Effectiveness Of Laparoscopic Sleeve Gastrectomy Research Articles

Laparoscopic sleeve gastrectomy for premenstrual syndrome symptoms in patients with obesity.

Premenstrual syndrome (PMS) is a pathological condition characterized by a series of abnormal physical, psychological, and behavioral symptoms. We evaluated the effectiveness of laparoscopic sleeve gastrectomy (LSG) in the treatment of patients with obesity and PMS. In this case-control study, 131 patients with obesity (BMI ≥ 27.5kg/cm2) diagnosed with moderate-to-severe PMS from March 2018 to March 2022 were prospectively selected to undergo LSG or not at their own discretion. Participants self-reported their PMS severity using the Premenstrual Syndrome Screening Tool. Among them, 68 patients chose LSG surgery, and 63 control group patients were followed up without surgery. Data were recorded at baseline and at 3months post-treatment. We used a multivariate analysis to assess the improvement in PMS symptoms and associated factors. Of the 131 patients with obesity and PMS, the improvement rate of PMS in the LSG group was 57.35% (n = 39), while the improvement rate of PMS in the control group was 25.40% (n = 16). Furthermore, our study revealed that surgery is an independent factor affecting the improvement of patients with PMS. Additionally, there was a correlation between alcohol use, T2DM and obesity-related metabolic diseases, and BMI with PMS. The changes in BMI, testosterone, and estradiol(E2) levels may also contribute to the improvement of patients with obesity and PMS. LSG can improve the management of obesity in patients with PMS to some extent. Changes in BMI, testosterone, and E2 may be indicative of improvement in patients with obesity and PMS.

The Therapeutic Effectiveness of Laparoscopic Sleeve Gastrectomy Among Individuals with Low BMI Obesity (30-35 Kg/m2) and the Relationship of BMI to Weight Loss.

Investigating the therapeutic efficacy of Laparoscopic Sleeve Gastrectomy (LSG) in low BMI (30-35 kg/m2) patients with obesity, and exploring the correlation between patients' preoperative BMI and postoperative weight loss. Comparing the weight loss, remission of comorbidities, occurrence of complications, and quality of life among the different BMI patients who underwent LSG. Analyzing the relationship between BMI and percentage of excess weight loss (%EWL) by using Spearman correlation analysis and linear regression analysis. The %EWL at 12 months after the surgical procedure was (104.26±16.41)%, (90.36±9.98)%, and (78.30±14.64)% for patients with Class I, II, and III obesity, respectively, P<0.05. Spearman correlation coefficients between %EWL and BMI at 1, 3, 6, and 12 months after surgery were R=-0.334 (P<0.001), R=-0.389 (P<0.001), and R=-0.442 (P<0.001), R=-0.641 (P<0.001), respectively. The remission of hypertension, diabetes and dyslipidaemia did not differ significantly between groups (P>0.05). Individuals with obesity for varying BMI can experience favorable outcomes following LSG surgery. It is advisable to consider LSG treatment for patients with Class I obesity.

The effect of laparoscopic sleeve gastrectomy on metabolic syndrome parameters during one year of follow-up

Objective: We aimed to evaluate the effectiveness of laparoscopic sleeve gastrectomy (LSG) as a treatment method for morbid obesity&#x0D; and its impact on reducing the incidence of metabolic syndrome and its components.&#x0D; Patients and Methods: This retrospective and a single-center study included patients with obesity who underwent LSG and were&#x0D; followed up at an endocrinology and metabolism outpatient clinic for at least one year. Anthropometric measurements, blood pressure,&#x0D; and blood examinations including fasting plasma glucose and lipid profile were assessed before the surgery and one year after the&#x0D; surgery. The presence of metabolic syndrome and related comorbidities was documented.&#x0D; Results: The study included 62 patients, with a mean age of 38.2 ± 8 years and a female predominance (88.7%). At one year post-surgery,&#x0D; significant improvements were observed in body weight, waist circumference, blood pressure, and metabolic parameters (P

Laparoscopic Sleeve Gastrectomy in Patients Over 60 Years Old: A Long-Term Follow-Up.

