Efficacy Of Laparoscopic Sleeve Gastrectomy Research Articles

Efficacy of laparoscopic sleeve gastrectomy for the treatment of obesity in a non-Western society.

The objective of this study was to analyze the mid-term outcomes of sleeve gastrectomy in a cohort of obese patients. We analyzed the outcomes of 159 adult patients who had laparoscopic sleeve gastrectomy between January 2011 and January 2015 in our center. Data collected included patient demographics, presence of comorbid diseases, preoperative body mass index, percent excess weight loss, resolution of comorbid diseases, morbidity and in-hospital mortality. We achieved a 24th month percent excess weight loss of 75.1±10.5. Remission of diabetes mellitus, hypertension, hyperlipidemia and obstructive sleep apnea syndrome after sleeve gastrectomy was as high as 84, 63.9, 75.8 and 93%, respectively, in different studies. Our results in diabetes mellitus, hypertension and hyperlipidemia are comparable with other data on the improvement of comorbidites after sleeve gastrectomy. We found less improvement in obstructive sleep apnea syndrome in our cohort when compared to other reports. Sleeve gastrectomy is an efficient, durable technique for the treatment of obesity and associated comorbidities in all body mass index subgroups of obese population. For better outcomes, strategies for proper education and certification are needed.

Efficacy and Safety of Laparoscopic Sleeve Gastrectomy in Adolescents

Background: Adolescent obesity is increasing worldwide, and the demand for bariatric surgery in this patient population is rising. This study assesses the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) in the adolescent (≤21 years) population in two University hospitals in Lebanon. Methods: We retrospectively reviewed a cohort of 121 adolescent patients who underwent LSG at the American University of Beirut Medical Center and at Makassed General Hospital between January 2011 and September 2014. Results: The study included 119 patients with a median age of 18.6 ± 2.1 years (range 11–21). Most patients were female (71.4%). Mean preoperative weight and body mass index were 117.9 ± 24.3 kg and 41.9 ± 6.6 kg/m2 (range 32.3–71.0 kg/m2), respectively. Follow-up was achieved in 90.6%, 65.9%, and 59.5% at 1, 2, and 3 years, respectively. Mean percentage of total weight loss was 31.5% ± 8.4%, 32.6% ± 10.4%, and 29.6% ± 13.7%, while mean percentage of excess weight loss was 90.1% ± 28.6%, 89.9% ± 32.0%, and 82.2% ± 38.6% at 1, 2, and 3 years, respectively. Diabetes, hypertension, and dyslipidemia resolved in 100%, 62.5%, and 83.3% of patients, respectively, at a mean follow-up of 13.8 ± 9.1 months. Gastroesophageal reflux disease was reported in 21% of patients followed up at 3 years. The most common long-term complication was symptomatic gallstones necessitating surgical intervention (10.1%). Conclusion: The study shows that LSG is an effective and safe weight loss procedure for morbidly obese adolescents, offering good medium-term weight loss outcomes and significant resolution of obesity-related comorbidities.

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Five-year results after laparoscopic sleeve gastrectomy: a prospective study

BackgroundWhilst the early to mid-term efficacy of laparoscopic sleeve gastrectomy (SG) is well established, there is comparatively less detailing of long-term efficacy. The objectives of this study were to evaluate the long-term outcomes of patients undergoing SG at the authors’ institution. MethodsAll patients undergoing SG during the past 5 or more years were eligible. Outcomes included baseline demographic data, preoperative characteristics, percentage excess weight loss (%EWL), co-morbidity improvement and resolution, serum hemoglobin A1c (HbA1c), serum lipid profile, and the Bariatric Analysis Reporting Outcome System (BAROS) questionnaire. A subset analysis was also performed with patients stratified in to super obese (body mass index≥50 kg/m2). ResultsThere were 96 patients who underwent surgery between March 2007 and July 2008. Of these, 10 declined to participate, 28 were unable to be contacted, and 3 were deceased; therefore, 55 patients were included in the analysis. The mean yearly %EWL to postoperative year 5 was 56% (year 1), 55% (year 2), 46% (year 3), 43% (year 4), and 40% (year 5). Combined improvement and resolution rates at 5 years were 79%, 61%, and 73% for type 2 diabetes, hypertension, and obstructive sleep apnea, respectively. The HbA1c was significantly reduced at long-term follow-up. The mean BAROS score was 3.13 (95% CI: 2.4, 3.9). Weight loss outcomes were less favorable in super obese patients. ConclusionWeight loss outcomes at 5 year follow-up were modest after SG though improvement in co-morbidity status was maintained.

