Super obese patients undergoing bariatric surgery present multiple risks for medical, surgical and anesthetic complications. The best surgical procedure for the super obese patient to achieve optimum weigh loss is always a matter of concern. The high rate of risk dictates that this group of patients needs less aggressive, shorter duration, and less invasive surgical treatment options.
In a research article published in the Obesity Surgery journal in 2009, authored by Fiore Torchia and colleagues, The LapBand System was evaluated as a surgical procedure for the super-super obese (BMI>60). This type of surgery has a relatively short duration, lasting approximately 40 minutes.
A number of pre-operative co-morbidities were diagnosed in the 823 patients who underwent the LAGB bariatric surgical procedure.
- Hypertension in 49.3% of the patients
- Diabetes in 12.6% of the patients
- Sleep Apnea and Pickwick Syndrome in 39.4% of the patients
- Osteoarthropathy in 71.8% of the patients
- Dyslipidemia, (LDL>250 mg/dl, Triglycerides >250 mg/dl) in 24.9% of the patients
- NASH (liver inflammation) in 11.1% patients
Necessary band adjustments varied among the patient group. No band adjustment was needed in 3% of the 823 patients. Twenty-four percent of patients received one adjustment, 42% received two, 16% received three, and 10% patients received four band adjustments.
Post-op Weight Loss And BMI Change
As the figure shows, one year after surgery the average BMI was 43.6. Two years post-operatively the BMI dropped to 37.9. Three years and 4 years after surgery the BMI was 29.1 and 28.9, respectively. Excess weight loss (EWL, the percentage of excess weight that was lost) increased during that time from 53.6% (one year post-op) to 82.1% (four years post-op).
Laparoscopic Options For Super Obese
Bariatric surgery for patients with a BMI above 60 is considered a challenge field due to the high risk of morbidity and mortality. The best surgical option for this class of patients is still under investigation. Options include BPD (biliopancreatic diversion), RYGBP (Roux-en-Y gastric bypass), and LAGB (laparoscopic adjustable gastric banding).
Though few comparative studies have been published, there are some reports from which to glean information.
Mongol reported that RYGBP has an early complication rate of 10% in super obese patients. In contrast, LAGB is associated with significantly lower early complications, at only 2.8%.
According to Dolan et al. super obese patients suffered more complications with BPD (56.5%) than patients with LAGB (8.3%) . These complications included anastomotic leaks, wound problems and bleeding.
The Best Choice For Super Obese
According to Torchia it is important that super obese patients be treated less aggressively, with a shorter and less invasive surgical approach, because of the high rate of complications.
Based on his experience with LAGB patients of BMI>60, where mortality was absent with only two minor complications, Torchia conludes that “LAGB can be considered an appropriate bariatric surgical option in super- obese patients, both for low morbidity rate and weight loss”.