Laparoscopic Sleeve Gastrectomy For Treatment Research Articles

Laparoscopic Sleeve Gastrectomy in Treatment of Morbid Obese child and Adolescent, Single center experience

Laparoscopic Sleeve Gastrectomy in Treatment of Morbid Obese child and Adolescent, Single center experience

Effect of preoperative anxiety level on postoperative pain, analgesic consumption in patients undergoing laparoscopic sleeve gastrectomy: an observational cohort study

BackgraundThis prospective observational cohort study aimed to investigate the relationship between preoperative anxiety levels and postoperative pain and analgesic requirement in patients undergoing laparoscopic sleeve gastrectomy. MethodsForty two female patients with body mass index ≥ 35, who underwent laparoscopic sleeve gastrectomy for treatment of obesity were included in the study. Spielberger's state and trait anxiety scales were used in this study. Demographic data of the patients, anesthetic and analgesic drugs during the surgery, pain levels measured with verbal analog scale at the postoperative 1st, 4th, 12th, and 24th hour, sedation levels measured with the Ramsay sedation scale, and the amount of analgesic consumed were recorded. Anesthesiologist, surgeon, and patient were not informed of the anxiety level results. The relationship between preoperative anxiety and postoperative pain and analgesic consumption was evaluated by Spearman's correlation analysis. Stepwise multiple linear regression analysis was applied. Normal Distribution control was performed by applying the Shapiro-Wilk test to residual values ​​obtained from the final model. ResultsThere was no relationship between trait anxiety level and postoperative pain and analgesic consumption. A correlation was found between state anxiety level and pain level up to 24 hours and analgesic consumption (p < 0.05). According to the obtained model it had been observed that the university graduates consumed more analgesic compared to other education level groups. ConclusionIn this study, a relationship was found between preoperative state anxiety level and 24-hour pain scores and analgesic consumption in patients who underwent laparoscopic sleeve gastrectomy under general anesthesia.

Three ports versus conventional five ports laparoscopic sleeve gastrectomy for treatment of morbid obesity; a retrospective study.

Abstract Aim: To assess and compare the feasibility and efficacy of three-port laparoscopic sleeve gastrectomy (3P LSG) and conventional 5 ports laparoscopic sleeve gastrectomy (5P LSG).Patients and Methods: A prospective comparative randomized clinical trial to compare patients who underwent 3P LSG versus conventional 5P LSG, each group contain 120 patients.Results: The follow-up was 12 months for both groups. Mean operative time was longer in 3P LSG (65.5 ± 10.24 min) vs. (55.9± 5. 2 min) in 5P LSG, (P < 0.000). There were 2 cases of intraoperative bleeding in each group. One case of leak in each group. Wound infection at port site was observed in 1 and 2 trocar sites in 3P LSG and 5P LSG (P = 1.000), respectively. At mean 12 months follow-up, with no lost, excess weight loss percentage (%EWL) was 40.44 ±6.34 in 3P LSG and 41.62±5.74 in 5P LSG ( P= 0.127).Conclusion: Three-port laparoscopic sleeve gastrectomy (3P LSG) is a feasible technique without affecting (%EWL) rates, with acceptable complication rate, but with longer operative time.

Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss at 5 Years Among Patients With Morbid Obesity

Laparoscopic sleeve gastrectomy for treatment of morbid obesity has increased substantially despite the lack of long-term results compared with laparoscopic Roux-en-Y gastric bypass. To determine whether laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass are equivalent for weight loss at 5 years in patients with morbid obesity. The Sleeve vs Bypass (SLEEVEPASS) multicenter, multisurgeon, open-label, randomized clinical equivalence trial was conducted from March 2008 until June 2010 in Finland. The trial enrolled 240 morbidly obese patients aged 18 to 60 years, who were randomly assigned to sleeve gastrectomy or gastric bypass with a 5-year follow-up period (last follow-up, October 14, 2015). Laparoscopic sleeve gastrectomy (n = 121) or laparoscopic Roux-en-Y gastric bypass (n = 119). The primary end point was weight loss evaluated by percentage excess weight loss. Prespecified equivalence margins for the clinical significance of weight loss differences between gastric bypass and sleeve gastrectomy were -9% to +9% excess weight loss. Secondary end points included resolution of comorbidities, improvement of quality of life (QOL), all adverse events (overall morbidity), and mortality. Among 240 patients randomized (mean age, 48 [SD, 9] years; mean baseline body mass index, 45.9, [SD, 6.0]; 69.6% women), 80.4% completed the 5-year follow-up. At baseline, 42.1% had type 2 diabetes, 34.6% dyslipidemia, and 70.8% hypertension. The estimated mean percentage excess weight loss at 5 years was 49% (95% CI, 45%-52%) after sleeve gastrectomy and 57% (95% CI, 53%-61%) after gastric bypass (difference, 8.2 percentage units [95% CI, 3.2%-13.2%], higher in the gastric bypass group) and did not meet criteria for equivalence. Complete or partial remission of type 2 diabetes was seen in 37% (n = 15/41) after sleeve gastrectomy and in 45% (n = 18/40) after gastric bypass (P > .99). Medication for dyslipidemia was discontinued in 47% (n = 14/30) after sleeve gastrectomy and 60% (n = 24/40) after gastric bypass (P = .15) and for hypertension in 29% (n = 20/68) and 51% (n = 37/73) (P = .02), respectively. There was no statistically significant difference in QOL between groups (P = .85) and no treatment-related mortality. At 5 years the overall morbidity rate was 19% (n = 23) for sleeve gastrectomy and 26% (n = 31) for gastric bypass (P = .19). Among patients with morbid obesity, use of laparoscopic sleeve gastrectomy compared with use of laparoscopic Roux-en-Y gastric bypass did not meet criteria for equivalence in terms of percentage excess weight loss at 5 years. Although gastric bypass compared with sleeve gastrectomy was associated with greater percentage excess weight loss at 5 years, the difference was not statistically significant, based on the prespecified equivalence margins. clinicaltrials.gov Identifier: NCT00793143.

