1Department of General Surgery, Medical Center of Brignoles, France; 2Department of General Surgery, Medical Center of Brignoles, France; 3Professor,  University hospital of Archet, Nice, France

Open Journal of Gastroenterology and Hepatology

Background: According to the official WHO publications, obesity became one of the greatest public health challenges of the 21st century. In addition to causing various physical disabilities and psychological problems, excess weight drastically increases a person’s risk of developing a number of noncommunicable diseases (NCDs), including cardiovascular disease, cancer and diabetes. The risk of developing more than one of these diseases (co-morbidity) also increases with body weight gain. Obesity is already responsible for 2–8% of health costs and 10–13% of death cases and the numbers rise progressively. Objective: To perform retrospective analysis of medical records data of patients with very specific range of morbid obesity (super-super obesity- BMI >60) with laparoscopic sleeve gastrectomy and systematized preoperative criteria and morbid risk for surgical treatment. Methods: Our study includes group of 13 patients with BMI>60 kg/m2. All patients taking part in the program for treatment of morbid obesity meet the criteria of the national regulatory health system. LSG was performed following official description. We conducted a 6, 9, 12, 24, 36, 60 months follow up of patient’s status and evaluation of quality of life, and we presented the percentage of excess weight loss (EWL). Results: Evaluation of preoperative consultations and clinical examinations permitted to perform as first step Laparoscopic SG for all patients. Postoperative results were very satisfying for nine of our (69 %) patients. Three patients after interval of 10-15 months obtained complementary second step operation – duodenal switch. We found that LSG is effective procedure for SSO patients. Conclusion: The group of Super-super obese patients is very specific because conservative treatment is usually not effective, limited and only weight loss surgery may propose acceptable results. Patients with BMI super to 60 kg /m2 presented satisfying results of LSG, their co-morbidities are not absolutely contraindications, and only well conducted preoperative and long term postoperative evaluation may give good results. Preservation of the anatomy of the gastrointestinal tract permitted to perform all diagnostic procedures.


Free Full-text PDF

How to cite this article:
Ludmil MARINOV, Daniel KRAWCZYKOWSKI, Jean GUGENHEIM.LAPAROSCOPIC SLEEVE GASTRECTOMY FOR SUPER – SUPER OBESE PATIENTS (BMI>60 KG/M2) – SINGLE INSTITUTION EXPERIENCE. Open Journal of Gastroenterology and Hepatology, 2019, 2:19. DOI: 10.28933/ojgh-2019-09-2005


