Frontiers in Surgery (Feb 2023)

The paradox of Zeno in bariatric surgery weight loss: Superobese patients run faster than morbidly obese patients, but can't overtake them

  • Fabio Medas,
  • Enrico Moroni,
  • Simona Deidda,
  • Luigi Zorcolo,
  • Angelo Restivo,
  • Gian Luigi Canu,
  • Federico Cappellacci,
  • Pietro Giorgio Calò,
  • Stefano Pintus,
  • Giovanni Fantola

DOI
https://doi.org/10.3389/fsurg.2023.1100483
Journal volume & issue
Vol. 10

Abstract

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IntroductionSuperobesity (SO) is defined as a BMI > 50 Kg/m2, and represents the extreme severity of the disease, resulting in a challenge for the surgeons.MethodsIn this retrospective study we aimed to compare the outcomes of SO patients compared to morbidly obese (MO) patients.ResultsWe included in this study 154 MO patients, with a median preoperative BMI of 40.8 kg/m2, and 19 SO patients with median preoperative BMI of 54.9 kg/m2. The MO patients underwent sleeve gastrectomy (SG) in 62 (40.3%) cases, laparoscopic Roux-and-Y gastric bypass (LRYGBP) in 85 (55.2%) cases and One-Anastomosis Gastric Bypass (OAGB) in 7 (4.5%) cases. underwent OAGB. The patients in the SO group were submitted to SG in 11 (57.9%) cases, LRYGBP in 5 (26.3%) cases, and OAGB in 3 (15.8%). At 24-month follow-up, an excess weight loss (EWL) >50% was achieved in 129 (83.8%) patients in the MO group and in 15 (78.9%) in the SO group (p = 0.53). A BMI < 35 kg/m2 was achieved in 137 (89%) patients in the MO group and from 8 (42.2%) patients in the SO group (p < 0.001). The total weight loss was significantly directly related to the initial BMI. Superobesity was identified as independent risk factor for surgical failure when considering the outcome of BMI < 35 kg/m2.DiscussionOur study confirms that, although SO patients tend to gain a greater weight loss than MO patients, they less frequently achieve the desired BMI target. In this setting, it should be necessary to re-consider malabsorptive procedures as first choice.

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