Background

There is a paucity of data regarding long-term outcomes of patients with super-super-obesity (SSO), Body Mass Index (BMI)>60kg/m2, following laparoscopic sleeve gastrectomy (LSG). A high-volume single-center experience was reviewed to evaluate the safety and long-term efficacy of LSG in patients with SSO compared to those without (non-SSO).

Methods

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project database was used to identify all patients undergoing LSG at a single institution between 1/1/2014 and 12/31/2019. Patients were stratified by BMI>60kg/m2. Pre-operative comorbidities, operative characteristics, post-operative complications, short-term (1, 3, 6 month) and long-term (12, 24 months) outcomes were compared.

Results

Of 468 patients undergoing LSG, 65 (13.9%) had BMI>60 kg/m2. SSO had higher preoperative rate of obstructive sleep apnea (73.8% vs 48.3%, p<0.01) and hypertension (66.2% vs 49.0%, p=0.01). While SSO had higher rate of postoperative UTI (3.1% vs 0.5%, p=0.04), there was no difference in rates of other post-operative complications. Percent excess BMI loss was higher at all time points in the non-SSO group. However, percent total body weight loss was comparable for both groups at all intervals (Table). Sub analysis of diabetic patients demonstrated similar pre- and post-operative Hemoglobin A1c (pre: 6.85+-1.36 vs 7.13+-1.70, p=0.76; post: 5.79+-1.12 vs 5.85+-1.0, p=0.551) and insulin requirement rate (pre: 30% vs 17%, p=0.17; post: 15% vs 7%, p=0.24).

Conclusions

LSG can safely and effectively be performed in patients with BMI>60kg/m2. Similar weight loss and improvement in glycemic control demonstrate the substantial benefit of LSG in this high-risk group.