Laparoscopic Sleeve Gastrectomy Patients Research Articles

Laparoscopic Sleeve Gastrectomy Smart Trocar Site Modification in Patients with Extreme Obesity.

Laparoscopic sleeve gastrectomy (LSG) is one of the most common bariatric surgeries performed worldwide. Although it has established itself as a satisfactory procedure on its own, it can also function as the first part of a two-stage treatment strategy. This is especially true in situations of extreme obesity (obesity grade IV or higher). One rationale for choosing a two-stage treatment is the technical difficulty of doing other types of bariatric procedures involving anastomoses due to body physique and level of visceral adiposity. LSG in patients with such a high body mass index (BMI) is comparatively simpler technically, but it does also have a degree of complexity for similar reasons. Here, we present an innovative port configuration for LSG that can significantly reduce ergonomic challenges and enhance the safety of the procedure in patients with extreme obesity. This new trocar site arrangement is generally suitable for individuals with grade IV obesity or above. It is especially effective for people with obesity at or above grade V. Only standard laparoscopic instruments are used. This design preserves the ideal manipulation and elevation angles at 60° and allows surgeons to use standard laparoscopic instruments with lowered shoulders, reducing muscular strain and fatigue. Additionally, it improves patient safety. In patients with extreme obesity, this proposed port configuration for LSG can significantly reduce ergonomic difficulties and increase surgical safety.

Short-Term Changes in Weight, Body Composition, and Metabolic Biomarkers After Laparoscopic Sleeve Gastrectomy in Patients with Obesity: A Comparative Prospective Study.

To investigate the changes in weight, body composition, and metabolic biomarkers in patients with obesity after laparoscopic sleeve gastrectomy (LSG) and compare those changes between patients with and without metabolic syndrome (MS). This retrospective longitudinal study included 76 patients who underwent LSG, among whom 32 had complete 1-year postoperative body composition and metabolic biomarkers. Body composition was measured by quantitative CT. Weight changes were compared between the MS and non-MS groups at 1-, 3-, 6-, and 12-month post-LSG in all patients; changes in body compositions and metabolic biomarkers from one day pre-LSG to 12-month post-LSG were also compared in those 32 patients. MS occurred in 46% (35/76) of all patients and 44% (14/32) of patients with complete follow-up data. Excess weight loss was lower in the MS group than that in the non-MS group at 1-, 3-, 6-, and 12-month post-LSG; the 12-month difference was significant (MS vs. non-MS: 0.91 ± 0.22 vs. 1.07 ± 0.42, P = 0.04). The greatest rate of visceral fat area (VFA) change occurred 12-month post-LSG in both the non-MS [0.62(0.55,0.7)] and MS [0.6(0.51,0.63)] groups. The most significant reduction in ectopic fat occurred in liver fat (LF) [non-MS, 0.45(0.22,0.58); MS, 0.39(0.23,0.58)]. LGS significantly improves weight, body composition, and metabolic biomarkers in populations with obesity, regardless of whether they have MS. Among the body composition, VFA and LF were the most significantly improved body composition measurements.

Prevention of the stapler line leak after laparoscopic sleeve gastrectomy in patients with morbid obesity

