Skip to main content
SpringerLink
Log in

Fully Ambulatory Laparoscopic Sleeve Gastrectomy: 328 Consecutive Patients in a Single Tertiary Bariatric Center

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) is becoming one of the most popular bariatric procedures because of its short operative time, good resolution of comorbidities, excellent weight loss, and low complications rate. However, the safety of LSG as a day-surgery procedure has not yet been widely documented.

Methods

A retrospective analysis of a prospectively collected bariatric database, in a single institution, between August 2012 and February 2015, yielded 980 patients who underwent LSG; 328 patients (33.5 %) responded to established criteria and were operated on a 1-day surgery basis (length of stay < 12 h).

Results

There were 258 (78 %) primary LSG and 70 revisional LSG (22 %) performed on 284 females and 44 males, with a mean age (±SD) of 38 ± 9 years. Mean (±SD) preoperative body mass index (BMI) was 45 ± 6 kg/m2. Operative time was 68 ± 17 min (mean ± SD). There were no deaths. A total of 322 patients (98.2 %) were discharged home the day of surgery. There were 6 (1.8 %) unplanned overnight hospitalization, and 28 patients (8.5 %) were readmitted between days 1 and 30. Most patients (25/34, 73 %) were hospitalized for minor problems, such as pain, nausea, and/or vomiting. There were two cases of (0.6 %) gastric staple line leaks, three (0.9 %) of intra-abdominal hematomas, two (0.6 %) of pneumonia, one (0.3 %) of acute pancreatitis, and one (0.3 %) of urinary tract infection. All patients recovered well.

Conclusions

LSG can be performed as an outpatient procedure in selected patients, with acceptable results in terms of retention, readmission, and complication rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet (London, England). 2011;377(9765):557–67.

    Article  Google Scholar 

  2. Cremieux PY, Buchwald H, Shikora SA, et al. A study on the economic impact of bariatric surgery. Am J Manag Care. 2008;14(9):589–96.

    PubMed  Google Scholar 

  3. Makary MA, Clark JM, Shore AD, et al. Medication utilization and annual health care costs in patients with type 2 diabetes mellitus before and after bariatric surgery. Arch Surg. 2010;145(8):726–31.

    Article  PubMed  Google Scholar 

  4. Rosenthal RJ, Diaz AA, Arvidsson D, et al. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.

    Article  PubMed  Google Scholar 

  5. Awad S, Carter S, Purkayastha S, et al. Enhanced recovery after bariatric surgery (ERABS): clinical outcomes from a tertiary referral bariatric centre. Obes Surg. 2014;24(5):753–8.

    Article  PubMed  Google Scholar 

  6. Mannaerts GH, van Mil SR, Stepaniak PS, et al. Results of Implementing an Enhanced Recovery After Bariatric Surgery (ERABS) Protocol. Obes Surg. 2015;24.

  7. 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(2):134–40.

    Article  PubMed  Google Scholar 

  8. De Oliveira Jr GS, Castro-Alves LJ, Ahmad S, et al. Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized controlled trials. Anesth Analg. 2013;116(1):58–74.

    Article  PubMed  Google Scholar 

  9. Allen TK, Jones CA, Habib AS. Dexamethasone for the prophylaxis of postoperative nausea and vomiting associated with neuraxial morphine administration: a systematic review and meta-analysis. Anesth Analg. 2012;114(4):813–22.

    Article  CAS  PubMed  Google Scholar 

  10. McCarty TM, Arnold DT, Lamont JP, et al. Optimizing outcomes in bariatric surgery: outpatient laparoscopic gastric bypass. Ann Surg. 2005;242(4):494–8. discussion 8–501.

    PubMed  PubMed Central  Google Scholar 

  11. Benevides ML, Oliveira SS, de Aguilar-Nascimento JE. The combination of haloperidol, dexamethasone, and ondansetron for prevention of postoperative nausea and vomiting in laparoscopic sleeve gastrectomy: a randomized double-blind trial. Obes Surg. 2013;23(9):1389–96.

    Article  PubMed  Google Scholar 

  12. Bergland A, Gislason H, Raeder J. Fast-track surgery for bariatric laparoscopic gastric bypass with focus on anaesthesia and peri-operative care. Experience with 500 cases. Acta Anaesthesiol Scand. 2008;52(10):1394–9.

    Article  CAS  PubMed  Google Scholar 

  13. Kahokehr A, Sammour T, Zargar Shoshtari K, et al. Intraperitoneal local anesthetic improves recovery after colon resection: a double-blinded randomized controlled trial. Ann Surg. 2011;254(1):28–38.

    Article  PubMed  Google Scholar 

  14. Kahokehr A, Sammour T, Srinivasa S, et al. Systematic review and meta-analysis of intraperitoneal local anaesthetic for pain reduction after laparoscopic gastric procedures. Br J Surg. 2011;98(1):29–36.

    Article  CAS  PubMed  Google Scholar 

  15. Moncada R, Martinaitis L, Landecho M, et al. Does preincisional infiltration with bupivacaine reduce postoperative pain in laparoscopic bariatric surgery? Obes Surg. 2015. doi:10.1007/s11695-015-1761-0.