The efficacy of laparoscopic sleeve gastrectomy in treating adolescent obesity.

Laparoscopic sleeve gastrectomy (SG) is becoming a popular and preferred primary bariatric intervention; however, its applicability in the adolescent age group remains controversial. The aim of this study is to evaluate the efficacy of SG in treating obesity and its co-morbidities among adolescents. A retrospective study was conducted of patients aged 12-21 who underwent SG from 2008 to 2012 at Amiri Hospital, Kuwait. The major outcome measures were percent excess weight loss (%EWL) over a 2-year follow-up period, resolution of co-morbidities, and occurrence of complications. A total of 135 adolescent patients underwent the procedure, of which, 97 (71.9 %) were females. The patients had a median age of 19 years (range 12-21), mean body mass index of 48.5 kg/m(2), and mean follow-up period of 20 ± 11.4 months. The %EWL at 2 years for males and females was 84 and 77 %, respectively. All of the patients with type 2 diabetes mellitus and 75 % of those with hypertension showed complete resolution of the disease at 2 years. SG seems to be an effective and safe bariatric procedure in obese adolescents, as it can significantly decrease excess body weight and reduce co-morbidities in a relatively short period of time.

Laparoscopic sleeve gastrectomy for morbid obesity: 5-year results

BackgroundData concerning the long-term efficacy of laparoscopic sleeve gastrectomy in the treatment of morbid obesity remain scarce. In this retrospective, the authors present 5-year follow-up of 30 patients having undergone laparoscopic sleeve gastrectomy. MethodsSince 2004, 30 patients underwent laparoscopic sleeve gastrectomy and completed 5 years of follow-up. Five patients were subsequently subjected to laparoscopic Roux-en-Y gastric bypass and were excluded from further analysis. The remaining 25 patients comprised the study population. ResultsMean excess weight loss was 65.2 ± 6.1%, 64.7 ± 5.6%, 62 ± 4.9%, 58.2 ± 5.5%, and 56.4 ± 5.8% for the first 5 years, respectively. There were no deaths, nor any major morbidity. Remission of comorbidities was observed in 40% to 80.9% of cases. ConclusionsLaparoscopic sleeve gastrectomy is a safe and effective means of treatment of morbid obesity both in the short and in the long term. More research is needed to better predict which patient will benefit most from this operation.

Laparoscopic sleeve gastrectomy in morbidly obese patients with end-stage heart failure and left ventricular assist device: medium-term results

BackgroundMorbid obesity precludes patients with end-stage heart failure from becoming cardiac transplant candidates. This study evaluates the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) as a means to transplant candidacy in such patients. MethodsMorbidly obese patients with end-stage heart failure, who were ineligible for cardiac transplantation and underwent LSG between 2008 and 2013, were reviewed retrospectively. Demographic characteristics, perioperative details, percentage of excess weight loss (%EWL), and status of transplant candidacy were analyzed. ResultsSix patients (3 men) with end-stage heart failure and morbid obesity underwent LSG. Three patients (50%) had a left ventricular assist device (LVAD) in place at the time of surgery. Median age was 34 (31–66) years and mean preoperative body mass index (BMI) was 47.6±3.0 kg/m2. Median operative time was 90 (66–141) minutes, with a median length of stay of 7 (4–16) days. There were no perioperative deaths. One patient suffered a spontaneous flank hematoma. The same patient also had thrombosis of the LVAD pump at 3 weeks postoperatively, requiring an uneventful device exchange. At median follow-up of 22 (12–70) months, the mean %EWL was 51.4±10.3% with a decrease in BMI to 34.3±2.4 kg/m2 (P<.05). All patients had lost sufficient weight to become transplant eligible within 12 months of surgery. Two patients had undergone successful transplantation and another 2 were on the transplant list. ConclusionLSG appears to be a safe, technically feasible, and effective method for obtaining adequate weight loss in morbidly obese patients with end-stage heart failure and mechanical circulatory support, subsequently improving their access to cardiac transplantation. This is the largest case series to date of this high-risk group of patients undergoing LSG.

