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Weight loss with intra-gastric balloon (IGB) insertion\u00a0prior to LRYGB may improve operative outcomes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Between June 2000 and June 2020, patients with a BMI\u2009\u2265\u200950\u00a0kg\/m<jats:sup>2<\/jats:sup> underwent either IGB insertion followed by LRYGB (two-stage group), or LRYGB as the definitive bariatric procedure (single-stage group) in our institution. The two-stage procedure was adopted for high risk individuals. Primary outcome measures were percentage total weight loss (%TWL) at 24\u00a0months, length of stay and postoperative morbidity. Propensity score analysis was used to account for differences between groups.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 155 (mean age 42.9\u00a0years\u2009\u00b1\u200910.60; mean BMI 54.6\u00a0kg\/m<jats:sup>2<\/jats:sup>\u2009\u00b1\u20094.53) underwent either the two-stage (<jats:italic>n<\/jats:italic>\u2009=\u200930) or single-stage procedure (<jats:italic>n<\/jats:italic>\u2009=\u2009125) depending on preoperative fitness. At 6 months following LRYGB, there was a significant difference in %TWL between the groups in a matched analysis (11.9% vs 23.7%, <jats:italic>p<\/jats:italic> &lt; 0.001).\u00a0At 24\u00a0months, there was no difference in %TWL (32.0% vs 34.7%, <jats:italic>p<\/jats:italic>\u2009=\u20090.13). Median hospital stay following LRYGB was 2.0\u00a0(1-4)\u00a0days with the\u00a0two-stage vs 2.0 (0-14)\u00a0days for the\u00a0single-stage approach (<jats:italic>p<\/jats:italic>\u2009=\u20090.75). There was also no significant difference in complication\u00a0rates (<jats:italic>p<\/jats:italic>\u2009=\u20090.058) between the two groups.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>There was no difference in weight loss after one or two-stage procedures in the treatment of patients with a BMI\u00a0\u2265 50 kg\/m<jats:sup>2\u00a0<\/jats:sup>super obesity in a propensity score weighted analysis\u00a0at 24 months. Length of stay and perioperative complications were similar for high risk patients; however, the two-stage approach was associated with delayed weight loss. Single-stage management is recommended for moderate risk patients, particularly with significant metabolic disorders, whilst two-stage approach is a safe and feasible pathway for high\u00a0risk individuals.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00423-022-02664-9","type":"journal-article","created":{"date-parts":[[2022,9,2]],"date-time":"2022-09-02T03:22:25Z","timestamp":1662088945000},"page":"3349-3356","update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical outcomes of single-stage versus two-stage laparoscopic Roux-en-y gastric bypass in the management of obesity (BMI \u2265 50 kg\/m2): a retrospective cohort study"],"prefix":"10.1007","volume":"407","author":[{"given":"Michael G","family":"Fadel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matyas","family":"Fehervari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Lairy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bibek","family":"Das","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khaled","family":"Alyaqout","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hutan","family":"Ashrafian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haris","family":"Khwaja","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evangelos","family":"Efthimiou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,9,2]]},"reference":[{"key":"2664_CR1","doi-asserted-by":"crossref","unstructured":"Peterson K, Anderson J, Boundy E et al (2017) Rapid evidence review of bariatric surgery in super obesity (BMI \u2265 50 kg\/m2). 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