Comparative Effectiveness of Laparoscopic Sleeve Gastrectomy
on Morbidly Obese, Super-Obese, and Super-Super Obese Patients
for the Treatment of Morbid Obesity
Published online: 12 December 2017
Springer Science+Business Media, LLC, part of Springer Nature 2017
Backgrounds The management of super-super obese patients is challenging for bariatric surgeons. Laparoscopic sleeve gastrec-
tomy (LSG) is feasible as two-stage treatment for high-risk patients. However, its efficacy as a stand-alone procedure in super-
super obese (SSO) patients is controversial. The study objective was to demonstrate the safety and efficacy of LSG in super-obese
(SO) and SSO patients.
Methods A retrospective analysis was performed of consecutive patients undergoing LSG. The patients were classified into three
groups: morbidly obese (MO), SO, and SSO. The patients’ data, including each patient’s characteristics, body mass index (BMI),
preoperative comorbidities, postoperative complications, the resolution of comorbidities, percentage of excess weight loss
(%EWL), and total weight loss (%TWL) were compared between groups.
Results Of the 186 patients, 163 (87.6%) were followed up for 41.2 ± 7.3 months (range 33–54 months). The mean BMI was
. Eighty-three patients (50.9%) were MO, 52 (31.9%) were SO, and 28 (17.2%) were SSO. The groups were similar in
terms of preoperative characteristics and postoperative complications. The mean %TWL were lower for the SSO group with no
significant difference. The mean %TWL at 12, 24, 36, and 41.2 months postoperatively was 34.7, 34.4, 31.4, and 29.6% in SSO
group, respectively. Also, the %EWL for the SSO group was significantly lower (48.3%) at the end of the follow-up period.
However, the rate of significant improvement or complete resolution of comorbidities was similar in all groups.
Conclusion Although %EWL was lower in the SSO group, LSG was a feasible and safe stand-alone bariatric surgical procedure
for the resolution of comorbidities in MO, SO, and SSO patients.
Keywords Super-super obese
Morbid obesity is defined as a high body mass index (BMI) ≥
and has been rapidly increasing worldwide in recent
years . After unsuccessful pharmacological, dietary, and
lifestyle management, bariatric surgical procedures remain
the most effective treatment modality for long-term weight
loss [2, 3]. Sleeve gastrectomy was first performed by
Marceau and Hess as part of biliopancreatic diversion (BDP)
with a duodenal switch [4, 5].Thetechniquewasproposedby
Gagner’s team for the first-line treatment of super-obese (SO)
patients at high perioperative risk of a laparoscopic Roux-en-
Y gastric bypass (LRYGB) . After demonstrating the effi-
cacy of laparoscopic sleeve gastrectomy (LSG) in excess
weight loss, this technique is widely preferred for the surgical
treatment of morbidly obese (MO) patients [7, 8]. LSG has
some advantages, such as reduced operative time, as well as a
learning curve that is of short duration for surgeons .
Several authors have reported that LSG exhibits similar results
to LRYGB in terms of percentage of excess weight loss
(%EWL) and an improvement in comorbidities .
Therefore, LSG has been applied for the surgical treatment
of SO patients . Recently, however, the effect of LSG on
* Ilhan Ece
Department of Surgery, Faculty of Medicine, Selcuk University,
42075 Konya, Turkey
Department of Nuclear Medicine, Faculty of Medicine, Selcuk
University, 42075 Konya, Turkey
Obesity Surgery (2018) 28:1484–1491