Outcomes of Roux-en-Y Gastric Bypass Stratified by a Body Mass Index of 70 kg/m 2 : A Comparative Analysis of 825 Procedures Ioannis Raftopoulos, M.D., Ph.D., Julie Ercole, Anthony O. Udekwu, M.D., James D. Luketich, M.D., Anita P. Courcoulas, M.D., M.P.H. We compared the safety, excess weight loss (EWL), and improvement in comorbidities after Roux-en- Y gastric bypass (RYGB) in morbidly obese and superobese patients (body mass index,  70 kg/m 2 or 70 kg/m 2 ). Of 825 patients who underwent RYGB by our group between 1995 and 2003, 79 (9.6%) were superobese (group A) and 746 were morbidly obese (group B). There were significant differences in age (A, 40.8 years; B, 43.2 years; P = 0.01), gender (males: A, 40.5%; B, 17.6%; P  0.0001), and type of access (laparoscopic RYGB: A, 4.1%; B, 34.2%; P  0.0001). Sleep apnea (A, 57%; B, 31.4%; P  0.0001) and venous insufficiency (A, 16.5%; B, 2.4%; P  0.0001) were more common in superobese patients. Hospital stay was similar (A, 6.3 days; B, 5.3 days) with adjustment for differences in type of access. Although morbidity was comparable, mortality was higher in the superobese group (A, 2.5%; B, 0.5%; P  0.05). At a comparable follow-up (A, 17.7 months; B, 18.25 months), percent EWL at 1 year was lower in the superobese group (A, 54.6%; B, 64.3%; P  0.0001), but it became similar at 3 years (A, 66.5%; B, 60.7%). Postoperative improvement of comorbidities was equally dramatic in both groups with the exception of venous insufficiency. In conclusion, complications are not increased in the superobese, but they are more often fatal. Superobese patients achieve their maximum weight loss in a longer period of time and reach their nadir at year 3. (J GASTROINTEST SURG 2005;9:44–53)  2005 The Society for Surgery of the Alimentary Tract KEY WORDS: Morbid obesity, superobesity, morbidity, mortality, weight loss, comorbidities Although superobesity is not officially recognized as a weight category, it has been the subject of intense scrutiny because of reported associations with a higher incidence of comorbid medical conditions and potentially greater health risks, 1 increased technical challenges with higher morbidity and mortality rates, 2 and suboptimal weight loss. 3 Superobesity has been arbitrarily defined as either a body weight of greater than 225% of the ideal body weight 4 or greater than 200 pounds of ideal body weight, 5 as well as either a body mass index (BMI) of 60 kg/m 2 or greater 6 or, more commonly, a BMI of 50 kg/m 2 or greater. 7 In our experience, patients with a BMI of 70 kg/m 2 or greater represent a distinct group of patients because of increased technical difficulties, Presented at the Forty-Fifth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, Louisiana, May 15–19, 2004 (oral presentation). From the Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Reprint requests: Anita Courcoulas, M.D., M.P.H., UPMC Shadyside Hospital, 5200 Centre Avenue, Suite 715, Pittsburgh, PA 15232. e-mail: courcoulasap@msx.upmc.edu  2005 The Society for Surgery of the Alimentary Tract 1091-255X/05/$—see front matter Published by Elsevier Inc. doi:10.1016/j.gassur.2004.10.004 44 limitations in the preoperative and postoperative diagnostic work-up, and higher intolerance to any adverse events after surgery. The outcome of Roux- en-Y gastric bypass (RYGB) in “extremely” superobese patients with a BMI of 70 kg/m 2 or greater in terms of safety, weight loss, and improvement in obesity- related disorders has not been previously investigated and is the objective of this study. MATERIALS AND METHODS This is a retrospective review of 825 morbidly obese patients who underwent RYGB between January 1995 and July 2003. All procedures were performed by one of three surgeons A.O.U. (n = 114), J.D.L. (n = 64),