Staging Weight Loss Surgery for the Morbidly Obese

A study has shown that a staged approach to Roux-en-Y gastric bypass surgery, in which high-risk, mobidly obese patients first undergo a procedure called laparoscopic sleeve gastrectomy (LSG), greatly reduces operative risk and results in significant short-term weight loss. The study was presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons in Denver (CO, USA) in 2004.

In LSG, a large portion of the stomach is surgically removed, and the stomach is reduced from being quart-sized and football-shaped to about the size and shape of a banana. The Roux-en-Y procedure involves constructing a small stomach pouch about the size of a plastic medicine cup and bypassing a small segment of intestines by constructing a Y-shaped limb of small bowel.

The study involved 75 patients, aged 23-72, with a body mass index ranging from 45-91, who underwent a LSG as an initial procedure at the University of Pittsburgh Medical Center (PA, USA; www.upmc.edu). Co-morbidities included obstructive sleep apnea (88%), degenerative joint disease (60%), asthma (18%), and coronary artery disease (18%). Of these, 64% were judged to be high-risk and 34% very high-risk. After six months, the patients had a mean body mass index of 49, a 19-point decrease, and mean excess weight loss of 37%. Operative risk significantly decreased in 100% of patients. To date, nine patients have successfully completed stage II (Roux-en-Y) with no mortality, no major complications, and only one minor complication.

"Our study found that by performing this less drastic surgery first, allowing the patient to lose a substantial amount of weight and then performing the laparoscopic Roux-en-Y, mortality is greatly reduced,” said Philip Schauer, M.D., assistant professor of surgery and director of bariatric surgery at the University of Pittsburgh.




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University of Pittsburgh Medical Center