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Preoperative Weight Loss with Intragastric Balloon Decreases the Risk of Significant Adverse Outcomes of Laparoscopic Gastric Bypass in Super-Super Obese Patients

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Abstract

Background

Extreme obesity increases morbi-mortality in bariatric surgery. We previously showed that significant weight loss can be obtained within 3 months in super-super obese patients (BMI > 60 kg/m2) with an intragastric balloon (IGB). Here, we explored the potential benefit of preoperative IGB on the outcome of laparoscopic gastric bypass (LGBP) in super-super obese patients.

Methods

In this case–control study, we compared the records of 60 consecutive super-super obese patients (66.5 ± 3.4 kg/m2) submitted to a LGBP between 2004 and 2009, with preoperative IGB (n = 23, cases) or without (n = 37, controls). We analyzed the clinical outcome of surgery and a composite end point of significant adverse events defined as the presence of at least one of the following conditions: conversion to laparotomy, intensive care unit stay for more than 2 days, and overall hospital stay superior to 2 weeks.

Results

All baseline clinical and biological characteristics were homogenous between both groups. IGB was maintained during 155 ± 62 days and induced a loss of 5.5 ± 1.3 kg/m2 (11.2 ± 3.2% of excess body mass index) at the time of LGBP, associated with a decrease in systolic blood pressure and gamma-glutamyl transpeptidase level (p < 0.05 vs. baseline). Operative time was lower in the IGB group (146 ± 47 vs. 201 ± 81 min in controls; p < 0.01). Significant adverse events occurred less frequently after LGBP in the IGB group (2 vs. 13 in controls; p < 0.05). All patients were alive at 1 year and overall weight loss was similar in both groups (52.4 ± 17.3 vs. 50.3 ± 12.7 percent of excess BMI loss in controls; NS).

Conclusions

IGB prior to LGBP in super-super obese patients significantly reduced excess BMI. It was associated with a shorter operative time and a lower overall risk of significant adverse outcomes.

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Conflicts of Interest

All contributing authors (Carlos Zerrweck, Vincent Maunoury, Robert Caiazzo, Julien Branche, Guélareh Dezfoulian, Philippe Bulois, Helene Verkindt, Marie Pigeyre, Laurent Arnalsteen, and François Pattou) declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Digestive and Endocrine Surgery, Lille University Hospital, Lille, France

    Carlos Zerrweck, Robert Caiazzo, Guélareh Dezfoulian, Laurent Arnalsteen & François Pattou

  2. Department of Gastroenterology and Hepatology, Lille University Hospital, Lille, France

    Vincent Maunoury, Julien Branche & Philippe Bulois

  3. Department of Nutrition, Lille University Hospital, Lille, France

    Helene Verkindt & Marie Pigeyre

  4. Department of General and Endocrine Surgery, Centre Hospitalier Régional Universitaire, 1 Place de Verdun, 59045, Lille, France

    François Pattou

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  1. Carlos Zerrweck
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  2. Vincent Maunoury
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  3. Robert Caiazzo
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  6. Philippe Bulois
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  9. Laurent Arnalsteen
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  10. François Pattou
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Correspondence to François Pattou.

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Zerrweck, C., Maunoury, V., Caiazzo, R. et al. Preoperative Weight Loss with Intragastric Balloon Decreases the Risk of Significant Adverse Outcomes of Laparoscopic Gastric Bypass in Super-Super Obese Patients. OBES SURG 22, 777–782 (2012). https://doi.org/10.1007/s11695-011-0571-2

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  • DOI: https://doi.org/10.1007/s11695-011-0571-2

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