Background

The new ASMBS/IFSO guidelines recommend bariatric surgery (MBS) as the preferred method to achieve weight loss in patients with extreme BMI. There are limited safety reports of MBS in patients with BMI≥70kg/m2. There exists no consensus on the best procedure in this cohort. We aim to compare the safety profiles, early and medium-term outcomes of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and duodenal switch (DS) in patients with BMI≥70kg/m2.

Methods

A multicenter retrospective review of patients who underwent SG, RYGB or DS as a primary procedure with a BMI≥70kg/m2 was performed. Patient baseline characteristics, perioperative complications and weight loss outcomes at 6, 12 and 24 months were collected. Kruskal-Wallis and Independent t-tests were used to analyze continuous variables.

Results

156 patients with BMI≥70kg/m2 underwent MBS (SG = 40, RYGB=40 and DS=76). Patient demographics and baseline characteristics were similar between all cohorts. Average baseline BMI was 75.5 kg/m2. %Total weight loss (TWL) at 24 months was highest in the DS group compared to RYGB (40.6% vs. 33.8%, p-value=0.03) and SG (40.6% vs. 28.5%, p-value=0.01). There was no significant difference between RYGB and SG (33.8% vs . 28.5%, p-value=0.20). The 30-day complication rates were similar [SG (7.5%), RYGB (10%), and DS (9.2%) (p-value=1.0)]. There was one reported leak (DS). The 30-day mortality was zero.

Conclusions

MBS is safe and effective in patients with BMI≥70kg/m2. All procedures had comparable safety profiles and complication rates. DS is the most effective procedure and achieved the highest %TWL at 24 months