Obesity has become a global pandemic, leading to increased morbidity and mortality among patients, both young and old. Bariatric surgery is the most effective method for treating pathological obesity. Laparoscopic sleeve gastrectomy has become the most popular bariatric procedure worldwide. However, staple line leak is the most dreaded postoperative complication following laparoscopic sleeve gastrectomy. In order to reduce the incidence of this complication, most surgeons prefer to reinforce the staple line. However, there is no compelling evidence to suggest that peritonealization of the staple line or the use of coated stapler cartridges during laparoscopic sleeve gastrectomy reduces the risk of leakage. Therefore, we conducted a retrospective analysis to assess the impact of coated stapler cartridges on preventing staple line leaks. The aim of the study. To evaluate the effect of using stapler with coating on preventing staple line leaks during laparoscopic sleeve gastrectomy in patients with morbid obesity. Materials and methods. This was a retrospective analysis of 45 patients who underwent laparoscopic sleeve gastrectomy using endostapler from Medtronic (Endo GIA™) without additional reinforcement (Group I) and 46 patients who underwent a similar procedure using endostapler from Medtronic (Endo GIA™) stapler with coating (Group II). Both patient groups were homogeneous in terms of demographic characteristics. We compared the duration of surgery, intraoperative blood loss, length of hospital stay, and the incidence of staple line leak. Results. The incidence of staple line leak was statistically significantly higher in Group I compared to Group II (5/40 vs. 0/46; χ2 = 5.4, p = 0.021). This resulted in a statistically significant increase in blood loss (U = 706; p = 0.006), prolonged total operation time (U = 310; p = 0.001), and extended postoperative hospital stay (U = 245; p = 0.001) in Group I. The median time to healing of the leak was 32 [20; 59] days. No patient died. Conclusions. Using the endostapler with purple cartridges with coating from Medtronic during laparoscopic sleeve gastrectomy significantly reduced postoperative leak rate and significantly decreased postoperative hospital stay.

Impact on carotid intima-media thickness after laparoscopic sleeve gastrectomy in patients with morbid obesity.

We aimed to investigate the impact of laparoscopic sleeve gastrectomy (LSG) on carotid intima-media thickness (CIMT) & left ventricular dysfunction (LVD) which are the independent predictors of subclinical atherosclerosis. To assess the change in CIMT & echocardiographic parameters of left ventricular function & correlate with %EWL 6months and 12months after LSG, the mean CIMT of bilateral common carotid arteries were measured at 3 different places & 7 parameters were assessed for left ventricular dysfunction after 6 and 12months of LSG & correlated with the %EWL. A total of 30 patients (27(90%) women & 3(10%) men) with the mean age of 38 ± 7.84 were prospectively enrolled. BMI was significantly reduced from 42.66 ± 3.79 to 37.93 ± 3.60kg/m2 at six months to 36 ± 3.34 at 12months after LSG. CIMT values were significantly decreased at 6months after surgery from 0.50 ± 0.11mm to 0.46 ± 0.09mm (p < 0.01) to 0.39 ± 0.07 (p < 0.05) at 12months. However, no significant change was observed in the right mean CCA values at 6months after surgery 0.50 ± 0.11mm vs 0.47 ± 0.09mm (p = 0.07) as compared to decrease at 12months after surgery to 0.40 ± 0.08 (p < 0.05). Left mean CCA values at 6months changed from 0.50 ± 0.11 to 0.45 ± 0.09 (p < 0.01) and at 12months after surgery to 0.39 ± 007(p < 0.05). On 2D ECHO, ejection fraction increased at 6months from 60.80 ± 5.89 to 61.93 ± 4.47 (p < 0.5) to after 12months at 64.30 ± 4.20 (p < 0.05). Wave deceleration time changed at 6months from 170 ± 36.80 to 150 ± 28.82 (p < 0.05) to 12months 139.07 ± 17.98 (p < 0.05). Peak early diastolic mitral annular velocity (e) changed at 6months from 8.12 ± 1.66 to 7.02 ± 1.76 (p < 0.05) to 12months 6.33 ± 0.76 (p < 0.05). Inter-ventricular septum thickness (IVSD) changed at 6months from 0.99 ± 0.14 to 0.91 ± 0.14 (p < 0.05) to 12months 0.82 ± 0.09 (p < 0.05). Intraventricular relaxation time (IVRT) at 6months changed from 94.33 ± 21.71 to 84.36 ± 14.85 (p < 0.03) to 12months after surgery 77.40 ± 10.19 (p < 0.05). Left atrial volume index (LAVI) at 6months decreased from 38.08 ± 11.23 to 30.93 ± 7.16 (p < 0.01) to 12months after surgery 25.43 ± 3.65 (p < 0.05). Left ventricular diastolic dysfunction [LVIDD] at 6months changed from 4.32 ± 0.52 to 4.11 ± 0.52 (p < 0.02) to 3.94 ± 0.26 (p < 0.05) to 3.94 ± 0.26 (p < 0.05) at 12months after surgery. PwD at 6 and 12months changed from 1.00 ± 0.19 to 0.87 ± 0.10 (p < 0.01) to 0.82 ± 0.08 (p < 0.05) respectively. LV mass changed in 6months from 148.37 ± 33.09 to 117 ± 29.90 (p < 0.001) to 12months at 110.64 ± 20.79 (p < 0.05) and left ventricular mass index [LVMI] changed in 6months from 70 ± 16.89 to 59.626 ± 15.35 (p < 0.001) reaching a value of 57.53 ± 11.18 (p < 0.05) at 12months. The mean 10-year risk of death due to CVD calculated was significantly reduced from 5.45 ± 6.6 to 2.8 ± 1.7% at 6months (p < 0.05). This significant decrease in CVD risk has a positive correlation with the decrease in CIMT over 6months showing a correlation coefficient of 0.018 with statistically significant analysis (p value < 0.05). We observed a significant reduction in CIMT & improvement in 2D ECHO parameters at 6 after LSG although no statistically significant change was observed in mean right CIMT & EF at 6months.

