Is BMI greater than 60 kg/m(2) a predictor of higher morbidity after laparoscopic Roux-en-Y gastric bypass?

Background: It has been hypothesized that patients who are super-super morbidly obese, defined as having a body mass index (BMI) of 60 kg/m(2) or higher, have an increased rate of postoperative complications. As surgical techniques and operator experience with Roux-en-Y gastric bypass improved with time, the selection criteria have expanded to include the super-super morbidly obese. We hypothesize that a higher BMI does not predict a higher postoperative complication rate.

Methods: The prospectively collected database for our Accredited Bariatric Program was queried for all laparoscopic Roux-en-Y gastric bypass procedures performed between January 2004 and July 2006. All cases were performed by a single surgeon at a tertiary-care center. Average postoperative follow-up time was 1 year. Patients were stratified into two groups: BMI < 60 kg/m(2) and BMI >or= 60 kg/m(2). The number of postoperative complications was compared between the two groups using a chi-square method with Yates correction.

Results: One hundred and sixty-nine patients with adequate follow-up data were identified during the study period. Of these, 148 patients had BMI < 60 kg/m(2) (group 1) and 21 had BMI >or= 60 kg/m(2) (group 2). There were 28 (19%) total complications in group 1, and 4 (19%) total complications in group 2. There was no statistical difference between the two groups (p = 0.98). Stricture rate was 10% in group 1 and 5% in group 2.

Conclusion: Patients with BMI >or= 60 kg/m(2) do not have a higher postoperative morbidity compared with other patients undergoing laparoscopic Roux-en-Y gastric bypass. The stricture rate is less in patients with BMI >or= 60 kg/m(2) compared with other patients. Longer follow-up is required to detect complications that occur after 1 year. Our study shows that laparoscopic Roux-en-Y gastric bypass can be safely performed on the super-supermorbidly obese.