Advertisement

Obesity Surgery

, Volume 19, Issue 9, pp 1203–1210 | Cite as

Short- and Mid-term Outcomes of Sleeve Gastrectomy for Morbid Obesity: The Experience of the Spanish National Registry

  • Raquel Sánchez-Santos
  • Carlos Masdevall
  • Aniceto Baltasar
  • Candido Martínez-Blázquez
  • Amador García Ruiz de Gordejuela
  • Enric Ponsi
  • Andres Sánchez-Pernaute
  • Gregorio Vesperinas
  • Daniel Del Castillo
  • Ernest Bombuy
  • Carlos Durán-Escribano
  • Luis Ortega
  • Juan Carlos Ruiz de Adana
  • Javier Baltar
  • Ignacio Maruri
  • Emilio García-Blázquez
  • Antonio Torres
Research Clinical

Abstract

Background

Reports on laparoscopic sleeve gastrectomy (LSG) communicate very good short-term results on very high-risk morbid obese patients. However, mid- and long-term results are still unknown. A National Registry has been created in Spain to achieve information on the outcomes of this bariatric procedure.

Methods

Data were obtained from 17 centers and collected in a database. Technical issues, preoperative comorbid conditions, hospital stay, early and late complications, and short- and mid-term weight loss were analyzed.

Results

Five hundred forty patients were included; 76% were women. Mean BMI was 48.1 ± 10. Mean age was 44.1 ± 11.8. Morbidity rate was 5.2% and mortality rate 0.36%. Complications presented more frequently in superobese patients (OR, 2.8 (1.18–6.65)), male (OR, 2.98 (1.26–7.0)), and patients >55 years old (OR, 2.8 (1.14–6.8)). Staple-line reinforcement was related to a lower complication rate (3.7 vs 8.8%; p = 0.039). Mean hospital stay was 4.8 ± 8.2 days. Mean follow-up was 16.5 ± 10.6 months (1–73). Mean percent excess BMI loss (EBL) at 3 months was 38.8 ± 22, 55.6 ± 8 at 6 months, 68.1 ± 28 at 12 months, and 72.4 ± 31 at 24 months. %EBL was superior in patients with lower initial BMI and lower age. Bougie caliber was an inverse predictive factor of %EBL at 12 and 24 months (RR, 23.3 (11.4–35.2)). DM is remitted in 81% of the patients and HTA improved in 63.2% of them. A second-stage surgery was performed in 18 patients (3.2%).

Conclusions

LSG provides good short- and mid-term results with a low morbid-mortality rate. Better results are obtained in younger patients with lowest BMI. Staple-line reinforcement and a thinner bougie are recommended to improve outcome.

Keywords

Sleeve gastrectomy Mid-term results Spanish National Registry Obesity surgery 

Notes

Acknowledgments

We would like to thank the members of the multidisciplinary bariatric teams in the participating hospitals: Complejo Hospitalario de Pontevedra, Hospital Universitari de Bellvitge (Barcelona), Hospital Virgen de los Lirios (Alcoy), Hospital Txagorritxu (Vitoria), Hospital San José (Vitoria), Centro Médico Delfos (Barcelona), Hospital Clínico San Carlos (Madrid), Hospital La Paz (Madrid), Hospital Virgen de la Paloma (Madrid), Hospital Universitario de Reus, Hospital de Mataró, Hospital Clinico Universitario (Salamanca), Clínica Santísima Trinidad (Salamanca), Hospital Universitario de Getafe, Hospital de Conxo (Santiago de Compostela), Hospital de Meixoeiro (Vigo), Hospital de Albacete.

