Introduction: The best bariatric procedure for super-obese patients is not well defined. Our current practice of assigning patients with a BMI ≥60 kg/m2 to undergo the malabsorptive Very Long Roux-en-Y Gastric Bypass (VLRYGB), and patients with BMI <60 kg/m2 to undergo proximal Roux-en-Y Gastric Bypass (RYGB), is based on empirical observations and historical data. Hence, patients with BMI 59 or 60 will undergo two different procedures (RYGB vs. VLRYGB, respectively). Our choice of a VLRYGB was based on our initial and disappointing results with RYGB for patients whose BMI was ≥60 kg/m2; additionally, we did not have preliminary data to justify a randomized trial of RYGB vs. VLRYGB. In this study we aimed to compare the outcomes of two groups of patients with a close range of BMI, namely patients whose BMI was 55-59 kg/m2 and underwent RYGB (Group 1) and patients whose BMI was 60-65 kg/m2 and underwent a VLRYGB (Group 2).
Methods: Prospectively collected data from all patients undergoing gastric bypass at a university-based program from 1998-2006 was evaluated. The BMI of our patient cohort (>1000 patients) is 51±2 kg/m2 [mean ± standard deviation (SD)] Therefore, we selected patients in Group 1 to include those with a BMI 59 -2SD (59-55) and Group 2 included patients with a BMI 60 +2SD (60-65). Means were compared using Fisher and t-tests; p<0.05 was significant.
Results: 106 patients underwent RYGB (Group 1) while 61 patients underwent VLRYGB (Group 2). Both groups had similar age (42±11 vs. 44±9 years), gender distribution (men: 20% vs. 24 %) and prevalence of comorbidities (all p>0.05). Duration of hospital stay and incidence of major complications was similar in both groups; there was only one in-hospital death in Group 2. Median follow up was shorter in Group 1 (11; range: 1-62 months) compared to Group 2 (23; range 1-83 months), p<0.001. Weight loss in patients who were >12 months postoperatively and had up-to-date follow up was similar in both groups [67±19 vs. 63±16 percent excess body weight loss (%EBWL), Group 1 vs. 2, p>0.05]. The majority of patients (78%) in Group 1 lost >50% EBWL, and 15% lost 25-50% EBWL; in Group 2, 83% of patients lost >50% EBWL, and 17% lost 25-50% EBWL (p>0.05).
Conclusion: These data support that the VLRYGB and RYGB have similar medium-term outcomes in two arbitrarily assigned cohorts of super-obese patients. Additional randomized trials are needed to delineate the role of the malabsorptive VLRYGB in the treatment of super-obesity.