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Early and Mid-term Outcomes of Single-Stage Laparoscopic Sleeve Gastrectomy

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Abstract

Background

This is the largest single-centre series of single-stage laparoscopic sleeve gastrectomy (LSG) reporting on perioperative outcomes, weight loss, comorbidity resolution including urological outcomes and results in the super obese. Review of prospectively collected data for patients who underwent LSG from March 2007–August 2009.

Methods

There were 253 patients with a mean age of 44 years (SD, 9) and a mean preoperative body mass index (BMI) of 50 kg/m2 (SD, 7). There were 17 (7%) major complications and no deaths. The mean follow-up was 9 months. One hundred and seventy-one patients with a mean follow-up of 12 months had a mean postoperative weight loss of 41 kg (SD, 16) and mean excess BMI (meBMI) loss of 59% (SD, 22).

Results

One hundred fourteen patients were super obese (BMI, >50 kg/m2). The mean weight loss was 45 kg (SD, 18), and the meBMI lost was 49% (SD, 21). Super-obese patients experienced more complications (p = 0.02) and lost less eBMI (49% vs. 61%; p < 0.01). Fifty-three patients (46%) remained morbidly obese (BMI, >40 kg/m2) postoperatively. Hypertension and diabetes improved or resolved in 73 (79%) and 73 (90%) patients, respectively. Stress urinary incontinence was reported preoperatively in 60 (32%) females, and complete resolution or improvement was reported in 54 (90%) patients.

Conclusions

LSG provides satisfactory weight loss and resolution of comorbidities in the short- and medium-term with inferior, though acceptable, results in the super obese.

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References

  1. Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5:469–75.

    Article  PubMed  Google Scholar 

  2. Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery. Updated Position Statement on Sleeve Gastrectomy as a Bariatric Procedure. Surg Obes Relat Dis. 2010;6(1):1–5.

    Article  Google Scholar 

  3. Akkary E, Duffy A, Bell R. Deciphering the sleeve: technique, indications, efficacy, and safety of sleeve gastrectomy. Obes Surg. 2008;18:1323–9.

    Article  PubMed  Google Scholar 

  4. Frezza EE. Laparoscopic vertical sleeve gastrectomy for morbid obesity. The future procedure of choice? Surg Today. 2007;37:275–81.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  CAS  PubMed  Google Scholar 

  6. Frezza EE, Wozniak SE, Gee L, et al. Is there any role of resecting the stomach to ameliorate weight loss and sugar control in morbidly obese diabetic patients? Obes Surg. 2009;19:1139–42.

    Article  PubMed  Google Scholar 

  7. Fetner R, McGinty J, Russell C, et al. Incretins, diabetes, and bariatric surgery: a review. Surg Obes Relat Dis. 2005;1:589–97.

    Article  PubMed  Google Scholar 

  8. Frezza EE, Wei C, Wachtel MS. Is surgery the next answer to treat obesity-related hypertension? J Clin Hypertens. 2009;11:284–8.

    Article  Google Scholar 

  9. Kueper MA, Kramer KM, Kirschniak A, et al. Laparoscopic sleeve gastrectomy: standardized technique of a potential stand-alone bariatric procedure in morbidly obese patients. World J Surg. 2008;32:1462–5.

    Article  PubMed  Google Scholar 

  10. Sanchez-Santos R, Masdevall C, Baltasar A, et al. Short- and mid-term outcomes of sleeve gastrectomy for morbid obesity: the experience of the Spanish national registry. Obes Surg. 2009;19:1203–10.

    Article  PubMed  Google Scholar 

  11. Stroh C, Birk D, Flade-Kuthe R, et al. Results of sleeve gastrectomy-data from a nationwide survey on bariatric surgery in Germany. Obes Surg. 2009;19:632–40.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. Tagaya N, Kasama K, Kikkawa R, et al. Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity. Obes Surg. 2009;19:1371–6.

    Article  PubMed  Google Scholar 

  14. Powers PS, Rosemurgy A, Boyd F, et al. Outcome of gastric restriction procedures: weight, psychiatric diagnoses, and satisfaction. Obes Surg. 1997;7:471–7.

    Article  CAS  PubMed  Google Scholar 

  15. American Society of Metabolic and Bariatric Surgery (ASMBS) Fact Sheet. Available at: www.asbs.org/Newsite07/media/asmbs_fs.pdf. Accessed 12 Feb 2010.

  16. Richter HE, Burgio KL, Clements RH, et al. Urinary and anal incontinence in morbidly obese women considering weight loss surgery. Obstet Gynecol. 2005;106:1272–7.

    PubMed  Google Scholar 

  17. Sugerman H, Windsor A, Bessos M, et al. Intra-abdominal pressure, sagittal abdominal diameter and obesity comorbidity. J Int Med. 1997;241:71–9.

    Article  CAS  Google Scholar 

  18. Uustal Fornell E, Wingren G, Kjolhede P. Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study. Acta Obstet Gynecol Scand. 2004;83:383–9.

