Long term predictors of success after laparoscopic sleeve gastrectomy (original) (raw)
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Laparoscopic sleeve gastrectomy: does bougie size affect mean %EWL? Short-term outcomes
Surgery for Obesity and Related Diseases, 2008
Background: Laparoscopic sleeve gastrectomy (LSG) has been increasingly offered to high-risk bariatric patients as the first-stage procedure before gastric bypass or biliopancreatic diversion or as the primary weight loss procedure. The bougie size has varied by surgeon during LSG. The aim of this study was to determine whether short-term weight loss correlates with the bougie size used during creation of the sleeve. Methods: We retrospectively reviewed the data from all patients who had undergone LSG at our institution between 2003 and 2006. Revision LSG for failed bariatric procedures was excluded. The data analyzed included preoperative age, body mass index (BMI), bougie size, and percentage of excess weight loss (%EWL). Results: A total of 135 patients underwent LSG during the 4-year period. Most of these patients (79%) underwent LSG as part of a 2-stage operation (either gastric bypass or duodenal switch within a mean of 11 months). The mean preoperative age and BMI was 43.5 years and 60.1 kg/m 2 , respectively. The mean BMI and %EWL at 6 months was 47.1 kg/m 2 and 37.9%, respectively. The mean BMI and %EWL at 12 months was 44.3 kg/m 2 and 47.3%, respectively. When stratifying the %EWL by bougie size (40F versus 60F), we did not find a significant difference at 6 months (38.8% versus 40.6%, P ϭ NS) or 12 months (51.9% versus 45.4%, P ϭ NS). Conclusion: LSG results in significant weight loss in the short term. When stratifying outcomes by bougie size, our results suggested that a bougie size of 40F compared with 60F does not result in significantly greater weight loss in the short term. However, longer follow-up of the primary LSG group is required to determine whether a difference becomes evident over time. (Surg Obes Relat Dis 2008;4: 528 -533.)
Long-term outcomes of laparoscopic sleeve gastrectomy as a definitive bariatric procedure
Surgery for Obesity and Related Diseases, 2010
Introduction Sleeve gastrectomy (LSG) is one of the most popular bariatric procedures. We present our long-term results regarding weight loss, comorbidities, and gastric reflux disease. Material and Methods We identified patients who underwent LSG in our institution between 2006 and 2009. We revised the data, and the patients with outdated contact details were tracked with the national health insurance database and social media (facebook). Each of the identified patients was asked to complete an online or telephone survey covering, among others, their weight and comorbidities. On that basis, we calculated the percent total weight loss (%TWL) and percent excess weight loss (%EWL), along with changes in body mass index (ΔBMI). Satisfactory weight loss was set at >50% EWL (for BMI = 25 kg/m 2). We evaluated type 2 diabetes (T2DM) and arterial hypertension (AHT) based on the pharmacological therapy. GERD presence was evaluated by the typical symptoms and/or proton pump inhibitor (PPI) therapy. Results One hundred twenty-seven patients underwent LSG between 2006 and 2009. One hundred twenty patients were qualified for this study. Follow-up data was available for 100 participants (47 female, 53 male). Median follow-up period reached 8.0 years (from 7.1 to 10.7). Median BMI upon qualification for LSG was 51.6 kg/m 2. Sixteen percent of patients required revisional surgery over the years (RS group), mainly because of insufficient weight loss (14 Roux-Y gastric bypass-LRYGB; one mini gastric bypass, one gastric banding). For the LSG (LSG group n = 84), the mean %EWL was 51.1% (±22.3), median %TWL was 23.5% (IQR 17.7-33.3%), and median ΔBMI was 12.1 kg/m 2 (IQR 8.2-17.2). Fifty percent (n = 42) of patients achieved the satisfactory %EWL of 50%. For RS group, the mean %EWL was 57.8% (±18.2%) and median %TWL reached 33% (IQR 27.7-37.9%). Sixty-two percent (n = 10) achieved the satisfactory weight loss. Fifty-nine percent of patients reported improvement in AHT therapy, 58% in T2DM. After LSG, 60% (n = 60) of patients reported recurring GERD symptoms and 44% were treated with proton pomp inhibitors (PPI). In 93% of these cases, GERD has developed de novo. Conclusions Isolated LSG provides fairly good effects in a long-term follow-up with mean %EWL at 51.1%. Sixteen percent of patients require additional surgery due to insufficient weight loss. More than half of the subjects observe improvement in AHT and T2DM. Over half of the patients complain of GERD symptoms, which in most of the cases is a de novo complaint.
