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Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient.
Obes Surg. 2003 Dec; 13(6):861-4.OS

Abstract

BACKGROUND

Surgical management of the supersuper obese patient (BMI >60 kg/m2) has been a challenging problem associated with higher morbidity, mortality, and long-term weight loss failure. Current limited experience exists with a two-stage biliopancreatic diversion and duodenal switch in the supersuper obese patient, and we now present our early experience with a two-stage gastric bypass for these patients.

METHODS

We completed a retrospective bariatric database and chart review of super-super obese patients who underwent laparoscopic sleeve gastrectomy as a first-stage procedure followed by laparoscopic Roux-en-Y gastric bypass as a second-stage for more definitive treatment of obesity.

RESULTS

During a two-year period, 7 patients with BMI 58-71 kg/m2 underwent a two-stage laparoscopic Roux-en-Y gastric bypass by two surgeons at the Mount Sinai Medical Center. 3 patients were female, 4 patients were male, and the average age was 43. Prior to the sleeve gastrectomy, the mean weight was 181 kg with a BMI of 63. Average time between procedures was 11 months. Prior to the second-stage procedure, the mean weight was 145 kg with a BMI of 50 and average excess weight loss of 37 kg (33% EWL). Six patients have had follow-up after the second-stage procedure with an average of 2.5 months. At follow-up the mean weight was 126 kg with a BMI of 44 and average excess weight loss of 51 kg (46% EWL). The mean operative times for the two procedures were 124 and 158 minutes respectively. The average length of stay for all procedures was 2.7 days. 4 patients had 5 complications, which included splenic injury, proximal anastomotic stricture, left arm nerve praxia, trocar site hernia, and urinary tract infection. There were no mortalities in the series.

CONCLUSIONS

Laparoscopic sleeve gastrectomy with second-stage Roux-en-Y gastric bypass are feasible and effective procedures based on short-term results. This two-stage approach is a reasonable alternative for surgical treatment of the high-risk supersuper obese patient.

Authors+Show Affiliations

Division of Laparoscopic Surgery, Department of Surgery, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1103, New York, NY, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14738671

Citation

Regan, J P., et al. "Early Experience With Two-stage Laparoscopic Roux-en-Y Gastric Bypass as an Alternative in the Super-super Obese Patient." Obesity Surgery, vol. 13, no. 6, 2003, pp. 861-4.
Regan JP, Inabnet WB, Gagner M, et al. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003;13(6):861-4.
Regan, J. P., Inabnet, W. B., Gagner, M., & Pomp, A. (2003). Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obesity Surgery, 13(6), 861-4.
Regan JP, et al. Early Experience With Two-stage Laparoscopic Roux-en-Y Gastric Bypass as an Alternative in the Super-super Obese Patient. Obes Surg. 2003;13(6):861-4. PubMed PMID: 14738671.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. AU - Regan,J P, AU - Inabnet,W B, AU - Gagner,M, AU - Pomp,A, PY - 2004/1/24/pubmed PY - 2004/5/5/medline PY - 2004/1/24/entrez SP - 861 EP - 4 JF - Obesity surgery JO - Obes Surg VL - 13 IS - 6 N2 - BACKGROUND: Surgical management of the supersuper obese patient (BMI >60 kg/m2) has been a challenging problem associated with higher morbidity, mortality, and long-term weight loss failure. Current limited experience exists with a two-stage biliopancreatic diversion and duodenal switch in the supersuper obese patient, and we now present our early experience with a two-stage gastric bypass for these patients. METHODS: We completed a retrospective bariatric database and chart review of super-super obese patients who underwent laparoscopic sleeve gastrectomy as a first-stage procedure followed by laparoscopic Roux-en-Y gastric bypass as a second-stage for more definitive treatment of obesity. RESULTS: During a two-year period, 7 patients with BMI 58-71 kg/m2 underwent a two-stage laparoscopic Roux-en-Y gastric bypass by two surgeons at the Mount Sinai Medical Center. 3 patients were female, 4 patients were male, and the average age was 43. Prior to the sleeve gastrectomy, the mean weight was 181 kg with a BMI of 63. Average time between procedures was 11 months. Prior to the second-stage procedure, the mean weight was 145 kg with a BMI of 50 and average excess weight loss of 37 kg (33% EWL). Six patients have had follow-up after the second-stage procedure with an average of 2.5 months. At follow-up the mean weight was 126 kg with a BMI of 44 and average excess weight loss of 51 kg (46% EWL). The mean operative times for the two procedures were 124 and 158 minutes respectively. The average length of stay for all procedures was 2.7 days. 4 patients had 5 complications, which included splenic injury, proximal anastomotic stricture, left arm nerve praxia, trocar site hernia, and urinary tract infection. There were no mortalities in the series. CONCLUSIONS: Laparoscopic sleeve gastrectomy with second-stage Roux-en-Y gastric bypass are feasible and effective procedures based on short-term results. This two-stage approach is a reasonable alternative for surgical treatment of the high-risk supersuper obese patient. SN - 0960-8923 UR - https://www.unboundmedicine.com/medline/citation/14738671/Early_experience_with_two_stage_laparoscopic_Roux_en_Y_gastric_bypass_as_an_alternative_in_the_super_super_obese_patient_ L2 - https://dx.doi.org/10.1381/096089203322618669 DB - PRIME DP - Unbound Medicine ER -