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Comparative Analysis of Body Fat Percentage Versus Body Mass Index to Predict Weight Loss After Bariatric Surgery
S98
Poster Presentations / Surgery for Obesity and Related Diseases 11 (2015) S56–S211 Postoperative lipid values for LRYGB vs. LSG.
Lipid value, mg/dL
LRYGB
LSG
Nutrient deficiencies in patients after LRYGB vs. LSG P value
N
Mean ± SD
N
Mean ± SD
Total cholesterol
872
161.2 ± 30.6
71
184.2 ± 38.9
<0.001
LDL
860
84.3 ± 25.1
70
105.3 ± 33.8
<0.001
HDL
868
59.0 ± 14.0
71
60.3 ± 13.1
0.999
Triglycerides
866
90.1 ± 39.6
71
97.0 ± 40.3
0.600
Roux-en-Y gastric bypass (LRYGB) compared to laparoscopic sleeve gastrectomy (LSG); with some indicating significantly greater reductions in total cholesterol and LDL in LRYGB vs. LSG, and others reporting no significant differences. Our objective was to evaluate the postoperative lipid values in LRYGB vs. LSG. Methods: A retrospective review of our prospective database was completed to identify patients who underwent either LRYGB or LSG at our institution from 2001 through 2013. Lipid values available at 6-18 months postoperative were evaluated. Statistical analysis included Wilcoxon Rank Sum and χ2 tests with P values adjusted for multiple tests. A P value o0.05 was considered significant. Results: There were 872 and 71 patients who underwent LRYGB and LSG during the study period, respectively, for whom measurements of lipid values from 6-18 month postoperative period were available. The mean preoperative BMI was 47.3 kg/ m2 in the LRYGB group and 45.3 kg/m2 in the LSG group (Po0.003). Postoperatively, the mean BMI was reduced by 13.9 kg/m2/year and 12.3 kg/m2/year in LRYGB and LSG patients, respectively (P¼0.002). Postoperative mean total cholesterol, LDL, and triglyceride values were lower in LYRGB vs. LSG patients (Table). Postoperatively, 11% and 30% of LRYGB and LSG patients had a total cholesterol value 4200 mg/dL (Po0.001); 5% and 23% had LDL values 4130 mg/dL (Po0.001); and 8% and 10% had triglyceride levels above 130 mg/dL (P¼0.49). HDL values were within the recommended range in 95% and 92% of LRYGB and LSG patients, respectively (P¼0.58). Conclusions: Patients who underwent LRYGB had lower postoperative total cholesterol, LDL, and triglyceride values compared to those who underwent LSG. In patients with significant preoperative hypercholesterolemia who are candidates for both procedures, LRYGB may be more appropriate than LSG. A5082
MICRONUTRIENT DEFICIENCIES IN PATIENTS AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS VERSUS SLEEVE GASTRECTOMY Andrew Van Osdol, MD1; Andrew Borgert , PhD1; Kara Kallies, MS1; Shanu Kothari, MD, FACS2; Brandon Grover, DO2; 1Gundersen Medical Foundation, La Crosse, WI, USA; 2Gundersen Health System, La Crosse, WI, USA Background: Nutritional deficiencies after laparoscopic sleeve gastrectomy (LSG) are common but poorly understood. Perioperative clinical practice guidelines recommend the same minimal daily nutritional supplementation for patients with LSG and laparoscopic Roux-en-Y gastric bypass (LRYGB). However, if LSG is less malabsorptive compared to LRYGB, LSG patients should require less dietary supplementation. The objective of this
Variable Albumin Ferritin Hemoglobin A1c Magnesium Parathyroid hormone Calcium Vitamin D Vitamin B12
LRYGB LSG N (%) with deficient values 75 / 126 (60) 9 / 12 (75) 66 / 275 (24) 14 / 79 (18) 33 / 256 (13) 4 / 52 (8) 6 / 95 (6) 0/23 (0) 35 / 210 (17) 3 / 35 (9) 5 / 277 (2) 0/74 (0) 90 / 238 (38) 17 / 45 (38) 30 / 287 (10) 24 / 74 (32)
P value 0.999 0.999 0.999 0.999 0.999 0.999 0.999 0.999