Purpose: This study analyzed the safety and effectiveness of laparoscopic sleeve gastrectomy (LSG) in patients over 60 years old, in a long-term follow-up, in a high-volume bariatric center. Methods: We retrospectively analyzed all patients older than 60 years who underwent LSG in our center from January 2009 to December 2018. A prospectively collected database of 4991 consecutive LSG cases was reviewed. Results: One hundred seventy-nine sleeve gastrectomy procedures were performed in patients older than 60 years, 135 were aged 60-65 years (group A) and 44 were older than 65 years (group B). We reported five cases (2.7%) of early complications: three postoperative hemorrhages, one cardial leakage, and one perigastric abscess. No thromboembolic events or mortality rates were reported. The mean follow-up period was 5.5 years (66 months). The follow-up loss rate was about 29%. At last follow-up, the mean body-mass index/body mass/percentage of excess weight loss values were, respectively, 33.7 ± 7/86.1 ± 21/60.4 ± 28.6 in group A and 32.4 ± 6.4/82.6 ± 18/61.8 ± 33 in group B. We reported 5 (4.0%) trocar site hernias, 1 (0.8%) cardial junction stenosis, and 22 (18%) new outbreaks of gastroesophageal reflux (GERD). There were 7 reinterventions (5.7%): 5 for weight regain and 2 for GERD not responding to medical therapy. There were no statistically significant differences between the two age groups. Conclusions: LSG is a safe and effective treatment for severe obesity in people over 60 years old. There are no differences in results of patients over 65 years and between 60 and 65 years old. Scales that include associated medical problems and the patient's general condition must be considered.

Assessment of Lipid Balance Parameters after Laparoscopic Sleeve Gastrectomy in 1-Year Observation.

Introduction: Currently, the increase in the percentage of obese people observed along with the development of civilization, reaching the level of a global pandemic, has forced a search for methods of effective and permanent obesity treatment. Obesity is a multifactorial disease; it coexists with many disease entities and requires multidisciplinary treatment. Obesity leads to metabolic changes in the form of metabolic syndromes, which include, among others, atherogenic dyslipidemia. The proven relationship between dyslipidemia and cardiovascular risk enforces the need to effectively improve the lipid profile of obese patients. Laparoscopic sleeve gastrectomy is a method of surgical treatment of morbid obesity which improves bariatric and metabolic parameters. The aim of the study was to assess the effectiveness of laparoscopic sleeve gastrectomy (LSG) at improving lipid profile parameters upon a 1-year follow up. Material and Methods: Bariatric parameters of 196 patients who underwent laparoscopic sleeve gastrectomy as well as the lipid profile of total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), non-NDL, and triglycerides (TG) in a 1-year observation were analyzed. Results: Improvements in bariatric parameters were observed in patients after LSG. Total cholesterol, low-density lipoprotein (LDL), triglycerides and non-HDL level decreases were observed along with an increase in high-density lipoprotein (HDL) cholesterol levels. Conclusions: Sleeve gastrectomy is an effective method of treating obesity and improving the lipid profile in obese patients.

Effectiveness of laparoscopic sleeve gastrectomy and one anastomosis gastric bypass on the resolution of metabolic syndrome — a review

The main cause of the development of metabolic syndrome seems to be an imbalance of calorie intake and energy expenditure. However genetic and epigenetic factors, sedentary lifestyle, poor food quality, and disturbances in gut microbiota also play a major role. There is no single effective method of treatment for metabolic syndrome. Dietary therapy and an increase in physical activity along with pharmacological treatment are not fully effective to recommend them as a therapy for metabolic syndrome. Today, modern bariatric-metabolic procedures such as laparoscopic sleeve gastrectomy or single anastomosis gastric bypass give the best chances of successful resolution of metabolic syndrome.

