Too Obese for Gastric Bypass Surgery?

Question

I want to talk to a doctor about getting bypass surgery but I am afraid of being turned down. My BMI is 80, height 5'5", weight 500lb. I'm nervous because this seems like my only hope. Even if I could exercise it off to a lower BMI that would take years. Is there an upper limit to how big I can be and still get surgery (either BMI or weight)? How much riskier is it?

Shawn Garber, MD, FACS, FASMBS · Answer

As your BMI gets higher the risks of surgery increase. We usually recommend liquid protein diets prior to surgery to lose weight prior on lower the risks of surgery. Our malpractice insurance carrier won't let us operate on anyone with a weight greater than 440 pounds because you can't fit into a Cat scan if there were any problems. I recommend seeing a surgeon to get you on track to save your life. You are presently cutting 12 - 15 years off your life.

David Buchin, MD · Answer

A BMI of 60 or above is categorized as super morbid obesity. A laparoscopic Roux-en-Y gastric bypass in these patients is technically very difficult due to the size of the abdominal wall, the size of the intra-abdominal fat and the size of the liver. Due to these technical aspects of the procedure, the risk of leak and other complications are increased. I think that a laparoscopic sleeve gastrectomy is a much better procedure in higher risk super morbidly obese patients. It is a technically easier operation than a Roux-en-Y gastric bypass and has a much lower complication rate for this patient population. The sleeve gastrectomy can also be the first stage in a two-stage procedure. Once the patient has lost a significant amount of weight, and if he/she is still morbidly obese, it is safer to then convert the laparoscopic sleeve gastrectomy into a gastric bypass or a duodenal switch. The sleeve gastrectomy started as a procedure for high-risk patients but is now used as a primary procedure for lower BMI patients as well.

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