Vidyya Medical News Service
Volume 6 Issue 95 Published - 14:00 UTC 08:00 EST 4-Apr-2004 Next Update - 14:00 UTC 08:00 EST 5-Apr-2004
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Two-stage weight loss surgery for high-risk, morbidly obese patients reduces surgical risk

A staged approach to Roux-en-Y gastric bypass surgery, in which high-risk, morbidly obese patients first undergo a procedure called laparoscopic sleeve gastrectomy (LSG), greatly reduces operative risk and results in significant short-term weight loss, according to a University of Pittsburgh study presented today at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons in Denver.

In laparoscopic sleeve gastrectomy, a large portion of the stomach is surgically removed, and is reduced from being about 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 of approximately the size of a plastic medicine cup, and bypassing a small segment of intestines by constructing a Y-shaped limb of small bowel.

"Extremely high-risk patients are typically denied bariatric surgery management because of their excessive operative risk," said Philip Schauer, M.D., assistant professor of surgery and director of bariatric surgery at the University of Pittsburgh, principal investigator in the study and co-director of the Minimally Invasive Surgery Center at the University of Pittsburgh Medical Center (UPMC). "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 was greatly reduced."

The study followed 75 patients who underwent a LSG as an initial procedure at UPMC between June 2001 and July 2003. Patients ranged in age from 23 to 72 years with a body mass index ranging from 45 to 91. Patient co-morbidities included obstructive sleep apnea (88 percent), degenerative joint disease (60 percent), hypertension (60 percent), asthma (18 percent) and coronary artery disease (18 percent). By the American Society of Anesthesia (ASA) risk classification, 64 percent of patients were high-risk (ASA III) and 34 percent were very high-risk (ASA IV).

After six months, patients who had undergone the LSG had a mean body mass index of 49, a 19-point decrease and mean excess weight loss of 37 percent. Operative risk significantly decreased in 100 percent of patients. All ASA IV patients were converted to ASA III and all ASA III patients were significantly improved. All life-threatening co-morbidities were downgraded to only moderate severity.

Type 2 diabetes mellitus, obstructive sleep apnea, hypertension and asthma were improved or resolved in all patients. Nine patients thus far have successfully completed stage II (Roux-en-Y) with no mortality, no major complication, and only one minor complication.

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