As people age their BMI naturally gets higher, but a BMI that is too high can have a significant impact on longevity. Recent studies indicate that a BMI over 40 can reduce expected lifespan by 6.5 years. A BMI of 50+, called “Super Obese” can reduce lifespan by 10 years. A study Dr. Christine Ren-Fielding participated in looked at whether or not laparoscopic bariatric surgery in super obese patients was safe and effective.

Unique Challenges of Operating on Super Obese Patients

While laparoscopic bariatric surgery has repeatedly been found safe and effective across a variety of demographics, super obese patients carry extra risk during surgery. Super obese patients often have existing comorbidities. Other challenges include difficulties in exposure of visceral fat, retracted the fatty liver, and the strong torque applied to instruments.

Study Overview

Dr. Christine Ren-Fielding and other doctors performed a retrospective review of 332 patients with a pre-surgery BMI of 50+ who underwent one of the common types of laparoscopic bariatric surgeries:

• Laparoscopic adjustable gastric banding (192)
• Roux-en-Y gastric bypass (97)
• Biliopancreatic diversion with or without a duodenal switch (43)

The doctors involved in the study evaluated patients at 30 day intervals for morbidity and mortality to determine the safety of the procedure.

331 super obese patients with an average age of 42 underwent one of the surgeries between October 2000 and June 2004. The mean BMI was 55.3 and 75% of the patients were women.

For each type of surgery the doctors looked at:

• Duration of procedure
• Conversion rate (changing which surgery was done)
• Length of hospital stay
• Morbidity

Dr. Christine Ren-Fielding and her colleagues found that laparoscopic bariatric surgery is safe in super-obese patients. LAGB (laparoscopic adjustable gastric banding), which is the least invasive surgery, resulted in the:

• Shortest operative time
• Lowest conversation rate
• Shortest hospital stay
• Lowest morbidity

There were no deaths.

With each more invasive surgery each evaluated metric increased minimally.

Despite being a high-risk demographic among patients, super obese patients can successfully undergo a minimally invasive weight loss procedure that is likely to improve their quality of life, health, and possibly lifespan.

For more information about bariatric surgery and Dr. Christine Ren-Fielding, contact The Weight Management Program at NYU Langone.