Long term predictors of success after laparoscopic sleeve gastrectomy

BackgroundTo evaluate early, mid and long term efficacy of laparoscopic sleeve gastrectomy as a definitive management of morbid obesity and to study factors that may predict its success. Materials and methodsA retrospective study was conducted by reviewing the database of patients who underwent LSG as a definitive bariatric procedure, from April 2005 to March 2013. Univariate and multivariate analysis were performed. Results1395 patients were included in this study. Mean age was 33 years and women:men ratio was 74:26. The mean preoperative BMI was 46 kg/m2. Operative time was 113 ± 29 min. Reinforcement of staple line was done only in 447 (32%) cases. 11 (0.79%) cases developed postoperative leak, with total number of complications 72 (5.1%) and 0% mortality. Percentage of excess weight loss (%EWL) was 42%, 53%, 61%, 73%, 67%, 61%, 59% and 57% at 6 months, 1–7 years. Remission of diabetes (DM), hypertension (HTN) and hyperlipidaemia (HLP) occurred 69%, 54% and 43% respectively. 56 (4%) patients underwent revision surgery, for insufficient weight loss (n = 37) and severe reflux symptoms (n = 19). Mean follow up was 76 ± 19 (range: 6–103) months. Smaller bougie size and leaving smaller antrum were associated with significant %EWL. Bougie ≤36F remained significant in multivariate analysis. ConclusionThis study supports safety, effectiveness and durability of LSG as a sole definitive bariatric procedure. Smaller bougie size and shorter distance from pylorus were associated with significant %EWL.

Co-morbidity resolution in morbidly obese children and adolescents undergoing sleeve gastrectomy

BackgroundBariatric surgery is becoming important for the reversal of co-morbidities in children and adolescents. We previously reported the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) in the pediatric population. However, evidence pertaining to the effect of LSG on co-morbidities in this age group is scarce. The objective of this study was to assess the remission and improvement of co-morbidities (dyslipidemia, hypertension, diabetes, and obstructive sleep apnea) after LSG in children and adolescents. MethodsAnthropometric changes, complications, remission, and improvement in co-morbidities were assessed over 3 years. OSA was diagnosed using the Pediatric Sleep Questionnaire (PSQ) and polysomnography and its resolution was assessed according to PSQ score alone. Diabetes, prediabetes, hypertension, prehypertension, and dyslipidemia were assessed using standard pediatric-specific definitions. ResultsThe review yielded 226 patients; 74 patients were prepubertal (5–12 yr of age, mean: 9.8±2.3), 115 adolescents (13–17 yr of age, mean: 15.4±1.7), and 37 were young adults (18–21 yr of age, mean: 19.2±.8). Overall mean age was 14.4±4.0 years (range: 4.94–20.99), and 50.4% were females. Mean body mass index (BMI) and BMI z score were 48.2±10.1 kg/m2 and 2.99±.35, respectively. Mean BMI z score at 1, 2, and 3 years postoperative was 2.01±.87, 2.00±1.07, and 1.66±.65, respectively. Mean preoperative height was 158.0±15.1 cm, and at 1, 2, and 3 years postoperative, it was 160.3±13.4, 161.4±14.1, and 163.2±11.1, respectively. All patients at different age groups experienced normal growth velocity. Within 2 years of follow-up, 90.3% of co-morbidities were in remission or improved, 64.9% of which were within the first 3 months postoperatively. No further improvement or remission was observed beyond 2 years, and there was no recurrence up to 3 years in patients who were seen in follow-up. The lost to follow-up in each of the 3 years was 4.2%, 7.6%, and 15.3%, respectively. ConclusionLSG performed on children and adolescents results in remission or improvement of>90% of co-morbidities within 2 years after bariatric surgery with few complications, no mortality, and normal growth.

