Abstract
Background
LSG is widely accepted as a definitive treatment for obesity. Due to lack of large series with long-term follow-up, disagreement remains regarding its safety and efficacy. We present a series of 1020 consecutive LSGs performed with long-term follow-up.
Methods
A retrospective review of a prospectively collected database was conducted on patients who underwent LSG from January 2005 to February 2014. Data included weight, height, BMI, ideal body weight, comorbid conditions, intraoperative complications, mean length of hospital stay (LOS), early (<30 days) readmission, early and late (>30 days) postoperative complications, and percentage of excess weight loss (%EWL).
Results
Of the 1020 patients, 66.6 % (n = 679) were female, with a mean age of 38.4 ± 16.5 years. Mean BMI at the time of first visit was 43.4 ± 5.8 kg/m2. The most common comorbid conditions identified were diabetes mellitus (89.4 %), sleep apnea (86.4 %), hypertension (80.3 %), and hyperlipidemia (70 %). Over the entire follow-up period, 57 % of diabetic patients experienced significant improvement or remission. There was no mortality in this series. Early postoperative complications within 30 days of surgery included leak in 0.1 % (n = 1), stricture in 0.1 % (n = 1), emesis in 23 % (n = 234), dehydration in 19 % (n = 194), prolonged ileus in 18 % (183), and self-limited bleeding in 3 % (n = 30). Mean LOS was of 3.4 ± 2.1 days, with a 3.8 % overall rate of early readmissions. Long-term morbidity was found in 3.9 % of patients (n = 40) and included stricture in 0.49 % (n = 5) and GERD in 6 % (n = 61). The overall 30-day mortality rate was 0 %. Mean %EWL at 3 months to 1, 3, 5, and 8 years was 72 ± 16.8, 86 ± 22.3, 63 ± 19, 61 ± 11, and 52 ± 9.2, respectively.
Conclusions
This study confirms that LSG is safe and has very low rates of early and long-term complications when compared to other well-established procedures. Additionally, LSG that appears results in significant improvement of obesity-related comorbid conditions.
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References
D’Hondt M, Pottel H, Devriendt D, Van Rooy F, Vansteenkiste F (2011) Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss. Surg Endosc 25:2498–2504
Strain GW, Saif T, Gagner M, Rossidis M, Dakin G, Pomp A (2011) Cross-sectional review of effects of laparoscopic sleeve gastrectomy at 1, 3, and 5 years. Surg Obes Relat Dis 7:714–719
Rawlins L, Rawlins MP, Brown CC, Schumacher DL (2013) Sleeve gastrectomy: 5-year outcomes of a single institution. Surg Obes Relat Dis 9:21–25
Rosenthal RJ, Panel ISGE (2012) International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of > 12,000 cases. Surg Obes Relat Dis 8:8–19
Iannelli A, Dainese R, Piche T, Facchiano E, Gugenheim J (2008) Laparoscopic sleeve gastrectomy for morbid obesity. World J Gastroenterol 14:821–827
Roa PE, Kaider-Person O, Pinto D, Cho M, Szomstein S, Rosenthal RJ (2006) Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg 16:1323–1326
Ren CJ, Patterson E, Gagner M (2000) Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg 10:514–523
Regan JP, Inabnet W, Gagner M, Pomp A (2003) Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super-obese patient. Obes Surg 13:861–864
Himpens J, Daprie G, Cadiere GB (2006) A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg 16:1450–1456
Milone L, Strong V, Gagner M (2005) Laparoscopic sleeve gastrectomy is superior to intragastric balloon as a first-stage procedure for super-obese patients (BMI > 50 kg/m2). Obes Surg 15:612–617
