Early Results of Laparoscopic Sleeve Gastrectomy for Treatment of Morbid Obesity : Experience of Surgery Unit 8b- Ain Shams University, Egypt

Abstract

Background: Sleeve gastrectomy (SG) is a relatively new bariatric procedure with a number of advantages compared with Roux-en-Y gastric bypass. However, SG also has a number of disadvantages and associated risks. We sought to examine perioperative complications and early outcomes of laparoscopic SG (LSG). Patients and methods: Since July 2013, LSG has been performed at surgery unit8B- department of surgery, Ain Shams University, Cairo, Egypt, and we reviewed the cases of all patients. We conducted a retrospective review in September 2015. Results: Forty patients had LSG, and none was lost to follow-up. Indications for LSG over other bariatric procedures were patient preference 80% (n = 32), severe obesity with a body mass index (BMI) greater than 60 kg/m2 (n =5) and severe upper abdominal adhesions (n = 3). 28 patients out of forty were women, while the other 12 were men; and the average age was 38 (standard deviation [SD] 10) years. Preoperatively, the average BMI was 50.3 (SD 7.7) kg/m2. Preoperative obesity-related comorbidity rates were 25% (n = 10) for type 2 diabetes mellitus (T2DM), 50% (n = 20) for hypertension, 20% (n = 8) for dyslipidemia, 10% (n = 4) for obstructive sleep apnea (OSA), 30% (n = 12) for knee and/or hip pain and 37.5% (n = 15) for depression and/or anxiety. The mean duration of surgery was 78 (SD 21) minutes. There were 2 major perioperative complications: 1 staple line leak and 1 gastric pouch (sleeve) stricture. The median stay in hospital was 3 days. Postoperative upper gastrointestinal imaging studies were conducted in all patients; 1 was positive for staple line leak. Histopathology on the excised gastric segments revealed chronic helicobacter pylori gastritis in 4 patients. The mean postoperative follow-up interval was 10 months. Weight loss averaged 28.4 (SD 9.3) kg. Overall weight loss was 3.7 (SD 1.8) kg/month. Resolution occurred in 60% of patients with T2DM, 40% with hypertension, 25% with dyslipidemia, 75% with OSA, 25% with joint pain and 80% with depression/anxiety. Overall satisfaction was rated as excellent by 60% of patients (n = 24), good by 25% (n = 10) and poor by 15% of patients (n = 6). Conclusion: Preliminary analysis of our experience with LSG indicates that this is an effective and safe procedure for the treatment of obesity.