Obesity Surgery, 2015
Background Most surgeons calibrate the sleeve with 32-French (Fr) to 40-Fr bougies hypothesizing that smaller bougies are associated with greater weight loss and long-term lower weight regain. The purpose of this study was to assess the weight loss results and resolution of comorbidities 5 years after laparoscopic sleeve gastrectomy (LSG). Methods A prospective study of all the morbidly obese patients undergoing laparoscopic sleeve gastrectomy calibrated with a 50-Fr bougie between October 2007 and February 2010 was performed. Excess weight loss (EWL) and remission of comorbidities were investigated at 1, 2, and 5 years after surgery. Results Fifty patients were included for the analysis. One year after surgery, mean excess weight loss (EWL) of 81.8 % was achieved, type 2 diabetes mellitus (T2DM) resolution rate was 76.9 %, hypertension resolution was observed in 73.3 %, sleep apnea hypopnea syndrome (SAHS) resolution in 100 % hypertriglyceridemia was normalized in all the cases, and hypercholesterolemia in 21.4 %. Two years after surgery, mean EWL was 84.4 % and comorbidity resolution rate similar to that obtained after the first postoperative year. Five years after surgery, mean EWL was 78.7 %, T2DM resolution 69.2 %, hypertension 66.7 %, SAHS 100 %, hypertriglyceridemia 100 %, and hypercholesterolemia 14.3 %. Conclusions LSG calibrated with a 50-Fr bougie obtained excellent results in weight loss and resolution comorbidities and their maintenance in the long-term follow-up in our series. In our opinion, the results depend more on a preoperative correct selection of candidates and a close postoperative follow-up, rather than using a narrow calibration bougie.
Medium-Term Results of Laparoscopic Sleeve Gastrectomy: a Matched Comparison with Gastric Bypass
Obesity Surgery, 2015
Background Laparoscopic sleeve gastrectomy (LSG) is considered a primary bariatric surgery and is increasingly being performed worldwide; however, long-term data regarding the durability of this procedure are inadequate. Here, we report the long-term results of LSGs in comparison to those of gastric bypass surgeries. Methods A prospectively collected bariatric database from Ming-Shen General Hospital was retrospectively studied. Five hundred nineteen morbidly obese patients (mean age 36.0± 9.1 years old (14-71), 74.6 % female, mean body mass index (BMI) 37.5±6.1 kg/m 2 ) underwent LSG as a primary bariatric procedure from 2006 to 2012 at our institute. The operative parameters, weight loss, laboratory data, and quality of life were followed. Another two matched groups of laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic single anastomosis (mini-) gastric bypass (SAGB) patients who were matched in terms of age, sex, and BMI were recruited for comparisons. Results The mean surgical time for LSG was 113.5 ± 31.3 min, and the mean blood loss was 49.1+100.9 ml. The rate of major complications was 1.6 %, and the average length of the postoperative stay was 3.0±1.7 days. The operation times of the RYGB patients were longer than those of both the LSG and SAGB patients. The RYGB and SAGB patients experienced higher major complication rate than the LSG patients. The weight loss of the LSG patient at 5 years was 28.3+ 8.9 %, and the mean BMI was 27.1+4.3. The RYGB patients exhibited a 5-year weight loss similar to the LSG patients, and the SAGB patients exhibited greater weight loss than both of the other groups. Both the RYGB and SAGB patients exhibited significantly better glycemic control and lower blood lipids than the LSG patients, but the LSG patients exhibited a lesser micronutrient deficiency than the RYGB and SAGB groups. All three of the groups exhibited improved quality of life at 5 years after surgery, and there was no significant between-group difference in this measure. Conclusions LSG appears to be an ideal bariatric surgery, and the efficacy of this surgery is not inferior to that of gastric bypass.