Ramadan fasting following laparoscopic sleeve gastrectomy: a prospective online survey cohort study in Egypt.

This study aims to explore the feasibility and implications of Ramadan fasting for patients who have undergone laparoscopic sleeve gastrectomy (LSG), assessing impacts on hydration, nutrient intake, weight management, and gastrointestinal symptoms. A prospective online survey was conducted among 218 LSG patients and 83 control individuals with obesity who had not undergone surgery. Participants were surveyed before and after Ramadan, providing data on fasting practices, hunger and satiety levels, fluid and nutrient intake, and the occurrence of gastrointestinal symptoms. Statistical analysis was used to compare outcomes between fasting and non-fasting periods and between LSG patients and control participants. A total of 70.2% of LSG patients completed the entire month of Ramadan fasting, with a significant correlation found between the duration post-surgery and the ability to fast. Fasting LSG patients reported decreased hunger, increased satiety, and significant reductions in fluid and nutrient intake during Ramadan. Weight loss was reported in 90.8% of fasting patients, with an average total weight loss of 7.2%. Gastrointestinal symptoms were mild and manageable. The majority of LSG patients can successfully fast during Ramadan with appropriate precautions, including adequate fluid and protein intake. The study highlights the need for patient education and tailored nutritional guidance to ensure safe and effective fasting post-LSG. In order to fast for the entire month, patients may be advised to consider postponing surgery for a few months after Ramadan, avoid overeating during non-fasting hours, and ensure sufficient fluid consumption and protein intake during fasting.

LSG vs OAGB: 7-Year Follow-up Data of a Randomised Control Trial and Comparative Outcome Based on BAROS Score.

This study aims to evaluate and compare long-term results of laparoscopic sleeve gastrectomy (LSG) and one anastomosis gastric bypass (OAGB) based on bariatric analysis reporting and outcome system (BAROS) score. Patients operated for morbid obesity between 2013 and 2015 were randomised to LSG and OAGB groups. Based on inclusion and exclusion criteria, 201 patients (100 LSG and 101 OAGB) were analysed for changes in total body weight (TBW), body mass index (BMI), percent excess weight loss (%EWL), percent total weight loss (%TWL), QoL (quality of life) scores, comorbidity resolution and outcome based on BAROS at 7years. Sixty-six LSG and 64 OAGB patients were followed up at 7years. Mean pre-operative TBW and BMI were 119 ± 28.2 and 44.87 ± 7.71 for LSG group and 113.25 ± 23.74 and 44.71 ± 8.75 for OAGB group respectively. At 7years after surgery, there was significant drop in mean TBW and BMI in both groups. Mean %EWL for LSG and OAGB patients was 50.78 ± 28.48 and 59.99 ± 23.32 and mean %TWL for LSG and OAGB patients was 23.22 ± 12.66 and 27.71 ± 12.27 respectively. Mean QoL scores at 7years were significantly higher than the pre-operative scores and most of the patients in both groups had remission or improvement in their comorbidities. 68.76% OAGB patients had very good or excellent outcome on BAROS score while only 36.37% LSG patients had similar outcome. LSG and OAGB are successful bariatric procedures over the long term. OAGB outperforms LSG and has significantly higher %EWL and %TWL over the long term.

