P-28 Sleeve gastrectomy before laparoscopic ROUX-en-Y gastric bypass (LRYGB) as a staged procedure for super super obese patients-safety and outcomes

scopic Gastric Bypass (LGB) in general and in subgroups of patients with pre-operative BMI less and more than 50 kg/m. Methods: Retrospective study of patients undergoing VSG and LGB for a period of 3 years. Results: In 2007-2010 VSG was performed in 93 and LGB in 860 patients. Mortality was 0% and 0.11%, respectively. Major morbidity was 6.3% and 4.5%. Baseline BMI was 47.5 kg/m and 49.8 kg/m, excess body weight 143.9 lbs and 155.5 lbs. Average length of stay 2 days. There were 3 proximal suture line leaks and one intractable stricture requiring revision to LGB in VSG group. One delayed leak over suture line presenting 6 months post-operatively with abdominal wall abscess. At 1, 2 and 3 year of follow-up %EBWL were 66%, 67% and 65% in VSG group compared to 67%, 69% and 65% in LGB group. Both groups of patients had decreased their BMI by 15-16 kg/m. When stratified by preoperative BMI 50 kg/m and 50 kg/m both VSG and LGB patients continued to demonstrate similar patterns of %EBWL. There is obvious higher percentage %EBWL with both VSG and LGB in patients with BMI 50 kg/m. Conclusion: Preliminary results indicate that VSG is capable of producing weight loss results comparable to gastric bypass with medium length follow-up. While seemingly a technically simple procedure VSG is prone to higher morbidity and requires meticulous execution. Effectiveness of vertical sleeve gastrectomy as a primary procedure in patients with BMI 50 kg/m is actually higher than in insurance mandated coverage group of mega-obese patients.