Is gastric bypass associated with more complications in patients weighing >500 lb (>227 kg)?

Increasing weight and BMI are believed to be independent risk factors for postoperative morbidity and mortality following Roux-en-Y gastric bypass (RYGBP).

A retrospective chart review was performed. 25 patients weighing >500 lb (227 kg), mean BMI 78 kg/m(2) (range 69-97) underwent open RYGBP by a single surgeon over a 3-year period (Group A). Co-morbid conditions included diabetes, hypertension, obstructive sleep apnea, degenerative joint disease, and gastroesophageal reflux disease. Acute complications in this group were compared with an age and gender matched cohort of patients with similar co-morbidities who underwent the same operation by the same surgeon during the same period (Group B). The study group was also compared with the cumulative data of all patients who underwent the open RYGBP during the same period (Group C, n=253). Comparisons were made for hospital length of stay, ICU days, mortality, deep vein thrombosis (DVT), pulmonary embolism (PE), anastomotic leak, evisceration, and need for postoperative ventilation or reoperation.

There was no mortality,evisceration, leaks, or reoperation in the study group and no statistically significant differences between the groups. The incidence of DVT and PE was also not significantly different among the 3 groups. The days on postoperative mechanical ventilation (7 vs 0 vs 0 days), ICU days (0.68 vs 0 vs 0.03 days), and total LOS (4.56 vs 3.04 vs 3.0 days) was greater in the study group and statistically significant.

Gastric bypass in patients weighing >500 lb (>227 kg) can be performed safely. A longer LOS, need for ICU stay and mechanical ventilation should be anticipated. Complications in this group were no greater than age-matched controls who weighed <500 lb or when compared with all patients who underwent RYGBP over the 3 years. Super-obese patients should not be discriminated against when considering a surgical option.