Bariatric Surgery in Patients with Super-Super Obesity Causes Metabolic Improvement Beyond Weight Loss

Background: Extreme obesity leads to increased health risks and perioperative complications. The results of bariatric surgery in patients with super-super obesity (SSO) are presented in this study. Methods: From April 2008 to August 2019, 60 patients with super-super obesity underwent bariatric surgery. Their weight loss and outcome were analyzed. The mean follow-up time was 72.25 months. Results: At baseline, the mean age was 41.5 years old, the mean BMI was 63.81 kg/m2, 80% of the patients suffered from co-morbidities, and 23.33% were revisional surgeries. Weight loss continued for up to two years after surgery. The percentage of excess weight lost at two years was 62.27%, from two to five years: 61.48%, from five to 10 years: 36.82% and after ten years it was 31.89% (P<.001). The mean at last follow-up BMI was 45.11 kg/m2 and 48.33% of the patients failed to lose at least 50% of excess weight. Patients with fatty liver, diabetes, sleep apnea and hyperlipidemia had a cure or improvement in more than 70% of the cases. There were 5% complications and two (3.33%) deaths were reported. Conclusion: Bariatric surgery in patients with SSO was feasible and safe. The amount of weight loss achieved was acceptable in the short term but decreased in the long term, almost 50% of the patients failed to decrease excess overweight of 50%. The metabolic effects of bariatric surgery were maintained during the follow-up time despite the increase in weight. However, the third or more revisional bariatric surgery increased the risk of mortality. Trial Registration: Clinicaltrials.gov (number NCT04663425). Funding Statement: There were no sources of support for the work being reported. Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: The study was approved by the Assuta Helsinki review board (number 2015-073).