Effectiveness of Laparoscopic Sleeve Gastrectomy for Weight Loss in Morbid Obese Patients

Objective: To determine the effectiveness of laparoscopic sleeve gastrectomy for weight loss in morbidly obese patients at Capital Hospital, Islamabad. Methodology: This descriptive case series study was done at Capital Hospital, CDA, Islamabad during a period of one-year from February 2019 to January 2020. All the patients with a body mass index of 35 or greater, with or without comorbidities, aged 18 to 65 years of either gender were included. All the patients underwent laparoscopic sleeve gastrectomy for weight loss. At the 1st, third, and 6th month’s follow-up, postoperative weight loss was noted. Effectiveness was taken in terms of &gt; 10% weight loss maintained at 6 months. Results: The overall study participants' average age was 57±9.77 years, and females were in the majority (62%). Overall, laparoscopic sleeve gastrectomy was effective in 85% of patients and was not effective in 15% of patients. The average BMI was 37.31 kg/m2. Laparoscopic sleeve gastrectomy showed effectiveness in 57 (85%) patients, while 10 (15%) of the patients' weight was not lost. Effectiveness was statistically insignificant according to age, gender, and comorbidities, p-values were quite insignificant (&gt;0.05). Conclusion: Laparoscopic sleeve gastrectomy was observed to be an effective technique for weight loss in morbid obese patients. It did decrease the morbidities and improve the quality of life.

Comparative Effectiveness of Laparoscopic Sleeve Gastrectomy in Morbidly Obese and Super Obese Patients.

BackgroundLaparoscopic sleeve gastrectomy (LSG) is a modified procedure derived from a biliopancreatic diversion (BPD)-duodenal switch. The present study evaluated the role of LSG in morbidly and super obese patients and compare its efficacy between the two groups.MethodologyA retrospective review was conducted in Dr. Sulaiman Al Habib Specialist Hospital, Riyadh, KSA, from January 2020 to April 2021. Patients' records were divided into two groups, morbidly obese (body mass index (BMI): 40-49 kg/m2) and super obese (BMI: 50-59 kg/m2), who were admitted to the department for laparoscopic sleeve gastrectomy during the study duration. However, patients with a history of gut surgery, hernias, comorbid use of illicit substances, and psychiatric disorders were excluded. For all patients, a routine preoperative investigation protocol was conducted. Postoperative surgical complications were also recorded. The Clavien-Dindo classification (CDC) score was applied to record surgical complications. Data collection was done using a semi-structured questionnaire. The Statistical Package for Social Sciences (SPSS) version 26 (IBM, Chicago, USA) was used to perform data analysis.ResultsA total of 176 patient records were included in this analysis, of which 126 (71.6%) were females. There were 101 (57.1%) patients who were morbidly obese and 76 (42.9%) who were super obese. The mean duration of follow-up records in this study was 23.2 ± 3.6 weeks, which was slightly longer in the morbidly obese group. Change in BMI was higher in the super obese patients (18.6 ± 3.1 versus 10.5 ± 1.9). Final body weight was still lower in the morbidly obese group as they were relatively slimmer even before the procedure. A higher reduction in excess weight loss (EWL) is seen in the morbidly obese group. Comorbidity resolution status was also remarkable with the procedure. Overall, there were procedure-associated complications in 11 (10.9%) patients in the morbidly obese group and 10 (13.2%) in the super obese group.ConclusionLaparoscopic sleeve gastrectomy is a safe procedure in morbidly and super obese patients. It is effective in sustainable total and excess weight loss over time. It is also effective in comorbidity resolution. Complications with LSG are minimal and nonserious. LSG should be the recommended procedure in morbidly and super obese patients with adverse health consequences to improve their morbidity, mortality, and overall quality of life.

Metabolic Effectiveness of Laparoscopic Sleeve Gastrectomy in Morbid Obesity Treatment: Early and Mid-Term Results of a Single Center