References

  1. 1.
    Mognol P, Chosidow D, Marmuse JP. Laparoscopic sleeve gastrectomy as an initial bariatric operation for high-risk patients: initial results in 10 patients. Obes Surg. 2005;15:1030–3.PubMedCrossRefGoogle Scholar
  2. 2.
    Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surgl Endosc. 2006;20:859–63.CrossRefGoogle Scholar
  3. 3.
    Regan JP, Inabnet WB, Gagner M, et al. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003;13:861–4.PubMedCrossRefGoogle Scholar
  4. 4.
    Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obes Surg. 2004;14:492–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Nguyen NT, Longoria M, Gelfand DV, et al. Staged laparoscopic Roux-en-Y: a novel two-stage bariatric operation as an alternative in the super-obese with massively enlarged liver. Obes Surg. 2005;15:1077–81.PubMedCrossRefGoogle Scholar
  6. 6.
    Nocca D, Krawczykowsky D, Bomans B, et al. A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obes Surg. 2008;18:560–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Frezza EE. Laparoscopic vertical sleeve gastrectomy for morbid obesity. The future procedure of choice? Surg today. 2007;37:275–81.PubMedCrossRefGoogle Scholar
  8. 8.
    Baltasar A, Serra C, Perez N, et al. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg. 2005;15:1124–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Bernante P, Breda C, Zangrandi F, et al. Emergency sleeve gastrectomy as rescue treatment for acute gastric necrosis due to type II paraesophageal hernia in an obese woman with gastric banding. Obes Surg. 2008;18:737–41.PubMedCrossRefGoogle Scholar
  10. 10.
    Baltasar A, Serra C, Bou R, et al. Sleeve gastrectomy in a 10-year-old child. Obes Surg. 2008;18:733–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Leon JM, McDermott JW, Salcedo IM, et al. Obesity surgery in a 12-year-old–an Ecuadorian experience. Obes Surg. 2007;17:258–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg. 2008;18:487–96.PubMedCrossRefGoogle Scholar
  13. 13.
    Clinical Issues Committee of American Society for Metabolic and Bariatric surgery, et al. Sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2007;3:573–6.CrossRefGoogle Scholar
  14. 14.
    Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Anna intern med. 2005;142:547–59.Google Scholar
  15. 15.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. Jama. 2004;292:1724–37.PubMedCrossRefGoogle Scholar
  16. 16.
    Sanchez-Santos R, Ruiz de Gordejuela AG, Gomez N, et al. Factors associated with morbidity and mortality after gastric bypass. Alternatives for risk reduction: sleeve gastrectomy. Cirugia Espanola. 2006;80:90–5.PubMedCrossRefGoogle Scholar
  17. 17.
    DeMaria EJ, Portenier D, Wolfe L. Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Surg Obes Relat Dis. 2007;3:134–40.PubMedCrossRefGoogle Scholar
  18. 18.
    Flancbaum L, Belsley S. Factors affecting morbidity and mortality of Roux-en-Y gastric bypass for clinically severe obesity: an analysis of 1, 000 consecutive open cases by a single surgeon. J Gastrointest Surg. 2007;11:500–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Consten EC, Gagner M. Staple-line reinforcement techniques with different buttressing materials used for laparoscopic gastrointestinal surgery: a new strategy to diminish perioperative complications. Surg technol int. 2004;13:59–63.PubMedGoogle Scholar
  20. 20.
    Shikora SA, Kim JJ, Tarnoff ME. Reinforcing gastric staple-lines with bovine pericardial strips may decrease the likelihood of gastric leak after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:37–44.PubMedCrossRefGoogle Scholar
  21. 21.