Rationale and Trial Protocol for a Double-Blinded Randomized Controlled Trial to assess the Impact of a Concomitant Crural Repair during Laparoscopic Sleeve Gastrectomy in Patients with a Lax Gastroesophageal Junction without Frank Hiatal Hernia (REPAIR trial protocol).

Laparoscopic sleeve gastrectomy (LSG) is associated with postoperative gastroesophageal reflux disease (GERD) and erosive esophagitis (EE). The role of crural repair during LSG is still controversial. The preoperative laxity of the gastroesophageal junction (GEJ), graded by the Hill's classification, is more predictive for postoperative GERD and EE after LSG than the presence of a hiatal hernia seen on endoscopy. Thus, the authors hypothesize that a concomitant crural repair in a specific subgroup of patients with a lax GEJ (Hill's III) may reduce the incidence of postoperative GERD and EE. A double-blinded, randomized controlled trial of patients with Hill's III GEJ undergoing LSG will be randomized to a concomitant crural repair (experimental) versus LSG alone (control). Primary outcome measures will be presence of EE at 1-year. Secondary outcome measures will include proton pump inhibitor use, postoperative complications, operative time, blood loss, quality of life, GERD and gastrointestinal symptoms. Conflicting crural repair results may be explained by differences in preoperative GEJ laxity. Patients with a frank hiatal hernia and patulous GEJ (Hill's IV) have a very high, while patients with an apposed GEJ (Hill's I, Hill's II) have a low incidence of postoperative GERD and EE respectively. Thus, the authors hypothesize that patients with a lax GEJ without frank hiatal hernia (Hill's III), might benefit from a crural repair. This study results can potentially highlight the clinical importance of preoperative endoscopic evaluation of the GEJ in all patients planned for LSG, to determine which subgroup patients may benefit from a crural repair. (Clinicaltrials.gov: NCT05330910, Registered 15-April-2022).

A Simple Way to Estimate a Difficult Sleeve Gastrectomy Prior to Operating

  BackgroundToday, bariatric procedures are common. These surgeries’ difficulties are classified as patient- or surgical team–related and are estimated by body mass index (BMI). More efficient methods are needed to help surgeons. This study evaluated the effect of measuring patients’ subcutaneous fat tissue thickness (SFT) and umbilicus-xiphoid (DXU) to anticipate surgical difficulties.Material and MethodsThis was a prospective retrospective data analysis study. Laparoscopic sleeve gastrectomy patients seen between May and October 2022 were included in the analysis and divided into three groups, according to a surgeon’s assessment. All patients’ SFT, DXU, rectus muscle thickness, total fat tissue amount (TFT), and operational time were recorded prospectively and analyzed.ResultsIn all, 151 patients were included in the study; of these, 124 (82.1%) were women and 27 (17.9%) were men. Their mean BMI value was 41.1 ± 6.2. Based on expert’s opinion, we classified three groups: easy (n = 123, 81.5%), intermediate (n = 22, 14.6%), or difficult (n = 6, 4%). When the easy group was compared to the intermediate/difficult groups, we found that intermediate/difficult groups’ SFT values were statistically significantly higher than the easy group (p = 0.000). Also, the intermediate/difficult group’s TFT value was statistically significantly higher than the easy group (p = 0.000). We found no statistically significant differences between groups’ DXU and rectus muscle thickness.ConclusionThis is the first study to anticipate sleeve gastrectomy difficulty using SFT and TFT. This is an easy technique to apply and no additional costs. Anticipating difficulties based on these criteria can ensure necessary preparations are made and help avoid complications.Graphical

Once-weekly semaglutide administered after laparoscopic sleeve gastrectomy: Effects on body weight, glycemic control, and measured nutritional metrics in Japanese patients having both obesity and type 2 diabetes

