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Defining Success After Gastric Bypass in the Super-Super Obese.
*Ian C Bostock, *Maureen V Hill, *Sarah E Billmeier, *Escar Kusema, *Maureen Quigley, Gina L Adrales
Dartmouth Hitchcock Medical Center, Lebanon, NH

Objective To compare the effectiveness of Roux-n-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) among super-super obese (SSO) (BMI>60) patients.
Design A retrospective review of a prospective database of SSO patients undergoing LRYGB or LSG from 2009-2015 was performed. Percent of excess weight loss (EWL) at 6 and 12 months was documented with success defined as EWL >30% at 6 and >50% at 12 months. Univariate associations between success of therapy and resolution of obesity related comorbidities were determined. T tests and Chi2 were performed.
Setting: Tertiary care center.
Patients: SSO patients.
Interventions: LRYGB vs. LSG.
Main outcome measure: EWL percentage at 6 and 12 months.
Results Fifty-five SSO patients underwent bariatric surgery during this time. The mean EWL at 6 months was 30.6 (±19.37) in LRYGB vs. 23.8 (±12.6) in LSG (p=0.09). The mean EWL at 12 months was 50.6 (±22.3) after LRYGB and 37.8 (±13.5) after LSG (p=0.11). There was no difference in success of therapy 6 months [56.5% (26/46) LRYGB and 41.6% (5/12) LSG, (p=0.35)] at 6 months or 12 months [51.7% (15/29) LRYGB and 22.2% (2/9) LSG (p=0.13)]. Univariate analysis revealed an association between resolution of hypertension, obstructive sleep apnea and CPAP use with success of therapy at 6 months (p=0.007, 0.04 and 0.04 respectively). At 12 months, only resolution of CPAP use remained statistically significant (p=0.03).
Conclusion SSO patients have a similar EWL and success rates after LRYGB and LSG at 6 and 12 months. The influence of comorbidities on failure of therapy warrants further investigation.


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