods: This is a retrospective review of prospectively collected data. A total of 102 consecutive super-obese (body mass index >50) patients underwent laparoscopic Roux-en-Y gastric bypass (Group 1), and 79 consecutive ones underwent laparoscopic adjustable gastric banding (Group 2). Early complications and weight loss outcomes were evaluated. Results: No significant difference was found in operative mean (±standard deviation) time (93.5 ± 33 vs 87.7 ± 39 min, p = 0.29), hospital stay (2.68 ± 2.27 vs 2.75 ± 1.84 days, p = 0.80), or overall early postoperative morbidity (17.65% and 10.12%, p = 0.20). Intra-operative complications occurred in six patients (5.9%) in Group 1 and none in Group 2 (0.0%, p = 0.04). Mean excess weight loss percent at 6 and 12 months in Group 1 was 44.75% ± 11.84% and 54.71% ± 18.18% versus 26.20% ± 12.42% and 31.55% ± 19.79% in Group 2 (p < 0.001). Conclusion: There seems to be no significant differences in early complications between laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding operations in the short term. Weight loss and excess weight loss percent at 6 and 12 months are significantly better after laparoscopic Roux-en-Y gastric bypass.

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“…We omitted complications whose incidence was < 0.1%. The calculated incidence of complications associated with laparoscopic bariatric surgery, obtained from the case series, 4,8,10,17,28,38,44,45,52,74,77,82,83,91,120 is summarized in Table 1; complications associated with DBS studies are shown in Table 2. 6,7,9,12,16,20,26,27,31,37,39,47,[55][56][57][58][59][60][61]64,[67][68][69]71,78,80,81,84,[86][87][88][89][96]…”

Section: Resultsmentioning

confidence: 99%

Deep brain stimulation compared with bariatric surgery for the treatment of morbid obesity: a decision analysis study

Pisapia

Halpern²,

Williams³

et al. 2010

FOC

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Object Roux-en-Y gastric bypass is the gold standard treatment for morbid obesity, although failure rates may be high, particularly in patients with a BMI > 50 kg/m2. With improved understanding of the neuropsychiatric basis of obesity, deep brain stimulation (DBS) offers a less invasive and reversible alternative to available surgical treatments. In this decision analysis, the authors determined the success rate at which DBS would be equivalent to the two most common bariatric surgeries. Methods Medline searches were performed for studies of laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB), and DBS for movement disorders. Bariatric surgery was considered successful if postoperative excess weight loss exceeded 45% at 1-year follow-up. Using complication and success rates from the literature, the authors constructed a decision analysis model for treatment by LAGB, LRYGB, DBS, or no surgical treatment. A sensitivity analysis in which major parameters were systematically varied within their 95% CIs was used. Results Fifteen studies involving 3489 and 3306 cases of LAGB and LRYGB, respectively, and 45 studies involving 2937 cases treated with DBS were included. The operative successes were 0.30 (95% CI 0.247–0.358) for LAGB and 0.968 (95% CI 0.967–0.969) for LRYGB. Sensitivity analysis revealed utility of surgical complications in LRYGB, probability of surgical complications in DBS, and success rate of DBS as having the greatest influence on outcomes. At no values did LAGB result in superior outcomes compared with other treatments. Conclusions Deep brain stimulation must achieve a success rate of 83% to be equivalent to bariatric surgery. This high-threshold success rate is probably due to the reported success rate of LRYGB, despite its higher complication rate (33.4%) compared with DBS (19.4%). The results support further research into the role of DBS for the treatment of obesity.

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Laparoscopic Bariatric Surgery in Super-obese Patients (BMI>50) is Safe and Effective: A Review of 332 Patients

Cited by 119 publications

References 13 publications

Resting energy expenditure and fuel metabolism following laparoscopic adjustable gastric banding in severely obese women: relationships with excess weight lost

Resting energy expenditure and fuel metabolism following laparoscopic adjustable gastric banding in severely obese women: relationships with excess weight lost

Laparoscopic Roux-En-Y Gastric Bypass Versus Laparoscopic Adjustable Gastric Banding in the Super-Obese: Peri-Operative and Early Outcomes

Deep brain stimulation compared with bariatric surgery for the treatment of morbid obesity: a decision analysis study

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