Objective: The aim of this study is to reveal the efficacy of laparoscopic sleeve gastrectomy (LSG) in the preventable metabolic consequences of morbid obesity. We evaluated the weight loss according to body mass index (BMI), changes in comorbid diseases accompanying obesity in patients who underwent surgery in our clinic in the early and mid-period postoperatively, whether there was vitamin deficiency in the mid-term, and the complications associated with the surgery.&#x0D; Methods: In this study, a total of 50 patients aged 18-60 who underwent LSG intervention due to morbid obesity between January 1, 2010 and December 2019 by Dicle University School of Medicine, General Surgery Clinic, were retrospectively evaluated. Sociodemographic data of the patients, preoperative BMI, postoperative 3th month, 6th month and 1st year BMI values, preoperative and postoperative 12th month HgA1c levels were measured. Mortality and complication rates were evaluated.&#x0D; Results: The mean BMI of 50 patients at pre-LSG, postoperative 3rd month, 6th month and 1st year controls were respectively; 45.83±6.37, 37.63±5.88, 31.91±5.10 and 26.82±3.08kg/m2. Compared to before the intervention, the decrease in BMI was significant at the 3rd month, 6th month and 1st year controls (p

Laparoscopic sleeve gastrectomy for the treatment of idiopathic intracranial hypertension in patients with severe obesity.

Severe obesity is a major risk factor for idiopathic intracranial hypertension (IIH). Data on the role of bariatric surgery for the treatment of this condition are scarce. To evaluate the effectiveness of laparoscopic sleeve gastrectomy (LSG) on treating IIH in severely obese patients. Two university bariatric surgery centers. Prospectively collected data from consecutive patients undergoing LSG were retrospectively analyzed. Patients with IIH and referred by neuroophthalmologists for bariatric surgery were included in the analysis. Fifteen female patients with IIH underwent LSG (median age: 31 yr). Median preoperative body mass index was 42.1 kg/m2. Preoperatively, 14 patients (93.3%) had chronic headaches, 8 (53.3%) pulsatile tinnitus, and 1 (6.6%) epistaxis episodes. Ophthalmologic assessment showed bilateral papilledema in all patients, of whom 13 had visual symptoms. Median initial cerebrospinal fluid opening pressure was 31 cmH2 O (range: 25-50 cmH2 O); 4 patients required repeated decompressing lumbar punctures (1 ventriculoperitoneal shunt). LSG was successfully performed in all patients. No patients were lost to follow-up. Mean excess weight loss was and 87.4% and 88.1% 1 and 2 years after LSG, respectively. Headaches totally resolved in 13 patients (93.3%) and improved in 1 (P < .001). Pulsatile tinnitus (P = .013), epistaxis, visual symptoms (P < .001), and papilledema (P < .001) significantly resolved. Medication was stopped in 14 patients (93.3%). Two years after LSG, IIH outcomes for 7 patients reaching this time point remained unchanged. This study suggests that LSG is effective for severely obese patients with IIH, resulting in complete remission or significant improvement of their symptoms as well as medication discontinuation.

Thoracoscopic radical surgery for a morbidly obese patient with early lung cancer after laparoscopic sleeve gastrectomy: a case report

BackgroundWe experienced a case of early stage lung cancer involving a morbidly obese patient. Obesity is associated with a higher incidence of surgical complications. We examined the effectiveness of laparoscopic sleeve gastrectomy as a primary weight loss procedure in a morbidly obese patient who required oncological surgery.Case presentationA 64-year-old morbidly obese female with a body mass index of 43.5 kg/m2 was referred to our hospital to undergo weight loss. A right-sided lung mass was found incidentally on computed tomography conducted in preparation for laparoscopic sleeve gastrectomy, which was performed prior to tumor surgery. As a result, weight loss was achieved within 2.5 months after the laparoscopic sleeve gastrectomy, and the patient’s type-2 diabetes, hypertension, and dyslipidemia, which are linked to obesity, were markedly ameliorated. After a quick intraoperative pathological inspection revealed that the tumor was malignant, thoracoscopic right lung superior lobe resection was performed safely.ConclusionsLaparoscopic sleeve gastrectomy proved to be a powerful approach in a case in which a morbidly obese patient with early stage cancer needed to lose weight rapidly.

Effectiveness of Laparoscopic Sleeve Gastrectomy in Super-obese and Non-Super-obese Patients.