1. EUROSTAT. Overweight and obesity – BMI statistics.12.02.2019.
2. Garrido-Miguel M, Oliveira A, Cavero-Redondo I, Álvarez-Bueno C, Pozuelo-Carrascosa DP, Soriano-Cano A, Martínez-Vizcaíno V.Prevalence of Overweight and Obesity among European Preschool Children: A Systematic Review and Meta-Regression by Food Group Consumption.
Nutrients. 2019 Jul 23;11(7)
3. Kakarla VR, Nandipati K, Lalla M, et al. Are laparoscopic bariatric procedures safe in superobese (BMI >/=50 kg/m2) patients? AnNSQIP data analysis. Surg Obes Relat Dis.201; 7(4):452-8.
4. Krawczykowsky d. Efficiency of surgery on morbid obesity. Obes.surg.; 1999;4:330-331.
5. Va n Rutte PW, Smulders JF, de Zoete JP, et al. Outcome of sleeve gastrectomy as a primary bariatric procedure. Br J Surg.2014;101(6):661–8.
6. Gagner, M., Gumbs, A. A., Milone, L., Yung, E., Goldenberg, L., & Pomp, A. (2008). Laparoscopic sleeve gastrectomy for the super-super-obese (body mass index >60 kg/m2). Surgery Today, 38(5), 399–403.
7. Hess DS, Hess DW. Biliopancreatic Diversion with a duodenal switch. Obes Surg. 1998;8:267–282.
8. J. de Csepel, S. Burpee, G. Jossart et al., “Laparoscopic biliopan- creatic diversion with a duodenal switch for morbid obesity: a feasibility study in pigs,” Journal of Laparoendoscopic and Advanced Surgical Techniques A, vol.II, no 2, pp 79-83, 2001.
9. Antonio Iannelli, M.D., Ph.D.a,, Anne-Sophie Schneck, M.D.a , Philippe Topart, M.D.b , Michel Carles, M.D., Ph.D.a , Xavier Hébuterne, M.D., Ph.D.a , Jean Gugenheim, M.D., Ph.D. Laparoscopic sleeve gastrectomy followed by duodenal switch in selected patients versus single-stage duodenal switch for superobesity: case–control study . Surgery for Obesity and Related Diseases 9 (2013) 531–538
10. Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obes Surg. 2004;14:492–497.
11. Krawczykowski D., Lecko M., Nore O. Preliminary results with laparoscopic sleeve gastrectomy. Chir Gastroenterol 2005; 21(suppl 1):26-30.
12. Iannelli A, DianeseR, Piche T, Facchiano E, GugenheimJ. Laparoscopic sleeve gastrectomy for morbid obesity: World J Gastroenterol.2008; 14:821-827.
13. Himpens J1, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity.Ann Surg. 2010 Aug;252(2):319-24. doi: 10.1097/SLA.0b013e3181e90b31.
14. Chekan E, Whelan R.Surgical stapling device-tissus interaction: what surgeons need to know to improve patient outcomes.Med Devices (Auckl). 2014; 7: 305–318.
15. Van Rutte PW, Naagen BJ, Spek M, et al. Gastric wall thickness in sleeve gastrectomy patients: thickness variation of the gastric wall. Surg Technol Int. 2015; 27:123–8.
16. Elariny H, Gonzalez H, Wang B. Tissue thickness of human stomach measured on excised gastric specimens from obese patients. Surg Technol Int. 2005;14:119–24.
17. Himpens J, Dapri G, Cadiere GB, et al. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006;16:1450 –6.
18. Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of laparoscopic biliopancreatic diversion with a duodenal switch) on comorbidities in superobese high-risk patients. Obes Surg. 2006;16(9):1138–44.
19. Boru CE, Coluzzi MG, de Angelis F, Silecchia G . Long-Term Results After Laparoscopic Sleeve Gastrectomy with Concomitant Posterior Cruroplasty: 5-Year Follow-up.J Gastrointest Surg. 2019 Aug 13.
20. Dupre A, El Gammal AT, Wolter S, Urbanek S, Sauer N, Mann O, Bush P.Perioperative short-term outcome in super-super-obese patients undergoing bariatric surgery. Obes Surg. 2018 Jul;28(7):1895-1901. doi: 10.1007/s11695-018-3118.
21. Weiner RA, Weiner S, Pomhoff I, Jacobi C, Makarewicz W, Weigand G. Laparoscopic sleeve gastrectomy-influence of sleeve size and resected gastric volume. Obes Surg 2007; 17: 1297-305.
22. Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleevegastrectomy as an initial weight-loss procedure for high-risk patients. with morbid obesity. Surg Endosc 2006; 20 (6): 859-63.
23. Catheline JM, Cohen R, Khochtali I, et al. [Treatment of super super morbid obesity by sleeve gastrectomy]. Presse Med 2006;35(3 Pt 1): 383-87.
24. Baltasar A, Serra C, Pérez N, Bou R, Bengochea M, Ferri L.Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg 2005; 15(8): 1124-28.
25. Regan JP, Inabnet WB, Gagner M, Pomp A. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg 2003; 13(6): 861-64.
26. Abbatini F,Rizzello M,Casella G,Alessandri G,Capoccia D,Leonetti F, Basso N. Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes. Surg Endosc (2010) 24:1005–1010 DOI 10.1007/s00464-009-0715-9.
27. Guetta O, Vakhrushev A, Dukhno O, Ovnat A, Sebbag G New results on the safety of laparoscopic sleeve gastrectomy bariatric procedure for type 2 diabetes patients.World J Diabetes. 2019 Feb 15; 10(2):78-86. doi: 10.4239/wjd.v10.i2.78.
28. Gutierrez-Blanco D, Romero Funes D, Castillo M, Lo Menzo E, Szomstein S, Rosenthal RJ. Bariatric surgery reduces the risk of developing type 2 diabetes in severe obese subjects undergoing sleeve gastrectomy. Surg Obes Relat Dis. 2019 Feb;15 (2):168-172. doi: 10.1016/j.soard.2018.11.023. Epub 2018 Nov 24.
29. Galtier F, Pattou F, Czernichow S, Disse E, Ritz P, Chevallier JM, Cosson E, Valensi P, Andreelli F, Robert M; DIAMS study group. Bariatric surgery and the perioperative management of type 2 diabetes: Practical guidelines. J Visc Surg. 2019 Aug 7. pii: S1878-7886(19)30124-9.
30. Iannelli A, Schneck AS, Noel P, Ben Amor I, Krawczykowski D, Gugenheim J. Re-sleeve gastrectomy for failed laparoscopic sleeve gastrectomy: a feasibility study. Obes Surg 2011;21:832–5.

Terms of Use/Privacy Policy/ Disclaimer/ Other Policies:
You agree that by using our site, you have read, understood, and agreed to be bound by all of our terms of use/privacy policy/ disclaimer/ other policies (click here for details).

This work and its PDF file(s) are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.