Efficacy of precision laparoscopic sleeve gastrectomy for the treatment of obesity

Objective To investigate the efficacy of laparoscopic sleeve gastrectomy (LSG) for the treatment of obesity.Methods The clinical data of 50 obese patients who received LSG under the guidance of precise weight loss at the First Affiliated Hospital of Jinan University from August 2011 to July 2013 were retrospectively analyzed.The body mass index (BMI),complication and metabolic disease remission before and after operation were recorded.Results All the 50 patients successfully underwent LSG.The operation time,blood loss,postoperative duration of hospital stay were (59 ± 10) minutes,(10 ± 4) ml and (5.2 ± 1.1) days.No severe complications were observed.The percentage of excess weight loss (EWL) and decrease of BMI of 23 patients who were followed up for more than 1 year were 80％ ± 18％ and (10.1 ± 3.4)kg/m2,respectively; the percentage of EWL and decrease of BMI of 13 patients who were followed up for 6-12 months were 71％ ± 15％ and (8.6 ± 2.3) kg/m2,respectively ; the percentage of EWL and decrease of BMI of 14 patients who were followed up for 1-6 months were 28％± 12％ and (4.2 ± 1.6)kg/m2,respectively.The condition of 6 patients with insulin resistance was back to normal.Six patients had hepatic adipose infiltration,5 of them had lipid levels decreased,and the change of lipid level was not obvious in the other 1 patient.Four patients had type 2 diabetes mellitus,3 patients did not need therapy,1 patient only needed drug therapy.Three patients had hypertension,and their blood pressure was controlled at the normal level after stop of drug administration.Conclusion The incidence of postoperative complication could be reduced by fine and accurate manipulation and applying the precision weight loss in operation. Key words: Obesity ; Precision surgery ; Laparoscopy ; Bariatric surgery

Efficacy of laparoscopic sleeve gastrectomy for the treatment of morbid obesity: a 5-year study

Objective To investigate the 5-year efficacy of laparoscopic sleeve gastrectomy for the treatment of morbid obesity.Methods The clinical data of 31 patients with severe morbid obesity and related complications who were admitted to the Shengjing Hospital of Chinese Medical University from January 2006 to December 2007 were retrospectively analyzed.The 31 patients received laparoscopic sleeve gastrectomy and were followed up for 5 years to observe the perioperative condition,incidence of long-term complications,application of hypoglycemic drug and insulin before and after operation,the body mass index (BMI) was detected 6 months,1,2,3,4,5 years after operation,and the decrease of excess weight loss (EWL) was analyzed.The remission rate of complications,incidence of complications and the patient satisfaction score were recorded.The count data were analyzed using the chi-square test or Fisher exact probability.Repeated measurement data were analyzed using the repeated measure ANOVA,a Greenhouse-Geisser adjustment was used to correct serial dependency.Results Twenty-five patients were followed up for 5 years postoperatively.Of the 25 patients,4 (16.0％) had gastroesophageal reflux disease,and were cured by medical treatment; 1 patient (4％) had anastomotic stenosis; the percentage of EWL of 2 patients (8.0％) was under 60％ ; 4 patients (16.0％) had occasional obdominal pain.The percentage of patients with diabetes mellitus was decreased from preoperative 9.7％ (3/31) to postoperative 4.0％ (1/25),with a significant difference (P ＜ 0.05).The percentage of patients with fatty liver was decreased from preoperative 93.5％ (29/31) to postoperative 32.0％(8/25),with significant difference (x2=19.10,P ＜ 0.05).The percentage of patients with hyperlipidemia was decreased from preoperative 77.4％ (24/31) to postoperative 12.0％ (3/25),with significant difference (x2 =35.51,P ＜ 0.05).The level of BMI was decreased from preoperative (38.8 ±4.2) kg/m2 to postoperative (28.5 ± 3.1) kg/m2,with significant difference (F =113.36,P ＜ 0.05).The percentage of EWL was increased from preoperative 42％ ± 11％ to postoperative 69％ ± 16％,with significant difference (F =41.71,P ＜0.05).There was no significant difference in the patient satisfaction score between each year within the 5 years (F =0.92,P ＞ 0.05).Conclusions Laparoscopic sleeve gastrectomy is effective in losing weight with few long-term complications. Key words: Obesity, morbid; Laparoscopy; Sleeve gastrectomy; Efficacy