The primary aim of this study was to assess the effectiveness of sleeve gastrectomy (SG) in super-obese patients. The secondary aim was to identify patient characteristics associated with worse SG outcomes in this group. A retrospective analysis was carried out of our electronic prospective bariatric surgery patient database, including all patients who underwent SG between January 2007 and January 2017. The sample was divided according to the initial body mass index (BMI) (> or <50 kg/m). The initial characteristics and results in terms of weight loss and comorbidity resolution between the groups were compared. A subanalysis of the variable distributions was carried out according to whether or not the final BMI in the super-obese group had reached <35 kg/m. Data analysis was carried out using STATA 13.1, with a P-value <0.05 considered to be significant. The mean initial BMI was 42.8 kg/m in group 1 (<50 kg/m) and 55 kg/m in group 2 (>50 kg/m). The median follow-up (FU) was 56.2 months. Maximum weight loss was attained at the 18-month FU in both groups (BMI: 28.8 and 34.7 kg/m, respectively). At the 5-year FU, percentage of total weight loss was higher in group 2 and percentage of excess weight loss was statistically higher in group 1 (29.6% vs. 33.1% and 67% vs. 59%, respectively). Outcomes for type 2 diabetes mellitus, hypertension, and dyslipidemia were similar in both groups. The variables associated with attaining a final BMI <35 kg/m in the super-obese group were lower initial BMI, absence of baseline weight-related conditions (type 2 diabetes mellitus, obstructive sleep apnea syndrome, home continuous positive airway pressure, arthropathy, heart disease), and absence of gastroesophageal reflux disease. We observed a statistically significant increase in poor outcomes in patients with a higher initial BMI and with weight-related comorbidities. These parameters could be considered to be potentially good predictors of less satisfactory outcomes in the super-obese patients.

The Safety and Benefits of Laparoscopic Sleeve Gastrectomy in Elderly Patients: a Case-Control Study

IntroductionThe advancement of minimal invasive techniques pushed the age limit for patients qualified for bariatric surgery.AimThe aim of the study was to evaluate the safety and effectiveness of laparoscopic sleeve gastrectomy (LSG) in a cohort of patients aged 60 years or more, compared with a group of matched controls below 40 years old.MethodsThe medical records of 856 patients were analyzed. Patients aged 60 years or older were identified as cases. Those below 40 years were identified as the controls. Cases were closely matched (1:1) with the controls by body mass index (BMI) (± 1 kg/m2) and presence or absence of hypertension and diabetes mellitus.ResultsA 34 matched pairs were included in the study. There was no significant difference in the median operation length. No conversion from laparoscopic to open surgery was needed. The hospital length of stay was significantly longer in the study group (4.5 ± 1.9 vs 3.9 ± 1.5 days, p = 0.047). The complication, 30-day reoperation, and 30-day reoperation rates were comparable in both groups. There were no 30-day readmissions nor 30-day mortality. ΔBMI after 12 months was significantly lower in the study group (13.56 ± 6.05 vs 10.3 ± 4.89, p = 0.008) as well as %EBMIL (50.71 ± 25.94 vs 64.20 ± 23.29, p = 0.015).ConclusionsThe study suggests that LSG is a safe method of bariatric treatment in patients aged above 60 years. Even though weight loss may be lesser than in younger patients, it can still be considered satisfactory.

SAT-111 Reversal of Nonalcoholic Fatty Liver Disease with Bariatric Surgery in South Asians: Does the Type of Surgery Matter?