Clinical efficacy of the three dimensional laparoscopic sleeve gastrectomy in treatment of obesity combined with type 2 diabetes mellitus

Objective To explore the clinical efficacy of three dimensional (3D) laparoscopic sleeve gastrectomy (LSG) in the treatment of obesity combined with type 2 diabetes mellitus. Methods The retrospective cross-sectional study was conducted. The clinical data of 28 patients with obesity combined with type 2 diabetes mellitus who were admitted to the Qinghai Red Cross Hospital between January 2013 and April 2016 were collected. All the patients underwent 3D LSG. Observation indicators: (1) surgical and postoperative recovery situations; (2) follow-up and metabolic indexes changes. Follow-up using outpatient examination and telephone interview was performed to detect complications of patients after discharge and usages of antidiabetic drugs or insulin up to February 2017. Body mass, body mass index (BMI), hemoglobin (Hb), albumin (Alb), fasting serum C-peptide, fasting blood sugar, 2-hours postprandial blood glucose (2HPBG) and glycosylated hemoglobin (GHb) were detected at month 1, 3, 6 and 12 postoperatively. Measurement data with normal distribution were represented as ±s. Repeated measurement data were analyzed by the repeated measures ANOVA. Count data were evaluated by the proportion. Results (1) Surgical and postoperative recovery situations: 28 patients underwent successful 3D LSG, without conversion to open surgery. Operation time, volume of intraoperative blood loss, time of postoperative gastrointestinal function recovery and time of postoperative drainage tube removal were (133±20)minutes, (45±22)mL, (2.5±1.2)days and (3.4±0.9)days, respectively. There were no postoperative complications and perioperative death. Duration of hospital stay was (7.1±1.5)days. (2) Follow-up and metabolic indexes changes: 28 patients were followed up for 6-12 months, with a median time of 8 months. During the follow-up, there was no death or severe complications. Body mass, BMI, Hb, Alb, fasting serum C-peptide, fasting blood sugar, 2HPBG and GHb from pre-operation to month 1, 3, 6 and 12 post-operatively were decreased from (113±26)kg to (78±14)kg, from (44±6)kg/m2 to (35±5)kg/m2, from (157±19)g/L to (140±13)g/L, from (43±5)g/L to (40±4)g/L, from (2.50±0.37)μg/L to (1.20±0.33)μg/L, from (10.5±2.0)mmol/L to (5.6±0.5)mmol/L, from (16.3±3.1)mmol/L to (7.9±0.9)mmol/L, from 9.2%±0.9% to 6.8%±0.6% with statistically significant differences between preoperative and postoperative indicators (F=396.47, 328.20, 111.10, 21.28, 161.06, 127.80, 243.40, 234.64, P<0.05), and showing a downward trend. Of 28 patients, 25 had complete remission of type 2 diabetes mellitus at 12 months postoperatively and 3 had partial remission, with an effective rate of 100.0%(28/28). The excess weight loss was 63%±16%. Conclusion 3D LSG is safe and effective in the treatment of obesity combined with type 2 diabetes mellitus, with a good short-term outcome. Key words: Obesity; Diabetes mellitus, type 2; Sleeve gastrectomy; Laparoscopy, three dimension

Outcome of Laparoscopic Sleeve Gastrectomy for Treatment Morbidly Obese Patients in Srinagarind Hospital