Efficacy of Laparoscopic Sleeve Gastrectomy and Intensive Medical Management in Obese Patients with Type 2 Diabetes Mellitus

There are a dearth of studies comparing laparoscopic sleeve gastrectomy (LSG) and intensive medical treatment (IMT) in obese type 2 diabetes mellitus (T2DM) patients. This study compares these modalities in terms of weight loss, metabolic parameters and quality of life (QOL) score. We evaluated the efficacy of LSG (n = 14) vs. IMT (n = 17) comprising of low calorie diet, exenatide, metformin and if required insulin detemir in 31 obese T2DM patients with BMI of 37.9 ± 5.3kg/m(2) and target HbA1c < 7%. The mean (±SD) age of the patients was 49.6 ± 11.9years and 74% were women. The mean duration of diabetes was 8.5 ± 6.1years and mean HbA1c was 8.6 ± 1.3%. Primary end point was excess body weight loss (EBWL) at the final follow-up. The mean duration of follow-up was 12.5 ± 5.0 (median 12) months. EBWL was 61.2 ± 17.6% and 27.4 ± 23.6% in LSG and IMT group respectively (p < 0.001). Glycemic outcomes improved in both with mean HbA1c of 6.6 ± 1.5% in LSG and 7.1 ± 1.2% in IMT group. In LSG group, there was resolution of diabetes and hypertension in 36 and 29% of patients respectively while none in the IMT group. HOMA-IR, hsCRP, ghrelin and leptin decreased while adiponectin increased significantly in LSG compared to IMT group. QOL score improved in LSG as compared to IMT. In obese T2DM patients, LSG is superior to IMT in terms of weight loss, resolution of comorbidities and QOL score.

Early Clinical Efficacy of Laparoscopic Sleeve Gastrectomy as a Bariatric Surgery for Obese Patients: A Uni-center Report in China

ObjectiveTo report the experience with laparoscopic sleeve gastrectomy as a bariatric surgery in our center. MethodsTwenty obese patients were followed up for 1 year after receiving laparoscopic sleeve gastrectomy as a bariatric surgery in our center from January 2009 to October 2010, during which their general conditions, complications, and improvement of obesity-related diseases were assessed. ResultsOf the 20 patients, 19 underwent laparoscopic sleeve gastrectomy and 1 underwent open sleeve gastrectomy with no death occurred. The average weight loss was 36.4±10.0 kg, the average BMI decreased from 46.1±11.5 to 33.6±5.6 kg/m2, and the excess weight loss was 55.9%±14.2% one year after the operation. The majority of obesity-related diseases were improved. In one year after the operation, excellent, good, fairly good and poor scores were achieved in 2 (10.0%), 8 (40.0%), 7 (35.0%), and 3 patients (15.0%), respectively. ConclusionLaparoscopic sleeve gastrectomy as a bariatric surgery is a safe and feasible procedure for obesity with excellent short-term effects. More studies with a long-term follow-up are needed to validate its benefits.

Laparoscopic sleeve gastrectomy is safe and efficacious for pretransplant candidates

BackgroundMorbid obesity is a relative contraindication for organ transplant because it is associated with higher postoperative morbidity and mortality. The safety and efficacy of laparoscopic sleeve gastrectomy (LSG) as a weight loss method for patients awaiting transplant has not been examined. MethodsA retrospective review was performed on morbidly obese patients awaiting liver or kidney transplant who underwent LSG from 2006 to 2012. Data included patient demographic characteristics, operative details, 30-day complications, percentage of excess weight loss, postoperative laboratory data, and status of transplant candidacy. ResultsTwenty-six pretransplant patients underwent LSG. The mean age was 57 years, and 17 (65%) were women. Six patients had end-stage renal disease, and 20 patients had end-stage liver disease. The preoperative mean body mass index was 48.3kg/m2 (range 38–60.4kg/m2). There were no deaths, and there were 6 postoperative complications: 2 superficial wound infections, 1 staple line leak, 1 postoperative bleed requiring blood transfusion, 1 transient encephalopathy, and 1 temporary renal insufficiency. The mean percentage of excess weight loss at 1, 3, and 12 months was 17% (n = 24/26), 26% (n = 23/26), and 50% (n = 18/20), respectively. All patients met our institution’s body mass index cutoffs for transplantation by 12 months after the procedure. One patient’s renal function stabilized, and he was taken off the transplant list. Eight patients eventually underwent solid organ transplant. Six received liver transplants, 1 patient received a combined liver and kidney transplant, and 1 received a kidney transplant. The mean time between LSG and transplant was 16.6 months. ConclusionsThis is the largest case series involving LSG in patients awaiting solid organ transplantation. LSG is well tolerated, is technically feasible, and improves candidacy for transplantation.

