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La sleeve gastrectomie est-elle une procédure bariatrique acceptable ? Résultats à 7 ans révolus

Is the sleeve gastrectomy an acceptable bariatric procedure? Results with 7 years completed

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Obésité

Résumé

But de l’étude

Évaluer l’efficacité et la sécurité de la sleeve gastrectomie (SG), 7 années révolues après sa réalisation.

Patients et méthodes

De mai 2004 à novembre 2006, 64 SG ont été consécutivement réalisées par le même opérateur (JMC). Les pourcentages de perte d’excès de poids (%PEP) et de perte d’excès d’IMC (%PEI), ainsi que les comorbidités liées à l’obésité, et les complications liées à la SG, ont été évaluées 2 ans après la SG d’après une étude rétrospective de notre base de données recueillies prospectivement, et 7 ans révolus après la SG d’après un questionnaire soumis aux patients par un des auteurs (RD), d’avril 2012 à novembre 2013.

Résultats

Un recueil complet des données a été obtenu pour 55 patients (85,9 %), incluant 45 patients ayant eu une SG comme seul traitement chirurgical et 10 patients qui ont eu une seconde intervention bariatrique, dans un deuxième temps, du fait d’une insuffisance de perte de poids (7 bypass gastriques, 3 re-SG). Pour ces 55 patients, nous avons constaté une PEP moyenne de 58,4 % à 2 ans et 53,4 % à 7 ans ; une PEI moyenne de 65,1 % à 2 ans et 59,5 % à 7 ans. Trois patients (5,5 %) ont présenté une complication dans les 30 jours postopératoires (2 fistules [3,7 %]), 1 hémorragie (1,9 %). Trois patients (5,5 %) ont présenté une éventration sur site de trocart opérée 10 à 34 mois après la SG.

L’analyse des résultats du groupe des 45 patients ayant eu exclusivement une SG a montré une PEP moyenne de 59,1 % à 2 ans, et 50,4 % à 7 ans ; une PEI moyenne de 66,1 % à 2 ans et 56,5 % à 7 ans. Parmi ces 45 patients, 13 (28,9%) avaient un traitement antidiabétique avant la SG, et 6 (15,6 %) 7 ans après la SG (diminution de 53,9 %) ; 17 (37,8 %) avaient un traitement antihypertenseur avant la SG et 9 (20 %) 7 ans après (diminution de 47,1 %) ; 12 (26,7 %) avaient un traitement hypolipémiant avant la SG, et 6 (15,5 %) 7 ans après (diminution de 50 %) ; 25 (55,6 %) avaient un syndrome d’apnée du sommeil (SAS) avant la SG et 8 (17,8 %) 7 ans après (diminution de 68 %). Par ailleurs, 5 patients (11,1 %) avaient un reflux gastrooesophagien (RGO) traité par IPP avant la SG, et 15 (33,3 %) 7 ans après (augmentation de 200 %).

Conclusion

7 années révolues après une SG, la perte de poids était satisfaisante d’après les critères de Reinhold, peu de complications ont été constatées, la diminution des comorbidités a été importante, mais la fréquence du RGO augmentée.

Abstract

Aims

Our primary objective was to evaluate the efficacy and safety of sleeve gastrectomy [SG] at 7 years post SG.

Methods

From May 2004 to November 2006, 64 SG were consecutively performed by the same operator (JMC). The percentage of excess weight loss (%EWL), the percentage of excess BMI loss [%EBL], as well as the presence of comorbidities, and surgical complications, were evaluated at 2 years according a retrospective study of our database collected prospectively, and at 7 years according to a patient survey conducted from April 2012 to December 2013.

Results

A complete record was obtained for 55 patients (85.9%), including 45 patients who only have had a SG, and 10 who have had a second bariatric procedure due to insufficient weight loss (7 gastric bypasses, 3 re-SG). The mean %EWL of 55 patients was 58.4% at 2 years and 53.4% at 7 years; the mean %EBL was 65.1% at 2 years and 59.5% at 7 years. Three patients [5.5%] have had postoperative complications (2 fistulas [3.7%]), 1 hemorrhage (1.9%). Three cases (5.5%) of trocar site hernia were observed between 10 months and 37 months post SG.

The group analysis of 45 patients who have had only a SG found a mean of 59.1% of %EWL at 2 years and 50.4% at 7 years; the mean %EBL was 66.1% at 2 years and 56.5% at 7 years. For these 45 patients we found a favorable evolution of comorbidities: 13 patients (28.9%) had preoperative antidiabetic treatment and 6 (15.6%) at 7 years post SG (decrease of 53.9%); 17 (37.8%) were treated preoperatively for hypertension and 9 (20%) at 7 years (decrease of 47.1%); 12 (26.7%) had preoperative lipid-lowering therapy and 6 (15.5%) at 7 years (decrease of 50%); 25 (55.6%) had a preoperative sleep apnea syndrom (SAS) and 8 (17.8%) at 7 years (decrease of 68%). Medical treatment for gastrooesophageal reflux disease (GERD) was observed in 5 patients (11.1%) preoperatively and in 15 patients (33.3%) at 7 years post SG (increase of 200%).

Conclusion

At 7 years post SG, weight loss was satisfying in agreement with Reinhold. Comorbidities decreased but the frequency of GERD was increased.

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Authors and Affiliations

  1. Service de chirurgie viscérale, Centre Hospitalier de Saint-Denis, 93200, Saint-Denis, France

    J. -M. Catheline, R. Dbouk, A. Kassem, Y. Bendacha & C. Bonnel

  2. Service d’endocrinologie, Centre Hospitalier de Saint-Denis, 93200, Saint-Denis, France

    R. Cohen

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  1. J. -M. Catheline
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Correspondence to J. -M. Catheline.

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Catheline, J.M., Dbouk, R., Kassem, A. et al. La sleeve gastrectomie est-elle une procédure bariatrique acceptable ? Résultats à 7 ans révolus. Obes 10, 34–40 (2015). https://doi.org/10.1007/s11690-014-0431-z

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