  16. Loizides S, Gurusamy KS, Nagendran M, et al. Wound infiltration with local anaesthetic agents for laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2014;3:CD007049.

    PubMed  Google Scholar 

  17. Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995;7(1):89–91.

    Article  CAS  PubMed  Google Scholar 

  18. Elnahas A, Urbach D, Okrainec A, et al. Is next-day discharge following laparoscopic Roux-en-Y gastric bypass safe in select patients? Analysis of short-term outcomes. Surg Endosc. 2014;28(10):2789–94.

    Article  PubMed  Google Scholar 

  19. Morton JM, Winegar D, Blackstone R, et al. Is ambulatory laparoscopic Roux-en-Y gastric bypass associated with higher adverse events? Ann Surg. 2014;259(2):286–92.

    Article  PubMed  Google Scholar 

  20. Billing PS, Crouthamel MR, Oling S, et al. Outpatient laparoscopic sleeve gastrectomy in a free-standing ambulatory surgery center: first 250 cases. Surg Obes Relat Dis. 2014;10(1):101–5.

    Article  PubMed  Google Scholar 

  21. Rebibo L, Dhahri A, Badaoui R, et al. Laparoscopic sleeve gastrectomy as day-case surgery (without overnight hospitalization). Surg Obes Relat Dis. 2015;11(2):335–42.

    Article  PubMed  Google Scholar 

  22. Singh R, Musielak M, Shahid H, et al. Same-day discharge after laparoscopic sleeve gastrectomy: our initial experience. Am Surg. 2014;80(12):1274–6.

    PubMed  Google Scholar 

  23. Joshi GP, Ahmad S, Riad W, et al. Selection of obese patients undergoing ambulatory surgery: a systematic review of the literature. Anesth Analg. 2013;117(5):1082–91.

    Article  PubMed  Google Scholar 

  24. Hawasli A, Jacquish B, Almahmeed T, et al. Early effects of bougie size on sleeve gastrectomy outcome. Am J Surg. 2015;209(3):473–7.

    Article  PubMed  Google Scholar 

  25. Weingarten TN, Flores AS, McKenzie JA, et al. Obstructive sleep apnoea and perioperative complications in bariatric patients. Br J Anaesth. 2011;106(1):131–9.

    Article  CAS  PubMed  Google Scholar 

  26. Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257(2):231–7.

    Article  PubMed  Google Scholar 

  27. Foletto M, Prevedello L, Bernante P, et al. Sleeve gastrectomy as revisional procedure for failed gastric banding or gastroplasty. Surg Obes Relat Dis. 2010;6(2):146–51.

    Article  PubMed  Google Scholar 

  28. Yazbek T, Safa N, Denis R, et al. Laparoscopic sleeve gastrectomy (LSG)-a good bariatric option for failed laparoscopic adjustable gastric banding (LAGB): a review of 90 patients. Obes Surg. 2013;23(3):300–5.

    Article  PubMed  Google Scholar 

  29. Gnecchi M, Bella G, Pino AR, et al. Usefulness of x-ray in the detection of complications and side effects after laparoscopic sleeve gastrectomy. Obes Surg. 2013;23(4):456–9.

    Article  CAS  PubMed  Google Scholar 

  30. Chivot C, Robert B, Lafaye N, et al. Laparoscopic sleeve gastrectomy: imaging of normal anatomic features and postoperative gastrointestinal complications. Diagnostic Interv Imaging. 2013;94(9):823–34.

    Article  CAS  Google Scholar 

  31. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kim J, Azagury D, Eisenberg D, et al. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Relat Dis. 2015;11(4):739–48.

  33. Brolin RE, Cody RP, Marcella SW. Differences in open versus laparoscopic gastric bypass mortality risk using the Obesity Surgery Mortality Risk Score (OS-MRS). Surg Obes Relat. 2015. doi:10.1016/j.soard.2015.02.001.

  34. Markar SR, Penna M, Karthikesalingam A, et al. The impact of hospital and surgeon volume on clinical outcome following bariatric surgery. Obes Surg. 2012;22(7):1126–34.

    Article  PubMed  Google Scholar 

  35. Weller WE, Rosati C, Hannan EL. Relationship between surgeon and hospital volume and readmission after bariatric operation. J Am Coll Surg. 2007;204(3):383–91.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, 5400 boul. Gouin ouest Montréal, Québec, H4J 1C5, Canada

    Fabio Garofalo, Ronald Denis, Omar Abouzahr, Pierre Garneau, Radu Pescarus & Henri Atlas

Authors
  1. Fabio Garofalo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ronald Denis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Omar Abouzahr
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pierre Garneau
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Radu Pescarus
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Henri Atlas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Henri Atlas.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Garofalo, F., Denis, R., Abouzahr, O. et al. Fully Ambulatory Laparoscopic Sleeve Gastrectomy: 328 Consecutive Patients in a Single Tertiary Bariatric Center. OBES SURG 26, 1429–1435 (2016). https://doi.org/10.1007/s11695-015-1984-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-015-1984-0

Keywords

Search

Navigation