BackgroundGlucagon-like peptide (GLP)-1 analogue may be useful for controlling weight recurrence and diabetes relapse after bariatric surgery, but may also adversely affect the measured nutritional metrics. This study aimed to investigate the effect of treatment with once-weekly semaglutide after laparoscopic sleeve gastrectomy (LSG) in patients with type 2 diabetes (T2D). We also examined the effects of combined use with a low-energy, high-protein formula diet (FD). MethodsThis study was a single-center retrospective database analysis. We enrolled 29 Japanese patients with T2D who underwent LSG, and more than 12 months later received semaglutide. The patients were divided retrospectively into a FD group (=6) and a conventional diet (CD) group (n = 23). ResultsBMI and HbA1c decreased significantly by 10.7 kg/m2 and 1.1 %, respectively, 12 months after LSG, and decreased by an additional 1.6 kg/m2 and 0.6 % after 12-months of treatment with semaglutide. Decreases in serum albumin, vitamin B12 and zinc were observed only after semaglutide administration. A ratio of energy from protein, fat and carbohydrates changed from 13:31:56 before to 19:30:50 after LSG, and from 17:32:51 before to 15:29:56 after semaglutide. Skeletal muscle ratio, which is the ratio of skeletal muscle mass to body weight, increased after LSG, but did not change after semaglutide. FD group showed a significant increase in skeletal muscle mass per 1 % body weight compared to CD group during semaglutide treatment. ConclusionSemaglutide after LSG in patients with obesity and T2D resulted in additional weight reduction and improved glycemic control, but worsened measured nutritional metrics. Administration of a low-energy, high protein formula diet may ameliorate adverse nutritional effects of semaglutide in patients with T2D after LSG. (Ethics Committee of Toho University Sakura Medical Center approval number S18061)

Intra-operative Tranexamic Acid Administration Significantly Decreases Incidence of Postoperative Bleeding Without Increasing Venous Thromboembolism Risk After Laparoscopic Sleeve Gastrectomy: a Retrospective Cohort Study of Over 400 Patients.

There is evidence that tranexamic acid (TXA) reduces surgical bleeding and is widely used in trauma, obstetrics and other specialties. This practice is less well-established in laparoscopic sleeve gastrectomy (LSG) due to concerns surrounding venous thromboembolism (VTE); equally postoperative bleeding is a serious complication often requiring re-operation. This retrospective cohort study compared 30-day outcomes following primary LSG in patients receiving intra-operative TXA (March 2020-July 2022) to those who did not (March 2011-March 2020). The primary outcome was postoperative bleeding (Hb < 9g/dL) requiring transfusion or re-operation. Secondary outcomes were incidence of VTE, serious postoperative complications (Clavien-Dindo > grade 3) and death. Patients underwent standardised-protocol LSG without staple line re-enforcement under a single surgeon within the independent sector (private practice). TXA 1g intravenous was administered immediately after a methylene blue leak test, prior to extubation. TXA group had 226 patients and non-TXA group had 192 patients. Mean age was 40.5 ± 10.3 and 39.1 ± 9.8years, respectively. In the TXA group, no postoperative bleeds [versus 3 (1.6%) in non-TXA group, p = 0.0279] occurred. One staple line leak (0.4%) occurred in the TXA group compared to zero in the non-TXA group (p = ns). There was no VTE or death. This is the largest cohort study of intra-operative TXA in primary LSG to date, which demonstrates significant decrease in postoperative bleeding without increasing VTE risk. The authors recommend administration of TXA immediately following leak test, or removal of bougie to maximise efficacy. Data of TXA in LSG is awaited from the randomised controlled PATAS trial.