Nonalcoholic fatty liver disease (NAFLD) is a common complication of obesity with prevalence rates of 65 - 85% in obese individuals. It can be associated liver cell injury eventually leading to cirrhosis. Weight loss is the primary modality of treatment of NAFLD which can be difficult to achieve and maintain in a majority of patients. Bariatric surgery has been shown to reverse NAFLD but the type of bariatric surgery that is most effective, especially in South Asian patients is not clear. In this study we aimed to compare the effectiveness of laparoscopic sleeve gastrectomy (LSG) versus laparoscopic mini gastric bypass (LMGB) in reversing NAFLD in obese Sri Lankans. We did a retrospective analysis of medical records of 155 obese patients who underwent LSG and LMBG at Colombo South Teaching Hospital, Sri Lanka. Overall 114 (73.5%) and 41 (26.5%) patients underwent LSG and LMBG respectively. Among patients who underwent LSG and LMGB, there was no statistically significant difference in the baseline body weight (112.5 ± 19.5 vs 120.2 ± 29.4 kg), BMI (44.7 ± 6.1 vs 45.9 ± 8.0 kg/m2), waist circumference (WC) (female: 118.9 ± 11.2 cm vs 117.9 ± 9.0 cm, male: 125.5 ±14.7 cm vs 130.7 ±15.9 cm) and body fat percentage (BFP) (female: 45.9 ± 3.1% vs 43.1 ± 9.5%, male: 40.9 ± 6.8% vs 39.4 ± 1.6%). There was no significant difference between patients who underwent LSG and LMBG, in decrease in weight (24.7 ±7.1 kg vs 32.6 ±14.7 kg, p=0.12) and decrease in BMI (10.0 ±2.9 kg/m2 vs 12.0 ±4.2 kg/m2, p=0.08) at 6 months post-procedure as compared to baseline, although LMBG showed a trend towards greater benefit. There was no statistically significant difference in the decrease in WC (19.0 ±9.9 cm vs 20.8 ±5.8) and decrease in BFP (7.4% ±5.8 vs 10.8% ±5.6). Overall 88.4% of patients had NAFLD by ultrasound scan (USS) imaging criteria. Patients with LSG and LMBG did not show a significant difference in baseline AST (31.8 ±21.1 vs 26.8 ±11.6 U/L, p>0.05) and ALT (41.1 ±30.3 vs 35.8 ±25.7, p>0.05). At 6 months post procedure, AST (21.6 ±8.1 vs 25.0 ±13.9 U/L, p=0.32) and ALT (19.1 ±9.4 vs 26.9 ±11.0 U/L, p<0.05) levels were lower in patients with LSG than patients with LMBG, although only ALT values reached statistical significance. Thus LSG showed a greater degree of AST (32.1% vs 6.7%, p<0.05) and ALT (53.5% vs 24.9%, p=0.001) reduction compared to LMBG. At 6 months post-procedure, patients who underwent LSG had less patients with elevated AST (4.4% vs 11.1%) and ALT (4.4% vs 12.5%) as compared to LMBG. Overall LSG showed a higher rate of complete reversal of NAFLD (75.0% vs 44.4%) and improvement of the grade of NAFLD (91.7% vs 66.7%) on USS imaging when compared with LMBG. In conclusion, our study reveal that LSG has a more favorable effect on complete reversal and improvement of NAFLD when compared with LMBG. This effect seems to be independent of weight loss. Thus LSG should be considered ahead of LMBG when bariatric surgery is planned for obese patients with NAFLD.

Laparoscopic Sleeve Gastrectomy in Heart Failure Patients with Left Ventricular Assist Device.

There is limited data in the literature evaluating outcomes of bariatric surgery in severely obese patients with left ventricular assist device (LVAD) as a bridge to make them acceptable candidates for heart transplantation. This study aims to assess the safety and effectiveness of laparoscopic sleeve gastrectomy (LSG) in patients with previously implanted LVAD at our institution. All the patients with end-stage heart failure (ESHF) and implanted LVAD who underwent LSG from2013 to January 2017 were studied. Seven patients with end stage heart failure (ESHF) and implanted LVAD were included. The median age and median preoperative BMI were 39years (range: 26-62) and 43.6kg/m2 (range 36.7-56.7), respectively. The median interval between LVAD implantation and LSG was 38months (range 15-48). The median length of hospital stay was 9days (rang: 6-23) out of which 4 patients had planned postoperative ICU admission. Thirty-day complications were noted in 5 patients (3 major and 2 minor) without any perioperative mortality. The median duration of follow-up was 24months (range 2-30). At the last available follow-up, the median BMI, %EWL, and %TWL were 37kg/m2, 47%, and 16%, respectively. The median LVEF before LSG and at the last follow-up point (before heart transplant) was 19% (range 15-20) and 22% (range, 16-35), respectively. In addition, the median NYHA class improved from 3 to 2 after LSG. Three patients underwent successful heart transplantations. Patients with morbid obesity, ESHF, and implanted LVAD constitute a high-risk cohort. Our results with 7 patients and result from other studies (19 patients) suggested that bariatric surgery may be a reasonable option for LVAD patients with severe obesity. Bariatric surgery appears to provide significant weight loss in these patients and may improve candidacy for heart transplantation.

