The first survey addressing patients with BMI over 50: a survey of 789 bariatric surgeons

Kermansaravi, Mohammad; Laïnas, Panagiotis; Shahabi, Shahab; Yang, Wah; Jazi, Amirhossein Davarpanah; Vilallonga, Ramón; Antozzi, Luciano; Parmar, Chetan; Kassir, Radwan; Chiappetta, Sonja; Zubiaga, Lorea; Vitiello, Antonio; Mahawar, Kamal; Carbajo, Miguel Ángel Martín; Musella, Mario; Shikora, Scott A.

doi:10.1007/s00464-021-08979-w

Cited by 15 publications

(8 citation statements)

References 87 publications

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“…Such data are probably due to the minor impact of the patient’s complexity on the robotic approach when compared to laparoscopy. Indeed, robotic procedures allow to overcome SO and SSO patients-related surgical difficulties, due to the aforementioned advantages of robotic technology [ 28 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted vs laparoscopic bariatric procedures in super-obese patients: clinical and economic outcomes

Marincola,

Procopio,

Pennestrì

et al. 2024

J Robotic Surg

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The increased operative time and costs represent the main limitations of robotic technology application to bariatric surgery. Robotic platforms may help the surgeon to overcome the technical difficulties in super-obese (SO, BMI ≥ 50 kg/m2) patients, in which multi-quadrant operations could be challenging. We aimed to evaluate the effect of robot-assisted (R) versus laparoscopic (L) approaches in Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) and Roux-en-Y Gastric Bypass (RYGB) in SO and Super-Super Obese (SSO, BMI ≥ 60 kg/m2) patients in terms of outcomes and cost-effectiveness. Bariatric procedures performed from 2012 to 2023 were retrospectively reviewed. The inclusion criteria were BMI ≥ 50 kg/m2, primary SADI-S or RYGB. Operative time (OT), early complications, post-operative stay (POS), overall costs and follow-up data were analyzed. A subgroup analysis for surgical procedures and SSO patients was also performed. Among 4596 patients, 174 RYGB and 91 SADI-S in BMI ≥ 50 kg/m2 patients were selected. After Propensity Score Matching analysis, two groups of patients were identified (laparoscopic and robot-assisted), each one composed of 18 RYGB and 26 SADI-S. Intraoperative and post-operative complication rates and POS were comparable. Mean OT was longer in robotic procedures compared with laparoscopy (199.1 ± 65.7 and 109.5 ± 39.1 min, respectively, p < 0.001). The difference in OT was eliminated after only SSO patients were included in the analysis (172.7 ± 24.1 vs 152.6 ± 26.2 min for R-SADI-S and L-SADI-S, respectively, p = 0.107). Robotic surgeries were associated with higher costs (8134.6 ± 1886.7 and 2386.7 ± 388.2 € in R-RYGB and L-RYGB, respectively; 7996.6 ± 873.1 and 3954.6 ± 631.1 € in R-SADI-S and L-SADI-S). Despite increased costs, robotic approach may represent an added value in more complex cases such as SSO patients.

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Section: Discussionmentioning

confidence: 99%

Robot-assisted vs laparoscopic bariatric procedures in super-obese patients: clinical and economic outcomes

Marincola,

Procopio,

Pennestrì

et al. 2024

J Robotic Surg

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“…A survey of 789 MBS surgeons worldwide regarding selection of surgery and management of patients with class IV obesity found that identifying the safest effective procedure for high-BMI patients was a primary challenge. 25 With respect to OAGB, a recent systematic review by Parmar et al that directly compared OAGB to SG and RYGB in class IV and V obesity concluded that the safety of OAGB was equivalent to that of the other two procedures. 16 Still, the existing evidence conflicts on the topic of perioperative complications in higher-BMI patients after OAGB, SG, and RYGB.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Early safety outcomes of laparoscopic one anastomosis gastric bypass in patients with class III, IV, and V obesity

Sakran,

Raziel,

Hod

et al. 2024

World j. surg.

