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  • Title: Outcome of hand-assisted laparoscopic gastric bypass in super obese patients.
    Author: Hamed O, Kerlakian G, Engel A, Bollmer C.
    Journal: Surg Obes Relat Dis; 2008; 4(5):618-24. PubMed ID: 18226979.
    Abstract:
    BACKGROUND: The optimal surgical treatment for super obese patients (body mass index [BMI] >or=50 kg/m2) has been a challenge and debate for most bariatric surgeons. To compare the outcomes of hand-assisted laparoscopic Roux-en-Y gastric bypass (HALGB) in super obese patients (BMI >or=50 kg/m2) to morbidly obese patients (BMI <50 kg/m2). METHODS: A total of 295 patients who underwent HALGB from October 2003 to December 2005 were studied. These patients included 177 with a BMI of <or=49 kg/m2 (morbidly obese) and 118 with a BMI of >or=50 kg/m2 (super-obese). The patient demographics, complications, and outcomes were examined. Additionally, the 12-month postoperative outcomes included the percentage of excess weight loss and improvement of co-morbidities. RESULTS: The patient age and gender were similar between the 2 groups. The super-obese patients had significantly more co-morbidities and required a greater number of medications. A significant difference was found in 3 early postoperative complications, with super-obese patients experiencing more wound infections (P = .039), nausea/vomiting (P = .003), and pulmonary failure (P = .010). Logistic regression analysis found, after controlling for significant risk factors, that the difference in the incidence of nausea/vomiting was still significant (odds ratio 14.33, 95% confidence interval 1.73-118.60, P = .01). Morbidly obese patients had a significantly greater percentage of excess weight loss at 12 months postoperatively compared with the super-obese patients (80% versus 55%, respectively, P <.001). CONCLUSION: HALGB is a safe and effective procedure in the super obese but with less favorable outcomes compared with those for morbidly obese patients regarding the percentage of excess weight loss.
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