Background: Laparoscopic sleeve gastrectomy (LSG) has been increasingly popular procedure for treatment morbidly obese patients and showing good weight loss and resolution of comorbidity diseases. The objective of this study was to evaluate postoperative outcome in term of operative complication, weight loss and comorbidity improvement after laparoscopic sleeve gastrectomy. Methods: From July 2011 to December 2014 there is 70 patients (45 woman; 64 percent) with an average age of 37.7 years (range; 17-62 years), mean body weight was 126.5 kg (range; 83-250 kg), mean BMI was 45.7 kg/m2 (range; 33-77 kg/m2) who underwent laparoscopic sleeve gastrectomy for treatment morbid obesity. Postoperative time, 1st day postoperative pain, postoperative complication and postoperative follow up data for the body weight change, percent EWL, BMI and improvement of comorbidity at the 6th, 9th,12th, 18th, and 24th months were recorded. Results: The mean operative time was 75 minutes. The mean operative blood loss was 20 ml. The mean 1st day postoperative pain score was 4. No conversion to laparotomy had to be performed. The mean percentages of excessive body weight loss (EWL) were 46.78 percent at 6 months, 59.75 percent at 1 year, 64.53 percent at 18 months, and 62.92 percent at 2 years. The mean BMI were 35.57 kg/m2 at 6 months, 32.69 kg/m2 at 1 year, 29.23 kg/m2 at 18 months, and 29.45 kg/m2 at 2 years. The rate of resolution of OSA was 65.7 percent and improvement of OSA was 31.4 percent. The rate of resolution of hypertension was 68.9 percent and improvement of hypertension was 31.1 percent. The rate of resolution of DM was 70 percent and improvement of DM was 30 percent. The rate of postoperative complication was 4.2 percent. Conclusions: Laparoscopic sleeve gastrectomy is safe and effective procedure for treatment morbidly obese patients. However, weight regained need to evaluated in long term follow up.

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

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.

Efficacy analysis of laparoscopic sleeve gastrectomy in treatment of obesity with type 2 diabetes mellitus

To investigate the efficacy and safety of laparoscopic sleeve gastrectomy(LSG) for the treatment of obesity with type 2 diabetes mellitus(T2DM). Clinical data of 32 obesity patients with T2DM patients undergoing LSG from May 2010 to February 2012 in our department were retrospectively analyzed. Their body weight indexes (body weight, waist circumference, BMI, EWL), blood glucose indexes [glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), insulin resistance index (HOMA-IR)], and blood lipid indexes [total cholesterol, triglyceride, low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C)] were measured 1, 3, 6, 12 months after operation and compared with preoperative levels. Improvement in complications was observed. All the patients completed operation under laparoscopy except 1 case because of abdominal cavity adhesion. The average operative time was (115.0±19.6) min, and the average blood loss (69.0±29.7) ml. No operative death, anastomotic leakage, or surgical site infection were found. The body weight, waist circumference and BMI at 1, 3, 6, and 12 months after surgery were significantly lower(all P<0.05) showing a decreasing trend over time. EWL showed significant increasing trend (P<0.05). During 12 months of follow-up, no over-low weight was observed. From 1 month after surgery, HbA1c, FPG and HOMA-IR decreased significantly (P<0.05). HbA1c and FPG maintained stable level at 12 and 6 months after operation respectively. FPG of 28 patients returned to normal 3 months after operation. Clinical complete remission rate of T2DM was 87.5%(28/32), and clinical partial remission rate was 12.5%(4/32) at the 12-month follow-up. Serum total cholesterol, triglyceride and LDL-C decreased obviously after surgery(P<0.05). LSG procedure is a safe and effective surgical method in treatment of obesity with T2DM.

Severe and Morbid Obesity in Crohn's Disease Patients: Prevalence and Disease Associations

Background: Crohn's disease (CD) is frequently associated with weight loss and malnutrition. However, as the prevalence of obesity increases worldwide, it may become a clinical problem even in CD. Aim: To assess the prevalence of severe/morbid obesity in CD patients and to compare their disease characteristics to nonobese CD patients. Methods: A retrospective analysis of a computerized CD patient database was performed to identify severely/morbidly obese patients (BMI >35). Prevalence was compared to data of the general population. Severely/morbidly obese CD patients were then compared to randomly selected nonobese CD patients (BMI <30) in a 1:3 ratio. Results: Thirteen severely/morbidly obese patients out of 560 CD patients were found (2.3%), which is significantly lower than the prevalence in the general population (5.6%, p = 0.001). When compared to 39 nonobese CD patients, colonic disease was significantly more common among severely/morbidly obese CD patients (odds ratio: 6, 95% CI: 1.35-26.3, p = 0.02), while there was no difference in other disease parameters. Interestingly, 4 morbidly obese CD patients had undergone laparoscopic sleeve gastrectomy for treatment of morbid obesity with a favorable surgical course. Conclusion: CD in severely/morbidly obese patients is more often colonic, but otherwise no different than CD in nonobese patients. Sleeve gastrectomy is a viable therapeutic option for morbidly obese CD patients.