LapBand System® in Super-Superobese Patients (>60 kg/m2): 4-Year Results

Abstract

LAGB can be considered an appropriate bariatric surgical option in super-superobese patients both for low morbidity rate and weight loss. The end-point of BMI < 30 can be achieved with a multidisciplinary follow-up. Additional studies with more patients and longer follow-up are needed to confirm these observations.

Non-transectional Open Gastric Bypass as the Definitive Bariatric Procedure for 61 Patients with BMI of 70 and Higher

“…In that lower BMI population, maximum weight loss was 142 lb [7], and % XSWL ranged from 38.3% to 60.8% [7][8][9]11] for laparoscopic gastric bypass and 47-69% for adjustable gastric banding [12,13]. Resolution of co-morbidities in the present study was achieved with efficacy similar to results seen elsewhere with open or laparoscopic gastric bypass [7][8][9][10][11], or gastric banding [12,13].…”

“…Operative information is listed in Table 2. Medians included incision length 15 cm [12][13][14][15][16][17][18][19][20], abdominal skin-tofascia fat thickness 8 cm [5][6][7][8][9][10][11][12][13], operative time 150 min (100-210), and EBL 100 ml . ICU monitoring was used for 16 (26%), while 45 (74%) were extubated in the OR and brought to the bariatric surgical floor for telemetry monitoring.…”

“…However, for massively obese patients with body mass index (BMI) exceeding 60, the ones most severely disabled by their weight, bariatric surgery, ironically, is technically more difficult and can be more dangerous than it is for less severely obese patients [3][4][5]. While open and laparoscopic gastric bypass and laparoscopic adjustable gastric banding have been performed on patients with BMI >60, technical challenges and post-operative morbidity remain significant [6][7][8][9][10][11][12][13][14][15]. Furthermore, few of these studies have addressed specifically weight loss surgery for the most extremely obese patients with BMI of 70 and above [16,17].…”

Résultats d’un suivi à long terme de la gastroplastie par anneau gastrique ajustable sur une cohorte de 186 patients avec un IMC supérieur ou égal à 50 kg/m2

“…Toutefois, 15 ans plus tard, très peu d'études ont permis d'établir des résultats à long terme, notamment pour les patients à IMC supérieur ou égal à 50 kg/m 2 . On peut noter l'étude de G. Fielding [23] (76 patients à IMC ≥ 60 kg/m 2 avec un suivi médian de 36 mois), celle de R. Mittermair [24] (60 patients à IMC ≥ 50 kg/m 2 suivis pendant 46 mois), l'étude comparative de W. Bowne [25] (106 patients, avec bras de l'anneau gastrique ajustable, qui contient 60 patients à IMC ≥ 50 kg/m 2 avec un suivi médian de 16,2 mois) et enfin celle de F. Torchia [26] (95 patients à IMC ≥ 60 kg/m 2 avec un suivi médian de 24 mois environ). Toutes ces études concernent un nombre limité de patients et représentent un suivi qui ne va pas au-delà du moyen terme.…”

Management of Extreme Obesity (BMI > 60 kg/m2)

“…Weiner et al showed 53 % EWL in 28 patients at 2 years follow up [ 11 ]. Torchia has managed to show 82 % EWL at 4 years follow up with 5 patients and 69.7 % in 55 patients at 2 years follow up [ 12 ]. Proponents of banding in extreme obesity draw attention to the near absence of mortality and morbidity when compared to LRYGB or LVSG; they also claim LAGB needs shorter operating times and length of hospital stay [ 13 ].…”