Clinical outcomes after one anastomosis gastric bypass versus sleeve gastrectomy in super-super-obese patients

Background Bariatric surgery in super-super-obese (SSO) patients remains a continuous challenge due to intraabdominal fat masses, higher liver volume and existing comorbidities. A convenient procedure in SSO patients is one anastomosis gastric bypass (OAGB). The aim of this study was to compare the outcome of SSO patients undergoing OAGB in comparison to laparoscopic sleeve gastrectomy (LSG). Methods We retrospectively reviewed data from SSO patients who underwent OAGB and LSG in our institution between 2008 and 2020. Primary endpoints included percentage total body weight loss and percentage BMI loss at 12, 24, and 36 months after the operation. Secondary endpoints were perioperative complications, procedure length, length of hospital stay and outcome of comorbidities. Results 243 patients were included in this study. 93 patients underwent LSG and 150 underwent OAGB. At any of the time points evaluated, weight loss in patients after OAGB was greater than in LSG patients, while procedure length was significantly shorter for OAGB than LSG (81.4 vs. 92.1 min, p-value < 0.001). Additionally, mean length of hospital stay was shorter in the OAGB group (3.4 vs. 4.5 days, p-value < 0.001). There were more severe complications (Clavien-Dindo ≥ 3a) in the LSG group (11.8% vs 2.7%, p-value = 0.005). Conclusion In this retrospective analysis, OAGB was superior to LSG in terms of weight loss in SSO patients. Procedure length and hospital stay were shorter after OAGB in comparison to LSG and there were fewer severe complications. OAGB can therefore be regarded a safe and effective treatment modality for SSO patients.

Dual Mobile Total Hip Replacement in Super Obesity: A Case Report and Review of Literature

Introduction:More than 13 million people in the US are morbidly obese. It is associated with various medical and anesthetic complications. Higher rate of dislocation in total hip replacement (THR) associated with morbid obesity due to thigh girth, low muscle mass and high-fat content. Morbid obesity is associated with a 38% increase in the 10-year mortality rate compare to non-obese after undergoing primary total hip arthroplasty (THA). Hip dislocation after THR is one of the earliest complications, and for every ten-point increase in BMI, the risk of dislocation increases by 113.9%. Case Report: We present a case report of a 69-year-old super-obese woman with a BMI of 62.2, who presented with repeated dislocation post THR. The patient was managed successfully with implant removal and implantation of dual mobile THR prosthesis. Conclusion: Morbid obesity with a need for arthroplasty is challenging. It needs proper planning, thorough preoperative preparation, proper intraoperative care and identification with adequate post-operative complications management. Preoperative bariatric surgery, dual mobile liner and constrained implants have shown good result in decreasing dislocation rate. The liner of dual mobile THR is efficient to prevent post-operative dislocation in morbidly obese and super-obese patients. Keywords: Dual mobile total hip replacement, super obesity, morbid obesity, bariatric surgery, hip arthroplasty, neck of femur fracture, revision hip arthroplasty.

EP.WE.1048Weight Regain After Sleeve Gastrectomy More Common in Male and Less Common in Super-Obese Patients - Results of an 18-Month Follow-up Study

Aims Long-term success of Sleeve Gastrectomy (SG) is undermined by weight regain (WR). Several procedure- and patient-specific factors have been proposed in previous studies. Here we look at 18-month follow-up post-SG to investigate WR and patient-specific variables influencing this. Methods A single-centre study involving retrospective analysis of a prospectively-maintained database. Inclusion criteria: Primary non-revisional SG patients with adequate follow-up data to assess WL/WR trends. Patients were divided into two subgroups based on their %EWL between 6-to-12 and 12-to-18 months: weight regainers (WR) and weight losers/maintainers (WL/M). Results Out of 338 SG cases between 2012-2017, 180 met inclusion criteria of which 18.3% were men and 45% were super-obese. All patients lost weight during first 6 months (mean %EWL 52.3%, P &lt; 0.0001). Between 6-to-12 months, 87.6% patients continued WL with a further mean %EWL of 10.35% (P &lt; 0.0001). Between 12-to-18 months, a drastic deceleration/reversal of WL progress was observed with an average of only 0.76% EWL (P = 0.84), with 42% of patients regaining weight in this period (mean EWG 6.8%). Male patients encountered significantly higher WR rate (OR 3.27, P = 0.003), whereas it was much less frequent in pre-operatively super-obese patients (OR 0.48, P = 0.036). Moreover, there was no difference in the 6-month %EWL between WR and WL/M subgroups (P = 0.62), thus negating the possibility of WL burn-out phenomenon. Conclusions Different rates of WR in men and super-obese patients may indicate underlying behavioural and biological differences. More research is needed to investigate them in detail, having implications for revisional surgery and follow-up support.