Obesity Surgery, 2011
Background The aim of this study was to assess outcomes of laparoscopic sleeve gastrectomy (LSG) as a stand-alone bariatric operation according to the Bariatric Analysis and Reporting Outcome System (BAROS). Methods Out of 112 patients included and operated on initially, 84 patients (F/M, 63:21) were followed up for 14-56 months (mean 22±6.75). Patients lost to follow-up did not attend scheduled follow-up visits or they have withdrawn their consent. Mean age was 39 years (range 17-67; SD±12.09) with mean initial BMI 44.62 kg/m 2 (range 29.39-82.8; SD±8.17). Statistical significance was established at the p<0.05 level. Results Mean operative time was 61 min (30-140 min) with mean hospital stay of 1.37 days (0-4; SD±0.77). Excellent global BAROS outcome was achieved in 13% of patients, very good in 30%, good in 34.5%, fair 9.5% and failure in 13% patients 12 months after surgery. Females achieved significantly better outcomes than males with the mean 46.5% of excess weight loss (EWL) versus 35.3% of EWL at 12 months (p=0.02). The mean percentage of excess weight loss (%EWL) was 43.6% at 12 months and 46.6% at 24 months. Major surgical complication rate was 7.1%; minor surgical complication rate 8.3%. There was one conversion (1.2%) due to the massive bleeding. Comorbidities improved or resolved in numerous patients: arterial hypertension in 62%, diabetes mellitus in 68.3%, respectively. Conclusions Presented LSG series shows that the LSG as a stand-alone procedure provides acceptable %EWL and good global BAROS outcomes. It significantly improves comorbidities as well.
Obesity Surgery, 2013
Background Laparoscopic sleeve gastrectomy (LSG) is emerging as a popular "stand-alone" bariatric procedure. We report our 5 years experience with LSG as a single-stage bariatric procedure with which to study the technical progress, learning curve, complications, and follow-up results. Methods Prospectively collected data of 228 patients (145 females and 83 males), who underwent LSG for morbid obesity, from February 2007 to March 2012, was retrospectively analyzed. Results The mean age was 34.68 years (range, 18-62 years) and the mean preoperative body mass index (BMI) was 37.42±4.75 kg/m 2 (range, 32.08-65.69 kg/m 2). Mean operative time was 60.63±27.37 min. The mean BMI decreased to 26.15 ± 3.71 kg/m 2 at 3 years (p < 0.001) and to 27.94±4.08 kg/m 2 at 5 years (p<0.001). Mean percentage excess weight loss was 71.96 ±21.30 % at 3 years and 63.71±20.08 % at 5 years. The 30-day readmission rate was 3.07 %.Overall complication rate was 4.3 %, including strictures, leaks, peritonitis, gastrocutaneous fistula, and one (0.43 %) mortality. One patient with weight regain and another with stricture underwent conversion to Roux-en-Y gastric bypass. Complication rates significantly decreased after the first 50 cases (p= 0.022), suggesting an initial learning curve. Resolution of diabetes, hypertension, and hyperlipidemia was 66.67, 100, and 50 %, respectively, at 5 years. Conclusions LSG as a single-stage bariatric procedure is safe and durable, achieving weight loss and resolution of comorbidities up to 5 years. Adherence to technical details is pivotal in reducing complications associated with the initial learning phase.
Obesity Surgery, 2009
Background In previous publications, we demonstrated the safety and short-term efficacy of laparoscopic sleeve gastrectomy (LSG) as a final step in the treatment of morbid obesity (MO). This study aimed to assess the midterm efficacy of LSG. Methods We performed a retrospective review of a prospectively collected database. Between November 2004 and January 2007, 130 consecutive patients underwent LSG as a final procedure to MO. Data including patient demographics, operative time, length of hospital stay, complications, preoperative body mass index (BMI), complications, and weight loss at 3, 6, 12, 18, and 24 months were recorded and analyzed. Results The mean age was 45.6 (range: 12-79) years while the mean BMI was 43.2 (range: 30.2-75.4) kg/m 2 . The mean operative time was 97 (range, 58-180) min and all operations were completed laparoscopically. The mean hospital stay was 3.2 (range, 1-19) days with zero mortality in this series.