    Article  PubMed  Google Scholar 

  19. Bump RC, Sugerman HJ, Fantl JA, et al. Obesity and lower urinary tract function in women: effect of surgically induced weight loss. Am J Obstet Gynecol. 1992;167:392–7. discussion 7–9.

    CAS  PubMed  Google Scholar 

  20. Burgio KL, Richter HE, Clements RH, et al. Changes in urinary and fecal incontinence symptoms with weight loss surgery in morbidly obese women. Obstet Gynecol. 2007;110:1034–40.

    PubMed  Google Scholar 

  21. Sugerman H, Windsor A, Bessos M, et al. Effects of surgically induced weight loss on urinary bladder pressure, sagittal abdominal diameter and obesity co-morbidity. J Obes Relat Metab Disord. 1998;22:230–5.

    Article  CAS  Google Scholar 

  22. Ministry of Health. A Portrait of Health: Key results of the 2006/07 New Zealand Health Survey. Wellington: Ministry of Health; 2008.

    Google Scholar 

  23. Sammour T, Hill AG, Singh P, Ranasinghe A, Babor R, Rahman H. Laparoscopic sleeve gastrectomy as a single-stage bariatric procedure. Obes Surg. 2010;20(3):271–5.

    Article  PubMed  Google Scholar 

  24. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  PubMed  Google Scholar 

  25. Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  Google Scholar 

  26. Thomas TM, Plymat KR, Blannin J, et al. Prevalence of urinary incontinence. Br Med J. 1980;281:1243–5.

    Article  CAS  PubMed  Google Scholar 

  27. Fried M, Hainer V, Basdevant A, et al. Interdisciplinary European guidelines for surgery for severe (morbid) obesity. Obes Surg. 2007;17:260–70.

    Article  PubMed  Google Scholar 

  28. Bohdjalian A, Langer F, Shakeri-Leidenmühler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20:535–40.

    Article  PubMed  Google Scholar 

  29. Gumbs AA, Gagner M, Dakin G, et al. Sleeve gastrectomy for morbid obesity. Obes Surg. 2007;17:962–9.

    Article  PubMed  Google Scholar 

  30. Dixon JB, O’Brien PE. Lipid profile in the severely obese: changes with weight loss after lap-band surgery. Obes Res. 2002;10:903–10.

    Article  PubMed  Google Scholar 

  31. Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247:401–7.

    Article  PubMed  Google Scholar 

  32. Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. [Summary for patients in Ann Intern Med. 2005 Apr 5;142(7):I55; PMID: 15809458]. Ann Int Med. 2005;142:547–59.

    PubMed  Google Scholar 

  33. Piazza L, Pulvirenti A, Ferrarra F, et al. Laparoscopic biliopancreatic diversion: our preliminary experience with 201 consecutive cases. Chir Ital. 2009;61:143–48.

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  35. Dindo D, Clavien P-A. What is a surgical complication? World J Surg. 2008;32:939–41.

    Article  PubMed  Google Scholar 

  36. Frezza E, Shebani K, Robertson J, et al. Morbid obesity causes chronic increase of intraabdominal pressure. Dig Dis Sci. 2007;52:1038–41.

    Article  PubMed  Google Scholar 

  37. Baltasar A, Serra C, Pérez N, et al. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg. 2005;15:1124–8.

    Article  PubMed  Google Scholar 

  38. Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg. 2006;16:1138–44.

    Article  PubMed  Google Scholar 

  39. 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 Rel Dis. 2007;3:134–40.

    Article  Google Scholar 

  40. 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.

    Article  PubMed  Google Scholar 

  41. Sanchez-Santos R, de Gordejuela AG Ruiz, 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.

    Article  PubMed  Google Scholar 

  42. Cummings JM, Rodning CB. Urinary stress incontinence among obese women: review of pathophysiology therapy. Int Urogynecol J. 2000;11:41–4.

    Article  CAS  Google Scholar 

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Acknowledgements

Sanket Srinivasa is supported by the Auckland Medical Research Foundation Ruth Spencer Medical Research Fellowship.

Conflicts of Interest

The authors declare that they have no conflict of interest (financial or otherwise).

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Authors and Affiliations

  1. Department of Surgery, South Auckland Clinical School, Middlemore Hospital, University of Auckland, Auckland, New Zealand

    Sanket Srinivasa, Laura S Hill, Tarik Sammour, Andrew G Hill, Richard Babor & Habib Rahman

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  1. Sanket Srinivasa
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  2. Laura S Hill
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  3. Tarik Sammour
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  4. Andrew G Hill
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Correspondence to Sanket Srinivasa.

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Srinivasa, S., Hill, L.S., Sammour, T. et al. Early and Mid-term Outcomes of Single-Stage Laparoscopic Sleeve Gastrectomy. OBES SURG 20, 1484–1490 (2010). https://doi.org/10.1007/s11695-010-0267-z

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