Outcomes of bariatric surgery in extreme obesity: results from the United Kingdom National Bariatric Surgery Registry for patients with a body mass index >70 kg/m2 |
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| Institution: | 1. Department of Metabolism, Digestion and Reproduction, Hammersmith Hospital, Imperial College London, London, United Kingdom;2. Department of Upper Gastrointestinal and Bariatric Surgery, The Whittington Hospital NHS Trust, London, United Kingdom;3. Department of Anaesthetics, Croydon University Hospital, Thornton Heath, United Kingdom;4. Department of Surgery and Cancer, Imperial College London, London, United Kingdom;5. Department of Bariatric Surgery, Sunderland Royal Hospital, Kayll Road, Sunderland, London, United Kingdom;6. Department of Bariatric Surgery, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom;1. Department of Gastroenterology, Health Research Institute (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain;2. Department of Endocrinology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain;1. Department of General Surgery, Temple University Hospital, Philadelphia, Pennsylvania;2. Department of Minimally Invasive and Bariatric Surgery, Temple University Hospital, Philadelphia, Pennsylvania;3. Department of Clinical Sciences, Temple University Hospital, Philadelphia, Pennsylvania;4. Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania;1. Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania;2. Department of General Surgery, Temple University Hospital, Philadelphia, Pennsylvania;3. College of Public Health, Temple University, Philadelphia, Pennsylvaia;4. Department of Minimally Invasive and Bariatric Surgery, Temple University Hospital, Philadelphia, Pennsylvania;1. Geisinger Obesity Institute, Danville, Pennsylvania;2. Department of Medical Genetics and Molecular Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania;3. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Massachusetts;1. Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, Texas;2. Department of Surgery, Mayo Clinic, Rochester, Minnesota;3. Universidad Autonoma de Guadelajara, Guadelajara, Mexico;1. Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland;2. Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland;3. Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland;4. Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland |
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| Abstract: | BackgroundBariatric and metabolic surgery (BMS) is an established safe, effective, and durable treatment for obesity and its complications. However, there is still a paucity of evidence on surgery outcomes in patients suffering from extreme obesity.ObjectivesThis study aimed to evaluate outcomes of BMS in weight loss and the resolution of co-morbidities in patients with a body mass index (BMI) ≥70kg/m2.SettingNational Health Service and private hospitals in the United Kingdom.MethodsThis cohort study analyzed prospectively collected records from the UK National Bariatric Surgery Registry of patients with a BMI ≥70 kg/m2 undergoing Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), or adjustable gastric band (AGB) between January 2009 and June 2014.ResultsThere were 230 patients (64% female) eligible for inclusion in the study: 22 underwent AGB; 102 underwent SG, and 106 underwent RYGB. Preoperative weight and BMI values were comparable (76 ± 7 kg/m2 for AGB; 75 ± 5 kg/m2 for SG; 74 ± 5 kg/m2 for RYGB). The median postoperative follow-up was 13 months for AGB (10–22 mo), 18 for SG (6–28 mo), and 15 for RYGB (6–24 mo). Patients undergoing RYGB and SG exhibited the greatest postoperative total body weight loss (35 ± 13% and 31 ± 15%, respectively; P = .14), which led to postoperative BMIs of 48 ± 10 kg/m2 and 51 ± 11 kg/m2, respectively (P = .14). All procedures conferred a reduction in the incidence of co-morbidities, including type 2 diabetes, and led to improved functional statuses. The overall complication rate was 7%, with 3 deaths (1%) within 30 days of surgery.ConclusionThis study found that primary BMS in patients with a BMI >70kg/m2 has an acceptable safety profile and is associated with good medium-term clinical outcomes. RYGB and SG are associated with better weight loss and great improvements in co-morbidities than AGB. Given the noninferiority of SG outcomes and SG’s potential for further conversion to other BMS procedures if required, SG may be the best choice for primary BMS in patients with extreme obesity. |
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| Keywords: | Bariatric and metabolic surgery Extreme obesity National Bariatric Surgery Registry |
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