1. Laparoscopic roux en y gastric bypass is safe and effective in patients with a BMI ≥ 60.
Wilson MSJ, Alhamdani A, Mahawar K, Boyle M*, Schroeder N, Balupuri S, Small PK
Department of General Surgery and Dietetics*, Sunderland Royal Hospital

2. BACKGROUND
Performing laparoscopic roux-en-y gastric bypass (LRYGB) in patients with BMI ≥60 is accepted to be more technically challenging than in patients with BMI <60.
Between January 2005 and August 2010 we have performed 309 LRYGB, of which 43 had BMI ≥60.
We present our experience with this cohort of patients.

3. METHODS
Patients who had undergone LRYGB were identified from our prospectively maintained database.
Patients were then classified as group A (BMI ≥ 60) or group B (BMI <60).
We compared Group A and Group B with regards to demographics, morbidity, mortality and weight loss with the application of Mann Whitney and Fisher’s exact test.

4. RESULTS 43 (14%) patients had BMI ≥ 60
Mean preoperative BMI was 66.2 in group A (range 60.0 to 80.3) versus 49.3 in group B (37.0 to 59.7), p-value <
There was no mortality in either cohort.
1 patient had early (<30d) reoperation for anastamotic leak.
2 patients required late (>30d) reoperations:
Incisional hernia
Drainage of intraabdominal abscess
Refashioning of jejunostomy (anastamotic ulcer), internal hernia repair and drainage of intraabdominal abscess

5. RESULTS Group A (n=43) Group B (n=266) P value Female:male 38:5 210:56
0.2140
Mean age
40.8
43.6
0.0590
Mean preoperative BMI
66.2
49.3
<0.0001
Mean % excess weight loss
51.2
54.9
0.2802
Mean follow-up (mo)
15.9
18.2
0.6841
Mean operating time
2h 55m
3h 00m
0.2318
Post op hospital stay
3.4
3.7
0.1088
Early readmission rate
4.7%
6.8%
1.000
Late readmission rate
18.6%
14.7%
0.4957
Conversion to open (%)
1 (2.3%)
4 (1.5%)
0.5298
Postop cholecystectomy
2 (4.7%)
5 (1.9%)
0.2525
Primary balloon insertion
7 (16.3%)
17 (6.4%)
0.0575

6. DISCUSSION
Patients with BMI ≥ 60 did not show any significant difference in terms of conversion to open procedure, weight loss or readmission rates.
These results include both primary and secondary LRYGB bypass patients.

7. CONCLUSION
We demonstrate safe and effective performance of LRYGB in patients with BMI ≥ 60.
Morbidity, mortality, and weight loss is comparable with our patients with BMI <60.
Our results are comparable with other published studies on patients with BMI ≥ 601,2.

8. REFERENCES
Alfalah H, Philippe B, Ghazal F, Jany T, Arnalsteen L, Romon M & Pattou F. Intragastric balloon for Preoperative Weight Reduction in Candidates for Laparoscopic Gastric Bypass with Massive Obesity. Obesity Surgery. 2006;16(2):
Farkas DT, Vemulapalli P, Haider A, Lopes JM, Gibbs KE & Teixeira JA. Laparoscopic Roux-en-Y Gastric Bypass is Safe and Effective in Patients with a BMI ≥ 60. Obesity Surgery. 2005;15(4):