Laparoscopic Sleeve Gastrectomy (LSG) Is Safe, Well Tolerated and Improves Candidacy in Morbidly Obese Patients Awaiting Liver Transplantation

Introduction: Morbid obesity is a relative contraindication to liver transplantation due to higher risks of perioperative morbidity and worse long-term outcomes. We evaluated the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) as a strategy for achieving long-lasting weight loss and improving transplant candidacy in morbidly obese patients with end stage liver disease (ESLD) awaiting liver transplantation. Methods: We collected data on patients with ESLD who were not eligible for transplantation due to morbid obesity and underwent LSG at our institution between 2006 -2011. Parameters included demographics, operative details, complications, percent excess weight loss (EWL), laboratory data, and transplant candidacy. Results: 20 patients with ESLD (8 NASH, 8 HCV, 2 Alcohol, and 2 autoimmune hepatitis) underwent LSG (Table 1). Mean age was 56 6y, 60% of the cohort was female, and mean follow-up was 2.5 1.7y. Mean preop body mass index (BMI) was 46 5 kg/m2 (range 38-55). There were 5 postop complications: 2 superficial wound infections, 1 staple line leak, 1 with transient encephalopathy, 1 temporary renal insufficiency, but no mortalities. Serum albumin and other nutritional parameters 12 months or later after surgery were similar to preop levels and were stable. Mean EWL was 45% at 12 mos. 19/20 patients reached our institution's BMI limit for transplantation (BMI< 40) within 6 mos of LSG and were activated on the waitlist. They have all maintained stable weight loss for the duration of the follow-up period. One patient was lost to followup. To date, 3 patients have received liver transplants and 1 underwent a combined liver and kidney transplant. All are doing well with stable graft function.Conclusion: This is the largest case series involving pre-transplant candidates and LSG. We demonstrate that LSG in selected patients with ESLD is safe, well tolerated, and improves candidacy for transplantation. Given the poor results achieved with non-surgical methods of weight loss, LSG can be safely integrated into a treatment program for morbidly obese patients with ESLD awaiting transplantation.

Laparoscopic Sleeve Gastrectomy (LSG) Is Safe, Well Tolerated and Improves Candidacy in Morbidly Obese Patients Awaiting Liver Transplantation

Introduction: Morbid obesity is a relative contraindication to liver transplantation due to higher risks of perioperative morbidity and worse long-term outcomes. We evaluated the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) as a strategy for achieving long-lasting weight loss and improving transplant candidacy in morbidly obese patients with end stage liver disease (ESLD) awaiting liver transplantation. Methods: We collected data on patients with ESLD who were not eligible for transplantation due to morbid obesity and underwent LSG at our institution between 2006 -2011. Parameters included demographics, operative details, complications, percent excess weight loss (EWL), laboratory data, and transplant candidacy. Results: 20 patients with ESLD (8 NASH, 8 HCV, 2 Alcohol, and 2 autoimmune hepatitis) underwent LSG (Table 1). Mean age was 56 6y, 60% of the cohort was female, and mean follow-up was 2.5 1.7y. Mean preop body mass index (BMI) was 46 5 kg/m2 (range 38-55). There were 5 postop complications: 2 superficial wound infections, 1 staple line leak, 1 with transient encephalopathy, 1 temporary renal insufficiency, but no mortalities. Serum albumin and other nutritional parameters 12 months or later after surgery were similar to preop levels and were stable. Mean EWL was 45% at 12 mos. 19/20 patients reached our institution's BMI limit for transplantation (BMI< 40) within 6 mos of LSG and were activated on the waitlist. They have all maintained stable weight loss for the duration of the follow-up period. One patient was lost to follow-up. To date, 3 patients have received liver transplants and 1 underwent a combined liver and kidney transplant. All are doing well with stable graft function.Conclusion: This is the largest case series involving pre-transplant candidates and LSG. We demonstrate that LSG in selected patients with ESLD is safe, well tolerated, and improves candidacy for transplantation. Given the poor results achieved with non-surgical methods of weight loss, LSG can be safely integrated into a treatment program for morbidly obese patients with ESLD awaiting transplantation.