study is to compare the postoperative nutritional lab values in LSG and LRYGB patients to determine if LSG patients require altered supplementation. Methods: A retrospective review of our prospective database was completed to identify patients who underwent either LRYGB or LSG at our institution from 2010 through 2013. Nutritional lab values obtained at 6-18 months postoperative were evaluated. All patients received recommendations for dietary supplementation consistent with clinical practice guidelines. Statistical analysis included Wilcoxon Rank Sum and χ2 tests with P values adjusted for multiple tests. A P value o0.05 was considered significant. Results: There were 444 and 121 patients identified who underwent LRYGB and LSG, respectively, with lab values available during the study period. The mean age at time of surgery was similar in the two groups at 46.7 years in the LRYGB group and 46.3 years in the LSG group. Mean preoperative BMI was 47.0 kg/ m2 and 45.1 kg/m2 in the LRYGB and LSG group, respectively. Postoperatively, the mean BMI was reduced by 13.8 kg/m2/year in the LRYGB group and 12.4 kg/m2/year in the LSG group. Postoperative mean nutrient values were similar in the two groups and there was no difference in the rate of nutrient deficiencies (Table). Conclusions: Nutritional deficiencies after LSG are common. Current clinical practice guideline adherence results in similar rates of deficiencies between LSG and LRYGB. Specifically, LSG patients still require supplementation with Vitamin B12 and iron. A5083
COMPARATIVE ANALYSIS OF BODY FAT PERCENTAGE VERSUS BODY MASS INDEX TO PREDICT WEIGHT LOSS AFTER BARIATRIC SURGERY Tara Mokhtari, BS; Sayantan Deb, BS; Lindsey Voller, BA; Sophia Koontz, BA; Dan Azagury, MD; Homero Rivas, MD, MBA; John Morton, MD; Stanford School of Medicine, Stanford, CA, USA Introduction: Body mass index (BMI) has become the preferred anthropometric parameter in obesity and bariatric medicine as it provides a convenient, noninvasive approximation of body habitus. However, BMI is limited by its neglect of overall body composition. This study aims to examine the utility of body fat percentage (%BF) as an anthropometric parameter and investigates its efficacy to predict postoperative weight loss. Methods: From 03/2003 to 03/2015, 2209 patients undergoing laparoscopic Roux-en-Y gastric bypass, sleeve gastrectomy, and gastric banding were prospectively enrolled. Demographic and
Poster Presentations / Surgery for Obesity and Related Diseases 11 (2015) S56–S211
anthropometric data were collected preoperatively and at 3 and 6 months postoperatively. %BF was determined by bioelectrical impedance analysis for 182 subjects from 11/2013 to 03/2015. Subjects were divided into %BF quartiles: %BF below the 25th percentile (r48.95 %BF) designated “Low %BF” while %BF above the 75th percentile (Z54.15 %BF) designated “High %BF”. Post-surgical weight loss was reported as percent excess weight loss at 3 and 6 months (%EWL3/6); %EWL was also divided into quartiles with %EWL below the 25th percentile (%EWL3r29.7%; %EWL6r43.7%) designating “Low Response” and %EWL above the 75th percentile (%EWL3Z47.5%; %EWL6Z85.2%) designating “High Response”. Student’s t-test and Fisher’s exact test were used to compare continuous and dichotomous variables respectively. Multivariate logistic regression was also performed to determine if %BF was correlated to weight loss. Analysis was performed with GraphPad Prism 6 and SAS version 9.3 Results: “Low %BF” subjects had a mean pre-op BMI of 41.5 kg/ m2 (range: 32.2 -55.3) and mean waist circumference of 49.5 in (range: 40.6-62.6). “High %BF” subjects had a mean pre-op BMI of 53.1 5 kg/m2 (range: 34.3-76.7) and waist circumference of 55.7 in (range: 42.9-73.0). Patients with “Low %BF” lost significantly more weight than those with “High %BF” at both 3 (%EWL 54.5 vs. 34.1%, po0.0001) and 6 months (%EWL 68.5 vs. 52.5%, p¼0.024). Furthermore, subjects with “Low %BF” preoperatively had lower rates of “Low %EWL Response” at 3 months (p¼0.0202) and higher rates of “High %EWL Response” at both 3 months (p¼0.0031) and 6 months (p¼0.0128). There were no differences in complication, readmission, or reoperation rates based on %BF classification. Pearson correlation demonstrated %BF to be significantly correlated with various of weight loss outcomes at both 3 and 6 months including weight, BMI, %EWL, and waist circumference (all p’s o0.05). Multivariate logistic regression adjusted for age, sex, and diabetes status showed preoperative %BF was significantly predictive of %EWL at 3 months (OR: 0.31; 95%CI: 0.12-0.84; p¼0.021). A second regression adjusting for the same variables showed that “Low % BF” significantly correlated to %EWL at 3 months (OR: 6.94; 95% CI:1.70-28.33; p¼0.007). When the regression was adjusted for pre-operative BMI, there was a strong trend correlating “Low % BF” and %EWL at 3 months (OR: 5.44, 95%CI: 0.98-30.23, p¼0.0532). Conclusions: In addition to variability of BMI, there is significant variability in %BF within the bariatric population. Multivariate logistic regression identified %BF to be significantly correlated to post-bariatric weight loss outcomes (subjects with lower %BF had superior weight loss). These results suggest that in addition to BMI, %BF may be an important
