Laparoscopic sleeve gastrectomy: A staged procedure for super-super obese patients

Abstract

Although laparoscopic bariatric surgery has evolved into a very safe and effective procedure, the super-super obese patients (BMI >60) continue to pose significant technical challenges. This translates to higher complications and poor outcomes in this group of patients, irrespective of the nature of the surgery. There seems to be a linear correlation between the outcomes and the risk of the surgery. The riskier the operation is-laparoscopic bilio-pancreatic diversion with duodenal switch (BPD-DS), laparoscopic Roux-en-Y gastric bypass (LGBP)-the more effective weight loss appears to be. The challenges in super-superobese patients (BMI >60) are both functional as well as technical. The functional challenges include poor cardiopulmonary reserve, exercise intolerance, restrictive as well as obstructive lung disorders (translates into inability to tolerate anesthesia) and inability to ambulate. © 2008 Springer New York.