Anesthesia management in laparoscopic sleeve gastrectomy: Outcomes of 81 patients

Background: Anesthesia management has critical role in the effectiveness of laparoscopic sleeve gastrectomy (LSG), due to the significant anatomic, physiological, and pathological challenges in obese population. Aim: To report and discuss our anesthetic management outcomes in patients who underwent LSG. Methods: Data of 81 obese patients who underwent LSG were retrospectively analyzed. All techniques used in the anesthesia management were compared between each other in terms of complications, duration of surgery intensive care unit (SICU) stay, total hospitalization time. Results: Two different protocols were used for induction of anesthesia: propofol-based protocol (n=27) and thiopental sodium-based protocol (n=54). Anesthesia was maintained by sevoflurane (n=59) or desflurane (n=22) inhalation. All anesthesia-related complications were found in thiopental sodium group (p=0.026). Sevoflurane and desflurane were similar in anesthesia-related complication, duration of SICU stay and total hospitalization time. Presence of obstructive sleep apnea (OSA) and coexisting chronic disease were found to be associated with longer SICU stay (p

Effectiveness of Laparoscopic Sleeve Gastrectomy in Treating Obesity and Its Co-morbidities

Objective To analyze the effectiveness and safety of laparoscopic sleeve gastrectomy (LSG) in treating obesity and its co-morbidities.Methods The clinical data of obese patients undergoing LSG in Peking Union Medical College Hospital from August 2012 to August 2017 were retrospectively analyzed. Medium-term outcome measures included excess weight loss (%EWL),co-morbidity improvement,and complications.Results Seventy-five obese patients comprising 28 men[ body mass index(BMI):(47.3±7.5)kg/m 2) ] and 47 women [BMI (41.1±7.0) kg/m 2] were enrolled in this analysis. The common co-morbidities were liver dysfunction (53.3%),dyslipidemia (52.0%),obstructive sleep apnea (45.3%),type 2 diabetes mellitus (38.7%),and arterial hypertension (37.3%),which were improved by 75.0%,58.3%,83.3%,75.0% and 58.3% three years after surgery. The mean %EWL at 1,2,and 3 years after surgery was 81.6±34.7,80.9±30.2 and 79.7±30.8,respectively. The proportions of patients achieving successful weight loss were 81.7% (n=49),81.0% (n=34),and 79.3% (n=23) at 1,2,and 3 years (%EWL>50%). Early severe complications (Clavien-Dindo classification>2) occurred in 2.6% of patients,and the most common late complications was gastroesophageal reflux disease,which could be relieved by acid suppressants.Conclusion LSG is effective and safe in treating obesity and its co-morbidities.

Effectiveness of laparoscopic sleeve gastrectomy for weight loss and obesity-associated co-morbidities: a 3-year outcome from Mainland Chinese patients

BackgroundLaparoscopic sleeve gastrectomy (LSG) is becoming a stand-alone bariatric surgery for obesity, but its effectiveness for Mainland Chinese patients remains unclear. ObjectivesTo evaluate the effectiveness and safety of LSG for Mainland Chinese patients SettingA tertiary hospital MethodsRetrospective analysis of patients admitted for LSG between January 2011 and February 2012 was performed. Medium-term outcome measures were: total weight loss (%TWL), excess weight loss (%EWL), co-morbidities, improvement, and complications. ResultsSeventy patients (body mass index [BMI] 40.8±5.9 kg/m2) underwent LSG, comprising 40 women and 30 men. The most common co-morbidity was diabetes (n = 29, 41.4%). Lost to follow-up rate for weight loss was 15.7%, 31.4%, and 41% at 1, 2, and 3 years. The %TWL was 34.4±6.1, 34.7±6.2 and 33.7±7.1 at 1, 2, and 3 years. The %EWL increased to 77.1±13.0, 77.9±12.2 and 77.2±13.1 at 1, 2, and 3years. The proportions of patients having successful weight loss were 100% or 85% at 3 years according the definition of %TWL>10% or %EWL>50%. Approximately 79.3%, 51.7%, and 44.8% of patients completed follow-up for glycemic control at each time point, respectively. The proportions of patients with optimal glycemic control (fasting blood glucose [FBG]<5.6 mmol/L; hemoglobin A1C [HbA1C]<6.5%) were 47.9%, 60.0%, and 69.2% at 1, 2, and 3years. The weight loss and glycemic control effect may be greater in the high BMI group (≥40 kg/m2). Early and late complications occurred in 8.6% and 7.1% of patients during follow-up. ConclusionsLSG is effective in weight loss and glycemic control and is safe for Mainland Chinese obese patients, especially for patients with a BMI≥40 kg/m2.