A5084
EARLY EXPERIENCE IN MULTI-MODALITY TREATMENT FOR OBESITY Tara Mokhtari, BS; Nairi Strauch, BA; Pooja Pradhan, BS; John Morton, MD; Stanford School of Medicine, Stanford, CA, USA Introduction: Several new prescription weight loss medications have recently gained approval for use in the United States. Among these are Qsymia (phentermine/topiramate) and Contrave
S99
(naltrexone/bupropion). These pharmacologic agents may be useful in a diverse array of settings, including primary weight loss and weight loss in the context of bariatric surgery. We report our experience and early outcomes using these agents for weight loss. Methods: Subjects were retrospectively identified through a custom EMR data extraction in partnership with the Center for Clinical Informatics. EMR files from patients presenting to our bariatric/weight management clinic between January 2013 and March 2015 were queried to retrieve all patients prescribed Qsymia or Contrave. A total of 110 patients were identified. Patient demographic data, medication start/stop dates, and anthropometric data were obtained. Wilcoxon matched-pairs signed rank test was used to compare weight loss outcomes over time. All analysis was performed with GraphPad Prism 6. Results: Prior to treatment, mean weight was 248 lb and BMI was 41.3 kg/m2. Distribution of medications showed 31.6% of subjects were prescribed Qsymia, 65.0% Contrave, and 3.4% took both Qsymia and Contrave simultaneously. At the time of analysis, 73.5% of subjects had an active prescription while 26.5% had discontinued medication use. Average length of time on medication was 4.3 months with a range of 0.4 to 21.1 months. Of participants on medical weight loss therapy, 50.0% underwent prior bariatric surgery: 41.8% Roux-en-Y gastric bypass, 29.1% sleeve gastrectomy, 5.5% gastric banding, 7.3% StomaphyX, 16.4% Apollo OverStitch. Of these patients, 85.5% initiated medical weight loss therapy following bariatric surgery (mean 46.1 months post-surgery) and 14.5% initiated prior to surgery (mean 6.8 months pre-surgery). Subjects showed significant decrease in BMI from baseline at 1 month (p¼0.0010) down to 39.1 kg/m2 at 3 months (p¼0.018). BMI continued to trend downward at 6 months (p¼0.22). Average total weight loss trended positively and was 0.93% at 2 weeks, 2.07% at 1 month, 2.13% at 3 months, and 3.74% at 6 months (all p’s o0.16). Conclusions: This study reports early experience with two prescription weight-loss medications in a clinical setting. In this early experience, reductions in BMI and percent weight loss were observed early within treatment initiation. These results shed light on a new paradigm in obesity treatment.
A5085
COMPARISON OF OMEGA LOOP GASTRIC BYPASS VERSUS SLEEVE GASTRECTOMY IN A MAINLY SUPER-OBESE PATIENT GROUP – SHORT- AND MIDTERM RESULTS Andreas Plamper, MD1; Philipp Lingohr, MD2; Jennifer Nadal Dipl, Math (FH)2; Karl Rheinwalt, MD1; 1St. Franziskus-Hospital, Cologne, NRW, Germany; 2University of Bonn, Bonn, NRW, Germany Introduction: Laparoscopic sleeve gastrectomy (LSG) is a well – established bariatric procedure especially in patients with a BMI 4 50 kg/sqm. However, there are doubts that all LSG patients are able to conserve their remarkable short – term results in the long run when being compared to the results of bypass procedures. There is on the other hand increasing evidence that the omega loop gastric bypass (MGB) is a safe and effective operation especially, but not only in super-obese patients. We also use MGB
Poster Presentations / Surgery for Obesity and Related Diseases 11 (2015) S56–S211 Postoperative lipid values for LRYGB vs. LSG.