Background Laparoscopic sleeve gastrectomy (LSG) is gaining wide acceptance as a single surgical treatment for obesity. The reported morbidity and mortality rates are low. We herein report the results of LSG performed in a high-volume center by an experienced team. Methods Retrospective analysis of a prospectively maintained database of all bariatric surgery (BS) was performed between May 2006 and December 2014. Data inspected included operative time, length of hospital stay (LOS), comorbidity resolution , re-operation, percent excess weight loss (%EWL), and 30-day morbidity and mortality. Results In the study period, 3003 patients underwent BS (1901 (63 %) female). Mean age and body mass index (BMI) were 43 years (range 14–73) and 42.8 kg/m 2 (range 35–73), respectively. %EWL at 1 year was 72 % (n = 937; 57 % follow-up rate). There was 1 perioperative mortality due to bleeding (0.03 %). Comorbidity improvement and resolution were 98 % for obstructive sleep apnea, 79 % for diabetes mellitus, 87 % for dyslipidemia, and 85 % for hyperten-sion. Mean operative time and LOS were 50 min (range 32– 94) and 2.2 days (range 1–38), respectively. Of the patients, 132 had complications (4.4 %), 25 leaks (0.83 %), 63 bleeding (2.1 %), 1 intra-abdominal abscesses (0.03 %), 3 sleeve stric-tures (0.1 %), 2 mesenteric vein thromboses (0.06 %), 10 trocar site hernias (0.3 %), and 78 symptomatic cholelithiasis (2.6 %). Re-operation was needed in 13 patients (0.43 %). Conclusion In a high-volume center with an experienced team, LSG can be performed with low morbidity and mortality.
Surgery, 2014
Introduction. Like Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy (LSG) has been validated as a bariatric surgery procedure in its own right. However, the few studies of the long-term outcomes of LSG have only featured small patient populations. The objective of the present study was to evaluate weight loss 5 years after LSG and assess the surgical learning curve for this procedure. Methods. We performed a retrospective, single-center study of a prospective database including all consecutive patients having undergone LSG at Amiens University Medical Center between November 2004 and July 2007. Data (weight, body mass index [BMI], percentage of excess weight loss [EWL], percentage of excess BMI loss, and percentage weight loss [PWL]) were collected during follow-up (particularly after 5 years). Results. The study population comprised 118 patients (100 females [85%]; mean ± SD age, 40 ± 11 years; mean preoperative weight, 131 ± 22 kg; mean preoperative BMI, 47.7 ± 7 kg/m 2 ). LSG was performed after failure of gastric banding in 23 cases (19%) and after failure of an intragastric balloon in 1 (0.8%). In all, 95 patients (81%) were analyzed $60 months after the LSG (mean follow-up period, 71 ± 9 months). The PWL and EWL were 25 ± 14% and 46 ± 26%, respectively. Eleven patients had undergone a second bariatric operation within 5 years of the LSG. Concerning the 84 patients in whom only LSG was the only operation, the PWL and EWL were 23 ± 14% and 43 ± 25%, respectively. The EWL was >50% in 35 of these 84 patients (42%) and between 25 and 50% in 30 cases (36%). Optimal weight results were achieved after only 28 LSG had been performed, which testifies to a shorter learning curve than for most other bariatric surgery techniques. Conclusion. Isolated LSG is a quickly mastered bariatric surgery technique with a short learning curve. It enables a mean PWL of >25% and an EWL of >50% in >40% of cases. (Surgery 2013;
Turkish Journal of Surgery, 2015
Laparoskopik sleeve gastrektominin morbid obezite ve obezite ilişkili komorbiditeler üzerine etkisi: Kohort çalışma Objective: Bariatric surgery in multimodal management modalities is a more effective method to treat morbid obesity and obesity-related comorbidities compared with nonsurgical treatments. Laparoscopic sleeve gastrectomy (LSG) was initially performed as the first stage of biliopancreatic diversion with duodenal switch in the super-obese population. In the past few years, however, LSG has been performed as a definitive procedure because of its promising early and midterm results. The aim of this study is to evaluate the efficacy of our initial LSG series of 73 patients on excess weight loss (EWL) and resolution of obesity-related comorbidities in short-term follow-up. Material and Methods: From March 2013 to May 2014, 78 morbid obese patients with an average body mass index (BMI) of 46.3 kg/m 2 underwent LSG. There is a 9-month follow-up period on average. Five patients were excluded from the study, because they could not be contacted. Comorbidities, preintervention BMI, glucose, HbA1c, and lipid profiles were recorded at 1, 6, and 12 months postintervention. Results: After the surgery, the percent EWL (%EWL) was 58%. The mean serum glucose level, HbA1c level, LDL-cholesterol level, triglyceride level, insulin, and insulin resistance decreased significantly and the mean HDL-cholesterol level increased. Conclusion: For the resolution of comorbidities, LSG may be used as an effective bariatric and metabolic surgery.