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Background

There is paucity of data on the appropriate bariatric procedure for super obesity (body mass index [BMI] > 50 kg/m2). The aim of this study is to compare the safety and effectiveness of BPD-DS to RYGB and SG in super obese Individual.

Methods

The Geisinger bariatric prospectively maintained database was used to perform retrospective analysis on bariatric surgery patients with BMI > 50 between 2015-2019. Two-sample t-tests and Chi-square tests were used to compare BPD-DS to RYGB and SG in terms of Perioperative Outcome, Weight loss, Remission of Diabetes and New onset GERD.

Results

Among 681 patients, 442 (65%) had RYGB, 121 (18%) SG, and 118 (17%) BPD. Age, Gender and preop Diabetes were comparable between groups. BPD group has the lowest percentage of females and had the highest mean BMI. Compared to RYGB and SG, BPD-DS has significantly higher length of stay (2.9 vs 1.6 and 1.5) but comparable 30-day readmission and reoperation. Increase incidence of early complications was higher BPD versus Sleeve (15.4% versus 4.7%). At 3 Year mean follow up BPD-DS had significantly greater total weight loss (41.5% vs 29.9% and 22.2%) and higher diabetes remission rate (96% vs 74% and 57%) compared to RYGB and SG. Conversely Incidence of GERD was higher in BPD Group versus RYGB.

Conclusions

Patients with super obesity have significantly improved weight Loss and Diabetes Remission with BPD-DS but at the cost of higher incidence of adverse events, compared to patients operated with RYGB and SG