Lipid value, mg/dL
LRYGB
LSG
Nutrient deficiencies in patients after LRYGB vs. LSG P value
N
Mean ± SD
N
Mean ± SD
Total cholesterol
872
161.2 ± 30.6
71
184.2 ± 38.9
<0.001
LDL
860
84.3 ± 25.1
70
105.3 ± 33.8
<0.001
HDL
868
59.0 ± 14.0
71
60.3 ± 13.1
0.999
Triglycerides
866
90.1 ± 39.6
71
97.0 ± 40.3
0.600
Roux-en-Y gastric bypass (LRYGB) compared to laparoscopic sleeve gastrectomy (LSG); with some indicating significantly greater reductions in total cholesterol and LDL in LRYGB vs. LSG, and others reporting no significant differences. Our objective was to evaluate the postoperative lipid values in LRYGB vs. LSG. Methods: A retrospective review of our prospective database was completed to identify patients who underwent either LRYGB or LSG at our institution from 2001 through 2013. Lipid values available at 6-18 months postoperative were evaluated. Statistical analysis included Wilcoxon Rank Sum and χ2 tests with P values adjusted for multiple tests. A P value o0.05 was considered significant. Results: There were 872 and 71 patients who underwent LRYGB and LSG during the study period, respectively, for whom measurements of lipid values from 6-18 month postoperative period were available. The mean preoperative BMI was 47.3 kg/ m2 in the LRYGB group and 45.3 kg/m2 in the LSG group (Po0.003). Postoperatively, the mean BMI was reduced by 13.9 kg/m2/year and 12.3 kg/m2/year in LRYGB and LSG patients, respectively (P¼0.002). Postoperative mean total cholesterol, LDL, and triglyceride values were lower in LYRGB vs. LSG patients (Table). Postoperatively, 11% and 30% of LRYGB and LSG patients had a total cholesterol value 4200 mg/dL (Po0.001); 5% and 23% had LDL values 4130 mg/dL (Po0.001); and 8% and 10% had triglyceride levels above 130 mg/dL (P¼0.49). HDL values were within the recommended range in 95% and 92% of LRYGB and LSG patients, respectively (P¼0.58). Conclusions: Patients who underwent LRYGB had lower postoperative total cholesterol, LDL, and triglyceride values compared to those who underwent LSG. In patients with significant preoperative hypercholesterolemia who are candidates for both procedures, LRYGB may be more appropriate than LSG. A5082
MICRONUTRIENT DEFICIENCIES IN PATIENTS AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS VERSUS SLEEVE GASTRECTOMY Andrew Van Osdol, MD1; Andrew Borgert , PhD1; Kara Kallies, MS1; Shanu Kothari, MD, FACS2; Brandon Grover, DO2; 1Gundersen Medical Foundation, La Crosse, WI, USA; 2Gundersen Health System, La Crosse, WI, USA Background: Nutritional deficiencies after laparoscopic sleeve gastrectomy (LSG) are common but poorly understood. Perioperative clinical practice guidelines recommend the same minimal daily nutritional supplementation for patients with LSG and laparoscopic Roux-en-Y gastric bypass (LRYGB). However, if LSG is less malabsorptive compared to LRYGB, LSG patients should require less dietary supplementation. The objective of this
Variable Albumin Ferritin Hemoglobin A1c Magnesium Parathyroid hormone Calcium Vitamin D Vitamin B12
LRYGB LSG N (%) with deficient values 75 / 126 (60) 9 / 12 (75) 66 / 275 (24) 14 / 79 (18) 33 / 256 (13) 4 / 52 (8) 6 / 95 (6) 0/23 (0) 35 / 210 (17) 3 / 35 (9) 5 / 277 (2) 0/74 (0) 90 / 238 (38) 17 / 45 (38) 30 / 287 (10) 24 / 74 (32)
P value 0.999 0.999 0.999 0.999 0.999 0.999 0.999 0.999
study is to compare the postoperative nutritional lab values in LSG and LRYGB patients to determine if LSG patients require altered supplementation. Methods: A retrospective review of our prospective database was completed to identify patients who underwent either LRYGB or LSG at our institution from 2010 through 2013. Nutritional lab values obtained at 6-18 months postoperative were evaluated. All patients received recommendations for dietary supplementation consistent with clinical practice guidelines. Statistical analysis included Wilcoxon Rank Sum and χ2 tests with P values adjusted for multiple tests. A P value o0.05 was considered significant. Results: There were 444 and 121 patients identified who underwent