Staging Weight Loss Surgery for the Morbidly Obese

The study was presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons in Denver (CO, USA) in 2004.

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

The study involved 75 patients, aged 23-72, with a body mass index ranging from 45-91, who underwent a LSG as an initial procedure at the University of Pittsburgh Medical Center (PA, USA; www.upmc.edu). Co-morbidities included obstructive sleep apnea (88%), degenerative joint disease (60%), asthma (18%), and coronary artery disease (18%). Of these, 64% were judged to be high-risk and 34% very high-risk. After six months, the patients had a mean body mass index of 49, a 19-point decrease, and mean excess weight loss of 37%. Operative risk significantly decreased in 100% of patients. To date, nine patients have successfully completed stage II (Roux-en-Y) with no mortality, no major complications, and only one minor complication.

"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 is greatly reduced,” said Philip Schauer, M.D., assistant professor of surgery and director of bariatric surgery at the University of Pittsburgh.




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University of Pittsburgh Medical Center