    Roa PE, Kaidar-Person O, Pinto D, et al. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg. 2006;16:1323–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Givon-Madhala O, Spector R, Wasserberg N, et al. Technical aspects of laparoscopic sleeve gastrectomy in 25 morbidly obese patients. Obes Surg. 2007;17:722–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Sanchez-Pernaute A, Rodriguez R, Rubio MA, et al. Gastric tube volume after duodenal switch and its correlation to short-term weight loss. Obes Surg. 2007;17:1178–82.PubMedCrossRefGoogle Scholar
  24. 24.
    Frezza EE, Chiriva-Internati M, Wachtel MS. Analysis of the results of sleeve gastrectomy for morbid obesity and the role of ghrelin. Surg today. 2008;38:481–3.PubMedCrossRefGoogle Scholar
  25. 25.
    Weiner RA, Weiner S, Pomhoff I, et al. Laparoscopic sleeve gastrectomy–influence of sleeve size and resected gastric volume. Obes Surg. 2007;17:1297–305.PubMedCrossRefGoogle Scholar
  26. 26.
    Langer FB, Bohdjalian A, Felberbauer FX, et al. Does gastric dilatation limit the success of sleeve gastrectomy as a sole operation for morbid obesity? Obes Surg. 2006;16:166–71.PubMedCrossRefGoogle Scholar
  27. 27.
    Baltasar A, Serra C, Perez N, et al. Re-sleeve gastrectomy. Obes Surg. 2006;16:1535–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Gagner M, Rogula T. Laparoscopic reoperative sleeve gastrectomy for poor weight loss after biliopancreatic diversion with duodenal switch. Obes Surg. 2003;13:649–54.PubMedCrossRefGoogle Scholar
  29. 29.
    Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy: a restrictive procedure? Obes Surg. 2007;17:57–62.PubMedCrossRefGoogle Scholar
  30. 30.
    Fruhbeck G, Diez-Caballero A, Gil MJ, et al. The decrease in plasma ghrelin concentrations following bariatric surgery depends on the functional integrity of the fundus. Obes Surg. 2004;14:606–12.PubMedCrossRefGoogle Scholar
  31. 31.
    Cummings DE, Shannon MH. Roles for ghrelin in the regulation of appetite and body weight. Arch Surg. 2003;138:389–96.PubMedCrossRefGoogle Scholar
  32. 32.
    Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15:1024–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Moon Han S, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese korean patients. Obes Surg. 2005;15(10):1469–75.PubMedCrossRefGoogle Scholar
  34. 34.
    Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006;16(11):1450–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Lee CM, Cirangle PT, Jossart GH. Vertical gastrectomy for morbid obesity in 216 patients: report of two year results. Surg endosc. 2007;21(10):1810–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Raquel Sánchez-Santos
    • 1
  • Carlos Masdevall
    • 2
  • Aniceto Baltasar
    • 3
  • Candido Martínez-Blázquez
    • 4
  • Amador García Ruiz de Gordejuela
    • 2
  • Enric Ponsi
    • 5
  • Andres Sánchez-Pernaute
    • 6
  • Gregorio Vesperinas
    • 7
  • Daniel Del Castillo
    • 8
  • Ernest Bombuy
    • 9
  • Carlos Durán-Escribano
    • 10
  • Luis Ortega
    • 11
  • Juan Carlos Ruiz de Adana
    • 12
  • Javier Baltar
    • 13
  • Ignacio Maruri
    • 14
  • Emilio García-Blázquez
    • 15
  • Antonio Torres
    • 16
  1. 1.Servicio de Cirugía General y DigestivaComplejo Hospitalario de PontevedraPontevedraSpain
  2. 2.Hospital Universitario de BellvitgeBarcelonaSpain
  3. 3.Hospital Virgen de los LiriosAlcoySpain
  4. 4.Hospital de TxagorritxuVitoriaSpain
  5. 5.Clinica DelfosBarcelonaSpain
  6. 6.Hospital Clinico San CarlosMadridSpain
  7. 7.Hospital Universitario La PazMadridSpain
  8. 8.Hospital Universitario de ReusReusSpain
  9. 9.Hospital de MataróMataróSpain
  10. 10.Hospital Virgen de la PalomaMadridSpain
  11. 11.Hospital Clinico de SalamancaSalamancaSpain
  12. 12.Hospital Universitario de GetafeGetafeSpain
  13. 13.Hospital de ConxoSantiagoSpain
  14. 14.Hospital MeixoeiroVigoSpain
  15. 15.Hospital de AlbaceteAlbaceteSpain
  16. 16.Spanish Society of Obesity Surgery and Metabolic Diseases (SECO: Sociedad Española de Cirugía de la Obesidad y Enfermedades Metabólicas)MadridSpain

Personalised recommendations