Sleeve gastrectomy as a bridge to a second bariatric procedure in superobese patients--a single institution...

The surgical treatment of superobese patients (body mass index ≥50 kg/m(2)) with significant co-morbidities remains a challenge. We evaluated our outcomes after initial laparoscopic sleeve gastrectomy (LSG) in the superobese undergoing staged procedures in the setting of a university hospital in the United Kingdom.

The data from patients with a body mass index of ≥50 kg/m(2) undergoing LSG as a part of a staged procedure from 2005 to 2008 were extracted from our database. The patient parameters were analyzed, along with the morbidity, length of stay, and weight loss after the initial procedure.

A total of 61 patients with a body mass index of ≥50 kg/m(2) (median 60, range 50-81.5) underwent LSG as a part of a staged procedure during the study period. The median age was 46 years (range 24-61.5), and 41 were women. Obesity-related co-morbidities were present in different combinations in 51 patients (83.6%). All the procedures were completed laparoscopically, barring 1. The median hospital stay was 4 days (interquartile range 3-4). Complications occurred in 6 patients (9.8%), and 3 required repeat laparoscopy for complications. No patient died. The median percentage of excess weight loss was 31% at 6 months (interquartile range 26-40) and 39% at 1 year (interquartile range 34-51). Diabetes, obstructive sleep apnea and hypertension had resolved in 90%, 100%, and 61% of the patients, respectively. Of the 61 patients, 41 went on to undergo a second-stage procedure, of whom 1 underwent laparoscopic Roux-en-Y gastric bypass, 5 underwent repeat LSG, and the rest underwent laparoscopic duodenal switch.

LSG is safe and effective for initial weight loss in the superobese undergoing 2-stage procedures.