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BackgroundThe extremely obese patient deserves special consideration: significant comorbidities, technical difficulties, and increased postoperative morbidity and mortality are all expected in this patient population. The study compared early postoperative complications (≤30‐day) following one‐anastomosis gastric bypass (OAGB) morbidity in patients with morbid obesity class IV obesity, body mass index (BMI) ≥50–59.9 kg/m2, and class V obesity, BMI ≥60 patients.MethodsWe retrospectively reviewed perioperative OAGB outcomes in three BMI groups. Operative time, length of stay (LOS), and overall early postoperative complication rates were studied. Patient‐reported complications were ranked by Clavien–Dindo Classification (CDC).ResultsBetween January 2017–December 2021, consecutive patients with obesity class III (n = 2950), IV (n = 256), and V (n = 23) underwent OAGB. BMI groups were comparable in sex, age, and associated comorbidities. Mean operative time was significantly longer in the higher BMI groups: class III (66.5 ± 25.6 min), IV (70.5 ± 28.7 min), and V (80.0 ± 34.7 min), respectively (p = 0.018); no difference in LOS. In respective BMI classes, ≤30‐day complication rates were 3.2%, 3.5%, and 4.3% (p = 0.926). The respective number of patients with CDC grades of one to two were 45 (1.5%), 6 (2.3%), and 1 (4.3%), p = 0.500; and in grade ≥3a, 25 (0.8%), 1 (0.4%), 0 (0.0%), p = 0.669. There was 0.06% mortality (n = 2 in 3229), both in BMI class III.ConclusionsOAGB is a safe BS procedure in patients with class III, IV, and V obesity in the perioperative term with comparable ≤30‐day morbidity in the three BMI groups.

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“…A survey of 789 MBS surgeons worldwide regarding selection of surgery and management of patients with class IV obesity found that identifying the safest effective procedure for high-BMI patients was a primary challenge [24]. With respect to OAGB, a recent systematic review by Parmar et al that directly compared OAGB to SG and RYGB in class IV and V obesity concluded that the safety of OAGB was equivalent to that of the other two procedures [15].…”

Section: Discussionmentioning

confidence: 99%

Early Safety Outcomes of Laparoscopic One Anastomosis Gastric Bypass in Patients with Class III, IV and V Obesity

Raziel¹,

Azaria²,

Goitein³

et al. 2023

WJS

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Background: Recent studies have reported higher postoperative complication rates in patients with severe obesity who undergo bariatric surgery. The extremely obese patient deserves special consideration: significant comorbidities, technical difficulties, and increased postoperative morbidity and mortality are all expected in this patient population. Current data are limited and discrepant on the relationship between patients with class IV obesity (body mass index (BMI) ≥50-59.9 kg/m2), and class V obesity (BMI ≥60 kg/m2). This study compared early postoperative complications (≤30-day) following one-anastomosis gastric bypass (OAGB) morbidity in patients with class III, IV, and V obesity. Methods: Retrospective analysis of perioperative OAGB outcomes in three BMI groups at a high-volume hospital. Operative time, length of stay (LOS), and overall early postoperative complication rates were studied. Complications were ranked by Clavien-Dindo classification (CDC). Results: Between January 2017-December 2021, consecutive patients with obesity class III (n= 2,950), IV (n= 256), and V (n= 23) underwent OAGB. BMI groups were comparable in gender, age, and associated comorbidities. Mean operative time was significantly longer in the higher BMI groups: class III (66.5±25.6 min), IV (70.5±28.7 min), and V (80.0±34.7 min), respectively (p= 0.018); no difference in LOS. In respective BMI classes, ≤30-day complication rates were 3.2%, 3.5%, and 4.3% (p= 0.926). The respective number of patients with CDC grades of 1-2 were 45 (1.5%), 6 (2.3%), and 1 (4.3%), p= 0.500; and in grade ≥3a, 25 (0.8%), 1 (0.4%), 0 (0.0%), p= 0.669. No significant differences in rates of early complications, reoperations, and readmissions were found in revisional patients across BMI groups. There was 0.06% mortality (n= 2 in 3,229), both in BMI class III. Conclusion: OAGB is a safe metabolic bariatric surgery procedure in patients with class III, IV, and V obesity in the perioperative term with comparable ≤30-day morbidity in the three BMI groups.

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The first survey addressing patients with BMI over 50: a survey of 789 bariatric surgeons

Cited by 15 publications

References 87 publications

Robot-assisted vs laparoscopic bariatric procedures in super-obese patients: clinical and economic outcomes

Robot-assisted vs laparoscopic bariatric procedures in super-obese patients: clinical and economic outcomes

Early safety outcomes of laparoscopic one anastomosis gastric bypass in patients with class III, IV, and V obesity

Early Safety Outcomes of Laparoscopic One Anastomosis Gastric Bypass in Patients with Class III, IV and V Obesity

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