When BMI Exceeds 50: What Ten Years of Follow-Up Reveal After Bariatric Surgery

Introduction: Patients with extreme obesity represent a high-risk group for metabolic bariatric surgery (MBS), and long-term outcome data remain limited. This study evaluated the safety and long-term efficacy of MBS in patients with BMI ≥50kg/m². Materials and Methods: This retrospective observational study included patients who underwent MBS between 2007 and 2014 and completed 10 years of follow-up. Patients were stratified by preoperative BMI (<50 vs. ≥50kg/m²). Outcomes included long-term weight loss, remission of type 2 diabetes (T2DM), hypertension (HT), obstructive sleep apnea (OSA), gastroesophageal reflux disease (GERD), and perioperative complications. Results: Eighty-nine patients had BMI ≥50kg/m², with a mean follow-up of 11.10 years. Patients with BMI ≥50kg/m² more often achieved ≥20%TWL (78.65% vs. 53.63%, p<0.001), while >50%EWL was observed in 58.43% with similar results between groups. Median final BMI remained higher in this group (36.33 vs. 32.27kg/m², p<0.001). Remission rates were 59.1% for T2DM, 61.5% for HT, 57.1% for OSA, and 75.0% for GERD. Thirty-day complications occurred in 7.86% of patients. Revisional surgery was more frequent in the BMI ≥50kg/m² group (43.82% vs. 19.61%, p<0.001). Conclusions: MBS leads to durable weight loss and improvement of obesity-related comorbidities in patients with BMI ≥50kg/m², although the risk of revisional surgery remains higher.