Results from a recent study published in the Journal Laparoendoscopic & Advance Surgical Techniques Part A showed that Laparoscopic bariatric surgery is safe and can be performed with acceptable perioperative outcomes in extremely high-risk patients. The team of researchers led by Dr. Aminian A. from the Bariatric and Metabolic Institute at the Cleveland Clinic in Cleveland, Ohio also determined that advanced age, BMI, and severe cardiopulmonary comorbidities should not exclude patients from consideration for bariatric surgery.
Obesity is the second leading cause of preventable death in the United States after smoking. Annually, obesity-related diseases account for 400,000 of premature deaths.
Bariatric surgery is a category of general surgical procedures traditionally done by laparotomy and, because of the patient population and complexity of the procedure, it is inherently less amenable to minimally invasive surgery than most procedures. Two procedures that have stood the test of time and are commonly performed today by celiotomy include the vertical banded gastroplasty (VBG) and the Roux-en-Y gastric bypass (RYGB). Both have long track records for safety and effectiveness, and proponents continue to argue for one or the other as the procedure of choice.
In order to evaluate the clinical outcomes following bariatric surgery in extremely high-risk patients in the study titled “Is Laparoscopic Bariatric Surgery a Safe Option in Extremely High-Risk Morbidly Obese Patients?” the researchers assessed a total of 3,240 high-risk obese patients who underwent laparoscopic bariatric surgery between 2006 and June 2012. Patients were identified taking into account age ≥65 years, body mass index (BMI) ≥50 kg/m2, and presence of at least two of six cardiopulmonary comorbidities, involving ischemic heart disease, congestive heart failure, obstructive sleep apnea, hypertension, chronic obstructive pulmonary disease, and history of venous thromboembolism. The researchers also assessed perioperative and intermediate-term clinical outcomes.
Results showed that forty-four extremely high-risk patients underwent adjustable gastric banding (n=11), laparoscopic Roux-en-Y gastric bypass (n=23), or sleeve gastrectomy (n=10).
Patients had a mean BMI of 54.8±5.5 kg/m2, a mean age of 67.9±2.7 years, and a median of two comorbidities associated with the cardiopulmonary system.
The researchers determined that there was no conversion to laparotomy, and identified 13 complications 30 days after surgery. Thirty-day re-operation, postoperative re-admission, and mortality rates were 2.3%, 15.9%, and 0%, accordingly.
Within a mean follow-up time of 24.0±18, four months mortality rates and late morbidity were 2.3% and 18.2%, accordingly. After 12 months of follow up, the results showed that the mean percentage excess weight losses and total weight were 44.1±20.6% and 26.7±12.0%, respectively.