LRYGB and LSG, respectively, with lab values available during the study period. The mean age at time of surgery was similar in the two groups at 46.7 years in the LRYGB group and 46.3 years in the LSG group. Mean preoperative BMI was 47.0 kg/ m2 and 45.1 kg/m2 in the LRYGB and LSG group, respectively. Postoperatively, the mean BMI was reduced by 13.8 kg/m2/year in the LRYGB group and 12.4 kg/m2/year in the LSG group. Postoperative mean nutrient values were similar in the two groups and there was no difference in the rate of nutrient deficiencies (Table). Conclusions: Nutritional deficiencies after LSG are common. Current clinical practice guideline adherence results in similar rates of deficiencies between LSG and LRYGB. Specifically, LSG patients still require supplementation with Vitamin B12 and iron. A5083
COMPARATIVE ANALYSIS OF BODY FAT PERCENTAGE VERSUS BODY MASS INDEX TO PREDICT WEIGHT LOSS AFTER BARIATRIC SURGERY Tara Mokhtari, BS; Sayantan Deb, BS; Lindsey Voller, BA; Sophia Koontz, BA; Dan Azagury, MD; Homero Rivas, MD, MBA; John Morton, MD; Stanford School of Medicine, Stanford, CA, USA Introduction: Body mass index (BMI) has become the preferred anthropometric parameter in obesity and bariatric medicine as it provides a convenient, noninvasive approximation of body habitus. However, BMI is limited by its neglect of overall body composition. This study aims to examine the utility of body fat percentage (%BF) as an anthropometric parameter and investigates its efficacy to predict postoperative weight loss. Methods: From 03/2003 to 03/2015, 2209 patients undergoing laparoscopic Roux-en-Y gastric bypass, sleeve gastrectomy, and gastric banding were prospectively enrolled. Demographic and
Poster Presentations / Surgery for Obesity and Related Diseases 11 (2015) S56–S211
anthropometric data were collected preoperatively and at 3 and 6 months postoperatively. %BF was determined by bioelectrical impedance analysis for 182 subjects from 11/2013 to 03/2015. Subjects were divided into %BF quartiles: %BF below the 25th percentile (r48.95 %BF) designated “Low %BF” while %BF above the 75th percentile (Z54.15 %BF) designated “High %BF”. Post-surgical weight loss was reported as percent excess weight loss at 3 and 6 months (%EWL3/6); %EWL was also divided into quartiles with %EWL below the 25th percentile (%EWL3r29.7%; %EWL6r43.7%) designating “Low Response” and %EWL above the 75th percentile (%EWL3Z47.5%; %EWL6Z85.2%) designating “High Response”. Student’s t-test and Fisher’s exact test were used to compare continuous and dichotomous variables respectively. Multivariate logistic regression was also performed to determine if %BF was correlated to weight loss. Analysis was performed with GraphPad Prism 6 and SAS version 9.3 Results: “Low %BF” subjects had a mean pre-op BMI of 41.5 kg/ m2 (range: 32.2 -55.3) and mean waist circumference of 49.5 in (range: 40.6-62.6). “High %BF” subjects had a mean pre-op BMI of 53.1 5 kg/m2 (range: 34.3-76.7) and waist circumference of 55.7 in (range: 42.9-73.0). Patients with “Low %BF” lost significantly more weight than those with “High %BF” at both 3 (%EWL 54.5 vs. 34.1%, po0.0001) and 6 months (%EWL 68.5 vs. 52.5%, p¼0.024). Furthermore, subjects with “Low %BF” preoperatively had lower rates of “Low %EWL Response” at 3 months (p¼0.0202) and higher rates of “High %EWL Response” at both 3 months (p¼0.0031) and 6 months (p¼0.0128). There were no differences in complication, readmission, or reoperation rates based on %BF classification. Pearson correlation demonstrated %BF to be significantly correlated with various of weight loss outcomes at both 3 and 6 months including weight, BMI, %EWL, and waist circumference (all p’s o0.05). Multivariate logistic regression adjusted for age, sex, and diabetes status showed preoperative %BF was significantly predictive of %EWL at 3 months (OR: 0.31; 95%CI: 0.12-0.84; p¼0.021). A second regression adjusting for the same variables showed that “Low % BF” significantly correlated to %EWL at 3 months (OR: 6.94; 95% CI:1.70-28.33; p¼0.007). When the regression was adjusted for pre-operative BMI, there was a strong trend correlating “Low % BF” and %EWL at 3 months (OR: 5.44, 95%CI: 0.98-30.23, p¼0.0532). Conclusions: In addition to variability of BMI, there is significant variability in %BF within the bariatric population. Multivariate logistic regression identified %BF to be significantly correlated to post-bariatric weight loss outcomes (subjects with lower %BF had superior weight loss). These results suggest that in addition to BMI, %BF may be an important