Fridman A, Moon R, Cozacov Y, Ampudia C, Lo Menzo E, Szomstein S, Rosenthal RJ (2013) Procedure-related morbidity in bariatric surgery: a retrospective short- and mid-term follow-up of a single institution of the American College of Surgeons Bariatric Surgery Centers of Excellence. J Am Coll Surg 4:614–620
Tucker ON, Szomstein S, Rosenthal RJ (2008) Indications for sleeve gastrectomy as a primary procedure for weight loss in the morbidly obese. J Gastrointest Surg 12:662–667
Oien DM, Buchwald H (2013) Metabolic/bariatric surgery worldwide 2011. Obes Surg 23:227–436
Victorzon M (2012) An update on sleeve gastrectomy. Minerva Chir 67:153–163
Choi YY, Bae J, Hur KY, Choi D, Kim YJ (2012) Reinforcing the staple line during laparoscopic sleeve gastrectomy: does it have advantages? A meta-analysis. Obes Surg 22:1206–1213
Bellanger D, Greenway FL (2011) Laparoscopic sleeve gastrectomy, 529 cases without a leak: short-term results and technical considerations. Obes Surg 21:146–150
Fezzi M, Kolotkin R, Nedelcu M et al (2011) Improvement in quality of life after laparoscopic sleeve gastrectomy. Obes Surg 21:1161–1167
Eid GM, Brethauer S, Mattar SG, Titchner RL, Gourash W, Schauer PR (2012) Laparoscopic sleeve gastrectomy for super obese patients. Forty-eight percent excess weight loss after 6 to 8 years with 93% follow-up. Ann Surg 2:262–265
Van Rutte P, Smulders JF, de Zoete JP, Nienhuijs SW (2014) Outcome on sleeve gastrectomy as primary bariatric procedure. Br J Surg 101:661–668
Marin-Perez P, Betancourt A, Lamota M, Lo Menzo E, Szomstein S, Rosenthal R (2014) Outcomes after laparoscopic conversion of failed adjustable gastric banding to sleeve gastrectomy or Roux-en-Y gastric bypass. BJS 101:254–260
Sakran N, Goitein D, Raziel A et al (2013) Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc 27:240–245
Lalor PF, Tucker ON, Szomstein S, Rosenthal RJ (2008) Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 1:33–38
Aurora AR, Khaitan L, Saber AA (2012) Sleeve gastrectomy and the risk of leak: a systemic analysis of 4,888 patients. Surg Endosc 26:1509–1515
Spyropoulos C, Argentou MI, Petsas T, Thomopoulos K, Kehagias I, Kalfarentzos F (2012) Management of gastrointestinal leaks after surgery for clinically severe obesity. SOARD 8:609–615
Csendes A, Braghetto I, León P, Burgos AM (2010) Management of leaks after laparoscopic sleeve gastrectomy in patients with obesity. J Gastrointest Surg 14:1343–1348
Moon Han S, Kim WW, Oh JH (2005) Results of laparoscopic sleeve gastrectomy at 1 year in morbidly obese Korean patients. Obes Surg 15:1469–1475
Hamoui N, Anthone GJ, Kaufman HS, Crookes PF (2006) Sleeve gastrectomy in the high-risk patient. Obes Surg 16:1445–1449
Cottam D, Qureshi FG, Mattar SG et al (2006) Laparoscopic sleeve gastrectomy as an initial weight loss procedure for high risk patients with morbid obesity. Surg Endosc 20:859–863
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Dr. Rosenthal is a speaker for Ethicon and has educational Grants from Ethicon, Covidien, and Karl Storz. Dr. Lo Menzo is a consultant for Baxter Healthcare Corporation. Dr. Szomstein is a consultant for Covidien and Ethicon. Dr. Alvarenga has no conflict of interest or financial ties to disclose.
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Alvarenga, E.S., Lo Menzo, E., Szomstein, S. et al. Safety and efficacy of 1020 consecutive laparoscopic sleeve gastrectomies performed as a primary treatment modality for morbid obesity. A single-center experience from the metabolic and bariatric surgical accreditation quality and improvement program. Surg Endosc 30, 2673–2678 (2016). https://doi.org/10.1007/s00464-015-4548-4
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DOI: https://doi.org/10.1007/s00464-015-4548-4