Laparoscopic sleeve gastrectomy for the super-super-obese (body mass index >60 kg/m(2))

Abstract

Purpose: We reviewed our experience of performing laparoscopic sleeve gastrectomy (LSG) in super-superobese (body mass index >60 kg/m(2)) patients and compared our results with those of laparoscopic adjustable gastric banding (LAGB) performed in similar patients.

Methods: All LSGs performed by our group were reviewed retrospectively. We analyzed only patients whose preoperative body mass index (BMI) was greater than 60 kg/m(2) and compared the results with a report in the literature of super-super-obese patients treated with LAGB.

Results: Between October 2000 and November 2005 we performed 63 LSGs for super-super-obese patients whose average preoperative BMI was 68 kg/m(2). By 6 months postoperatively, the average BMI had decreased to 58 kg/m(2). Forty-three patients subsequently underwent a second-stage duodenal switch procedure within 1 year. The BMI of the 20 patients who did not undergo further surgery decreased further to 50 kg/m(2), 1 year after the LSG.

Conclusions: Laparoscopic sleeve gastrectomy is comparable with LAGB for promoting short-term weight-loss in the super-super-obese. The benefits of LSG over LAGB include a decreased need for reoperation; first, because foreign material is not implanted in the body; and second, because the residual ghrelin-producing gastric mass is much smaller.