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Combined Bariatric Procedures for the “Super-Super Obese”

In a new open access article from BioMed Central, bariatric and general surgeons from Belgium discuss a combined bariatric procedure for super-super obese patients.

The authors performed “primary laparoscopic adjustable banded Roux-en-Y gastric bypass” in six patients meeting criteria for super-morbid obesity (BMI > 60kg/m2).

Adjustable gastric banding (i.e. the lap band) is sometimes combined with gastric bypass in a revision procedure, but not typically in a primary operation. Therefore the doctors chose to explore the combination procedure in this challenging group of patients.

Both of these surgical procedures are popular methods for inducing weight loss. The adjustable gastric band places a small ring on the upper portion of the stomach, while the Roux-en-y gastric bypass divides the stomach into a small pouch, which is then connected to a loop of the small intestine.

During the procedure, which required about 1–2 hours, surgeons described their technique (pg. 7) as follows:

….the procedure started with the creation of the gastric pouch following the same principles as previously published by our group [22]. After creation of the gastric pouch, an atraumatic grasper was passed through a small opening between the blood vessels on the lesser curve and the gastric pouch 1-2 cm above the horizontal cut edge of the pouch.  Following this step, an [adjustable gastric band] was introduced via the 15 mm port, drawn around the pouch and locked into place.

With no immediate major complications reported in their group, the doctors conclude that the combined bariatric operation is “feasible” and appears to be safe. Since the last operation was completed in March 2010, long-term results of the procedure are still being evaluated before definitive judgments are made about safety and effectiveness.

Read the abstract on BioMed Central, where you can also download the full article in PDF format.

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