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. 2022 Aug;36(8):6170-6180.
doi: 10.1007/s00464-021-08979-w. Epub 2022 Jan 21.

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

Mohammad Kermansaravi  1   2 , Panagiotis Lainas  3   4 , Shahab Shahabi Shahmiri  5 , Wah Yang  6 , Amirhossein Davarpanah Jazi  7 , Ramon Vilallonga  8   9 , Luciano Antozzi  10 , Chetan Parmar  11   12 , Radwan Kassir  13 , Sonja Chiappetta  14 , Lorea Zubiaga  15 , Antonio Vitiello  16 , Kamal Mahawar  17 , Miguel Carbajo  18 , Mario Musella  19 , Scott Shikora  20
Affiliations

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

Mohammad Kermansaravi et al. Surg Endosc. 2022 Aug.

Abstract

Background: Bariatric surgery in patients with BMI over 50 kg/m2 is a challenging task. The aim of this study was to address main issues regarding perioperative management of these patients by using a worldwide survey.

Methods: An online 48-item questionnaire-based survey on perioperative management of patients with a BMI superior to 50 kg/m2 was ideated by 15 bariatric surgeons from 9 different countries. The questionnaire was emailed to all members of the International Federation of Surgery for Obesity (IFSO). Responses were collected and analyzed by the authors.

Results: 789 bariatric surgeons from 73 countries participated in the survey. Most surgeons (89.9%) believed that metabolic/bariatric surgery (MBS) on patients with BMI over 50 kg/m2 should only be performed by expert bariatric surgeons. Half of the participants (55.3%) believed that weight loss must be encouraged before surgery and 42.6% of surgeons recommended an excess weight loss of at least 10%. However, only 3.6% of surgeons recommended the insertion of an Intragastric Balloon as bridge therapy before surgery. Sleeve Gastrectomy (SG) was considered the best choice for patients younger than 18 or older than 65 years old. SG and One Anastomosis Gastric Bypass were the most common procedures for individuals between 18 and 65 years. Half of the surgeons believed that a 2-stage approach should be offered to patients with BMI > 50 kg/m2, with SG being the first step. Postoperative thromboprophylaxis was recommended for 2 and 4 weeks by 37.8% and 37.7% of participants, respectively.

Conclusion: This survey demonstrated worldwide variations in bariatric surgery practice regarding patients with a BMI superior to 50 kg/m2. Careful analysis of these results is useful for identifying several areas for future research and consensus building.

Keywords: BMI over 50; Bariatric surgery; Super obesity; Survey.

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Conflict of interest statement

Mohammad Kermansaravi, Panagiotis Lainas, Shahab Shahabi Shahmiri, Wah Yang, Amirhossein Davarpanah Jazi, Ramon Villalonga, Luciano Antozzi, Chetan Parmar, Radwan Kassir, Sonja Chiappetta, Lorea Zubiaga, Antonio Vitiello, Kamal Mahawar, Miguel Carbajo, Mario Musella, and Scott Shikora declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Procedure of choice for three age categories of patients with BMIs over 50 kg/m2 as reported by the participants of the survey. A Under 18 years old, B 18 to 65 years old, and C older than 65 years old. LAGB laparoscopic adjustable gastric banding, LSG laparoscopic sleeve gastrectomy, LRYGB-S standard Roux-en-Y gastric bypass, LRYGB-LAL Roux-en-Y long alimentary limb > 100 cm gastric bypass, LRYGB-LBL Roux-en-Y long biliary limb > 150 cm gastric bypass, OAGB-F one anastomosis gastric bypass with fixed limb measures, OAGB-T one anastomosis Gastric Bypass with tailored limb measures, SADI-S single anastomosis duodeno–ileal bypass with sleeve gastrectomy, BPD-DS biliopancreatic diversion with duodenal switch
Fig. 2
Fig. 2
Metabolic and bariatric surgeries (MBS) algorithm in patients with BMIs over 50 based on respondent's answers. The percentage of the most responses of each items was mentioned. LSG laparoscopic sleeve gastrectomy, LRYGB-S standard Roux-en-Y Gastric Bypass, OAGB-T one anastomosis gastric bypass with tailored limb measures, SADI-S single anastomosis duodeno–ileal bypass with sleeve gastrectomy, BPD-DS biliopancreatic diversion with duodenal switch
See this image and copyright information in PMC

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