Does weight loss due to bariatric surgery affect serum uric acid levels?

BackgroundIn the current scenario, bariatric surgery has become a popular modality for long-term weight loss among obese population. The available data mainly concentrated on its impact on diabetes, dyslipidemia, hypertension, and or metabolic syndrome. However, there is paucity in literature regarding effectiveness of laparoscopic sleeve gastrectomy on serum uric acid. Methods and materialsIn a prospective interventional study, 100 obese patients were studied for weight loss and change in serum uric acid levels postlaparoscopic sleeve gastrectomy. The subjects were enrolled for a period of 1 year. Three patients died during the study and nine were lost to follow-up. All subjects were classified according to WHO criteria of obesity, as mild, moderate, and severe obesity groups. Body weight, body mass index, and uric acid levels were determined at baseline, 3 months, and 6 months postsurgery. ResultsStatistically significant reduction in postoperative body weight and body mass index were noted in comparison to preoperative values. The preoperative mean uric acid levels for mild, moderate, and severe obese groups were 4.65, 5.91, and 6.06mg/dl, which decreased to 2.55, 5.04, and 4.46mg/dl at 6 months postsurgery, respectively. However, on comparison of the change in uric acid levels among the three obesity groups from 3 months to baseline (P=0.17) and from 6 months to baseline (P=0.08), no group was found superior in terms of reducing uric acid level after surgery. ConclusionsBariatric surgery reduces the body mass and leads to the significant reduction in serum uric acid levels. However, this reduction was comparable among obesity groups.

Early post-operative weight loss after laparoscopic sleeve gastrectomy correlates with the volume of the excised stomach and not with that of the sleeve! Preliminary data from a multi-detector computed tomography-based study.

Pre- and post-operative stomach volumes can be important determinants for effectiveness of laparoscopic sleeve gastrectomy (LSG) in causing weight loss. There is little existing data on the volumes of stomach preoperatively and that excised during LSG. This study was designed to evaluate the change in gastric volume after LSG using multi-detector CT and to correlate it with early post-operative weight loss. Twenty consecutive patients with BMI ≥ 40 kg/m(2) and medical comorbidities underwent LSG between October 2011 and October 2013 and were analysed prospectively. The pre-operative stomach volume was measured by MDCT done 1-3 days before the surgery. LSG was performed in the standard manner using a 36F bougie. The volume of excised stomach was measured by distending the specimen with saline. MDCT of the upper abdomen was repeated 3 months postoperatively to calculate the gastric sleeve volume. Weight loss and resolution of comorbidities were documented. The mean pre-operative weight of patients was 123.90 kg, and the mean pre-operative stomach volume on MDCT was 1,067 ml. The stomach volume on pre-operative MDCT correlated with pre-operative weight and BMI. The mean volume of the excised stomach was 859 ml when measured by distension of the specimen and 850 ml on MDCT. After 3 months post surgery, the mean volume of gastric sleeve on MDCT was 217 ml, and the mean weight of the patients was 101.22 kg. The volume of the excised stomach calculated by MDCT correlated with the weight loss achieved 3 months postoperatively. However, no correlation was seen between the gastric sleeve volume 3 months postoperatively and weight loss during this period. MDCT is a good method to measure gastric volume before and after LSG. Early post-operative weight loss (3 months) correlates well with the volume of the excised stomach but not with that of the gastric sleeve.