Clinical Efficacy of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Gastric Bypass in Obese Type 2 Diabetic Patients: a Retrospective Comparison

Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are performed in patients with obesity and type 2 diabetes mellitus (T2DM). The aim of this study is to evaluate retrospectively the clinical efficacy of RYGB and SG in two groups of obese T2DM patients. From the hospital database, we extracted the clinical records of 31 obese T2DM patients, of whom 15 (7 F/8 M) had undergone laparoscopic SG (LSG) and 16 (7 F/9 M) laparoscopic RYGB (LRYGB) in the period 2005-2008. The groups were comparable for age (range 33-59years) and BMI (range 38-57kg/m(2)). LRYGB alimentary limb was 150cm, and biliopancreatic limb was 150cm from the Treitz ligament. LSG vertical transection was calibrated on a 40-Fr orogastric bougie. Data were analysed at 6, 12 and 18-24months with reference to weight loss and remission of comorbidities. The reduction in body weight was comparable in the two groups. At 18-24months the percent BMI reduction was 29 ± 8 and 33 ± 11% in LSG and LRYGB, respectively. Percent excess weight loss was 53 ± 16 and 52 ± 19% in LSG and LRYGB, respectively. Thirteen patients in LSG and 14 patients in LRYGB discontinued their hypoglycaemic medications. Five (55%) patients in LSG and eight (89%) in LRYGB discontinued antihypertensive drugs. Three out of five patients in LSG and one out of two patients in LRYGB withdrew lipid-lowering agents. LSG and LRYGB are equally effective in terms of weight loss and remission of obesity-related comorbidities. Controlled long-term comparisons are needed to establish the optimal procedure in relation to patients' characteristics.

Safety and Efficacy of Laparoscopic Sleeve Gastrectomy in the Super-obese

Safety and Efficacy of Laparoscopic Sleeve Gastrectomy in the Super-obese

Results of laparoscopic sleeve gastrectomy as a single stage bariatric procedure in Japanese patients

AbstractIntroduction: Laparoscopic sleeve gastrectomy (LSG) is a quick and relatively simple bariatric operation, which thus far has shown good resolution of comorbidities and weight loss. Here we report on the short‐term outcomes of LSG as a single‐stage bariatric procedure in Japanese cases of morbid obesity.Methods: Between June 2008 and January 2010, seven Japanese morbidly obese patients underwent LSG. The data collected included patient demographics, clinical outcomes, changes in ghrelin, and gastric expressions of ghrelin.Results: Late gastric leak occurred in one patient and was treated with an endoscopic mucosal closure after failed attempts to treat percutaneous abdominal drainage. The median postoperative body weight loss at 6 months and 1 year were 41 kg (range, 22–45 kg) and 55 kg (range, 52–58 kg), respectively. The median percentage excess weight loss at 6 months and 1 year were 56% (range, 42%–70%) and 68% (range, 49%–87%), respectively. Resolution or improvement rates of comorbidities in the five patients followed up for more than 6 months were 100% for type 2 diabetes, hypertension, sleep apnea syndrome, and dyslipidemia, and 80% for hyperuremia. Plasma ghrelin levels were very low and were not significantly different postoperatively, and the number of ghrelin‐positive cells assessed by immunochemistry of the gastric fundus was similar to that of the control group.Discussion: For Japanese patients with morbid obesity, LSG may represent an effective weight loss method that can resolve comorbidities in a single‐stage bariatric procedure. Further studies are required to determine the long‐term efficacy of LSG in term of weight loss.

Long-term outcomes of laparoscopic sleeve gastrectomy as a definitive bariatric procedure

Sparse data are currently available on the long-term efficacy of laparoscopic sleeve gastrectomy as a definitive bariatric procedure. The aim of this study was to examine the outcomes from sleeve gastrectomy at prolonged follow-up.