A5084
EARLY EXPERIENCE IN MULTI-MODALITY TREATMENT FOR OBESITY Tara Mokhtari, BS; Nairi Strauch, BA; Pooja Pradhan, BS; John Morton, MD; Stanford School of Medicine, Stanford, CA, USA Introduction: Several new prescription weight loss medications have recently gained approval for use in the United States. Among these are Qsymia (phentermine/topiramate) and Contrave
S99
(naltrexone/bupropion). These pharmacologic agents may be useful in a diverse array of settings, including primary weight loss and weight loss in the context of bariatric surgery. We report our experience and early outcomes using these agents for weight loss. Methods: Subjects were retrospectively identified through a custom EMR data extraction in partnership with the Center for Clinical Informatics. EMR files from patients presenting to our bariatric/weight management clinic between January 2013 and March 2015 were queried to retrieve all patients prescribed Qsymia or Contrave. A total of 110 patients were identified. Patient demographic data, medication start/stop dates, and anthropometric data were obtained. Wilcoxon matched-pairs signed rank test was used to compare weight loss outcomes over time. All analysis was performed with GraphPad Prism 6. Results: Prior to treatment, mean weight was 248 lb and BMI was 41.3 kg/m2. Distribution of medications showed 31.6% of subjects were prescribed Qsymia, 65.0% Contrave, and 3.4% took both Qsymia and Contrave simultaneously. At the time of analysis, 73.5% of subjects had an active prescription while 26.5% had discontinued medication use. Average length of time on medication was 4.3 months with a range of 0.4 to 21.1 months. Of participants on medical weight loss therapy, 50.0% underwent prior bariatric surgery: 41.8% Roux-en-Y gastric bypass, 29.1% sleeve gastrectomy, 5.5% gastric banding, 7.3% StomaphyX, 16.4% Apollo OverStitch. Of these patients, 85.5% initiated medical weight loss therapy following bariatric surgery (mean 46.1 months post-surgery) and 14.5% initiated prior to surgery (mean 6.8 months pre-surgery). Subjects showed significant decrease in BMI from baseline at 1 month (p¼0.0010) down to 39.1 kg/m2 at 3 months (p¼0.018). BMI continued to trend downward at 6 months (p¼0.22). Average total weight loss trended positively and was 0.93% at 2 weeks, 2.07% at 1 month, 2.13% at 3 months, and 3.74% at 6 months (all p’s o0.16). Conclusions: This study reports early experience with two prescription weight-loss medications in a clinical setting. In this early experience, reductions in BMI and percent weight loss were observed early within treatment initiation. These results shed light on a new paradigm in obesity treatment.
A5085
COMPARISON OF OMEGA LOOP GASTRIC BYPASS VERSUS SLEEVE GASTRECTOMY IN A MAINLY SUPER-OBESE PATIENT GROUP – SHORT- AND MIDTERM RESULTS Andreas Plamper, MD1; Philipp Lingohr, MD2; Jennifer Nadal Dipl, Math (FH)2; Karl Rheinwalt, MD1; 1St. Franziskus-Hospital, Cologne, NRW, Germany; 2University of Bonn, Bonn, NRW, Germany Introduction: Laparoscopic sleeve gastrectomy (LSG) is a well – established bariatric procedure especially in patients with a BMI 4 50 kg/sqm. However, there are doubts that all LSG patients are able to conserve their remarkable short – term results in the long run when being compared to the results of bypass procedures. There is on the other hand increasing evidence that the omega loop gastric bypass (MGB) is a safe and effective operation especially, but not only in super-obese patients. We also use MGB