Laparoscopic Gastric Bypass vs. Sleeve Gastrectomy in the Super Obese Patient: Early Outcomes of an Observational Study

Background Super obesity [body mass index (BMI) > 50 kg/m(2)] can yield to higher morbidity/mortality in bariatric surgery, this could be related to patient's characteristics and/or surgeon's experience. In morbid obesity, both techniques proved to have a positive impact and sometimes comparable outcomes during the first 2 years. This has not been clearly analyzed in the super obese patient. Methods Retrospective study comparing the records of 77 consecutive super obese patients (BMI: 50-59.9 kg/m(2)) submitted to either laparoscopic gastric bypass (LGBP, n = 32) or laparoscopic sleeve gastrectomy (LSG, n = 45) between 2010 and 2012 at a single institution. The primary objective was to analyze baseline demographics, comorbidities, operative outcomes, and early complications (< 30 days). Secondarily, weight loss [BMI and % excess weight loss (%EWL)] was also described and compared during the first year. Results Female sex comprised 72.7 % of all cases. Both groups had comparable BMI (52.7 +/- 2.1 kg/m(2) for LGBP vs. 53.87 +/- 2.8 kg/m(2) for LSG; p = 0.087) and homogeneous baseline characteristics. Operative time was lower for the LSG group (113.1 +/- 35.3 vs. 186.9 +/- 39 min for LGBP; p a parts per thousand currency signaEuro parts per thousand 0.001). Overall, early complications were observed in 16.8 % of patients (LGBP 9 % vs. LSG 22 %; p = 0.217). There were four major complications (two in each group), with two reinterventions. Weight loss (%EWL) at 6, 9, and 12 months was significantly higher in the LGBP group (51.6 +/- 12.9 %, 56.5 +/- 13 %, 63.9 +/- 13.3 %, respectively) than in the LSG group (40 +/- 12.8 %, 45.1 +/- 15.5 %, 43.9 +/- 10.4 %, respectively). Conclusions Just like in morbid obesity, LGBP and LSG are effective and safe procedures in super obese patients. LGBP had better weight loss at 1 year.