Surgery in Patients with Super Obesity: Medium‐Term Follow‐Up Outcomes at a High‐Volume Center

Abstract

Objective There is a need to determine which bariatric operations are the most effective for patients with super obesity and super‐super obesity. Methods A retrospective cohort study was performed on patients with super obesity and super‐super obesity at Mohak Bariatrics and Robotics Surgery Center in Indore, India. Results Five hundred fourteen patients with super obesity and super‐super obesity had surgery at our center from January 2010 through December 2013. The baseline characteristics were different in different operations. The initial average age, weight, and BMI were 44.4 (SD 11.9) years, 145.4 (SD 24.2) kg, and 55.48 (SD 5.32) kg/m2, respectively. Sleeve gastrectomy (SG) (227 [44.2%]) was the most common procedure, followed by one‐anastomosis gastric bypass (OAGB) (124 [24.1%]), Roux‐en‐Y gastric bypass (RYGB) (102 [19.8%]), banded sleeve gastrectomy (BSG) (33 [6.4%]), and banded Roux‐en‐Y gastric bypass (BRYGB) (28 [5.4%]). After 3 years, the percentages of excess body weight loss (%EBWL) for SG, OAGB, RYGB, BSG, and BRYGB were 62.38%, 78.59%, 69.55%, 85.11%, and 75.77% (P < 0.0001), respectively. Failure to achieve BMI < 35 kg/m2 was more frequent in the group who underwent SG (67.9%), followed by RYGB (29.16%), BRYGB (22.2%), OAGB (9.87%), and none in the BSG group. Conclusions BSG, OAGB, and BRYGB have very good to excellent midterm outcomes for patients with super obesity and super‐super obesity, whereas RYGB and SG have average outcomes at 3 years. There is a need for multicenter, long‐term, and prospective studies to be performed to confirm these findings.

What is The Effect of Sleeve Gastrectomy in Patients with a BMI ≥ 50 kg/m2?

“…In years 2 and 3 of this study, the EWL% was found to be 74.24% and 62.38% in the SG group and 71.4% and 69.55% in the RYBG group. Again, in the same study, this rate was identi ed as 87.88% and 85.11% in the Banded SG group (27). Rendo A et al…”

“…In the RYGB group, these were 67.58 and 72.19, respectively (29). In a study performed by (27). Arapis K et al also recommended SG as the primary surgical procedure in a study on a group of SSO patients.…”

“…Some studies performed showed that SG provided more weight loss and caused less development of insulin sensitivity as compared to RYGB (24,25). On the other hand, recent randomized clinical studies showed that SG and RYGB were equally effective in weight loss and treatment of comorbidities (26,27). One of the most important methods used to assess the success of surgery is EWL%.…”

Time to Seek a More Personalized Approach to Bariatric Surgery

“…Bhandari et al (3) found that 67.9% of patients with super obesity who had undergone SG failed to lose sufficient weight (defined as BMI ≥ 35) at 3 years. In comparison, only 29.2% of their patients who had undergone RYGB experienced weight loss failure during the same period.…”

“…In 2016, 69.8% of laparoscopic bariatric procedures in the United States were SG procedures (2). As with behavioral and medical approaches to obesity, the study by Bhandari et al (3) suggests that no one procedure is best for all. As more patients with super obesity seek bariatric procedures, establishing a more personalized bariatric approach is imperative.…”