Analysis of Changes in Glucose and Lipid Metabolism in Patients with Clinically Severe Obesity and Type 2 Diabetes Mellitus Undergoing Laparoscopic Sleeve Gastrectomy—Prospective Observational Study

IntroductionWe still lack studies providing analysis of changes in glucose and lipid metabolism after laparoscopic sleeve gastrectomy (LSG) in patients with type 2 diabetes mellitus (DM2). We aimed to investigate postoperative changes in glucose and lipid metabolism after LSG in patients with DM2.Material and MethodsProspective, observational study included patients with BMI ≥ 35 kg/m2 and ≤ 50 kg/m2, DM2 < 10 years of duration, who were qualified for LSG. Perioperative 14-day continuous glucose monitoring (CGM) began after preoperative clinical assessment and OGTT, then reassessment 1 and 12 months after LSG. Thirty-three patients in mean age of 45 ± 10 years were included in study (23 females).ResultsEBMIL before LSG was 17 ± 11.7%, after 1 month—36.3 ± 12.8%, while after 12 months—66.1 ± 21.7%. Fifty-two percent of the patients had DM2 remission after 12 months. None required then insulin therapy. 16/33 patients initially on oral antidiabetics still required them after 12 months. Significant decrease in HbA1C was observed: 5.96 ± 0.73%; 5.71 ± 0.80; 5.54 ± 0.52%. Same with HOMA-IR: 5.34 ± 2.84; 4.62 ± 3.78; 3.20 ± 1.99. In OGTT, lower increase in blood glucose with lesser insulin concentrations needed to recover glucose homeostasis was observed during follow-ups. Overtime perioperative average glucose concentration in CGM of 5.03 ± 1.09 mmol/L significantly differed after 12 months, 4.60 ± 0.53 (p = 0.042). Significantly higher percentage of glucose concentrations above targeted compartment (3.9–6.7 mmol/L) was observed in perioperative period (7% ± 4%), than in follow-up (4 ± 6% and 2 ± 1%). HDL significantly rose, while triglyceride levels significantly decreased.ConclusionsSignificant improvement in glucose and lipid metabolism was observed 12 months after LSG and changes began 1 month after procedure.Graphical

Sleeve gastrectomy versus endoscopic intragastric balloon in decreasing weight and associated comorbidities in Erbil city: A comparative study

Background: Surgical obesity treatment is difficult for both surgeons and patients. The three main categories of bariatric surgery procedures are malabsorptive, restrictive, or both in combination. Intragastric balloon (IB) is an easily applicable restrictive interventional and nonsurgical strategy for obese patients, and the surgical procedure known as laparoscopic sleeve gastrectomy (LSG) is frequently used to help obese patients decrease weight.&#x0D; Objective: To assess and compare these two restrictive approaches.&#x0D; Patients and Methods: A prospective study of 138 LSG patients was conducted, (n=82) and IB (n=56) between 1st January 2016 to 31st December 2021 in private hospitals in Erbil, Iraq. The study retrospectively evaluates patients' demographic information, changes in total body weight (TBW), changes in body mass index (BMI), and percentage of excess weight loss (%EWL), morbidities and change of comorbidities during a year of follow-up, at months 1, 3, 6, and 12 after surgery. Comparative analysis was undertaken for the follow-up results after 6 and 12 months.&#x0D; Results: In the IB group, 12 patients did not tolerate insertion, leaving 56; in the LSG group, 82 patients completed treatment. In terms of age (p=0.121), gender (p=0.242), and BMI (p=0.078), there were no statistical differences between the IB and LSG groups. The LSG group achieved statistically significant superior treatment outcomes in terms of changes in TBW, BMI, and %EWL.&#x0D; Conclusion: Both LSG and IB are beneficial in the short term for helping obese patients lose weight. IB has the benefit of being performed as an outpatient procedure with less complications, but it is less successful in helping people lose weight than LSG. The best options for various patient groups in terms of clinical outcomes and health system effectiveness must be determined through prospective, randomized control studies.&#x0D;  

Sleeve gastrectomy versus endoscopic intragastric balloon in decreasing weight and associated comorbidities in Erbil city: A comparative study

Background: Surgical obesity treatment is difficult for both surgeons and patients. The three main categories of bariatric surgery procedures are malabsorptive, restrictive, or both in combination. Intragastric balloon (IB) is an easily applicable restrictive interventional and nonsurgical strategy for obese patients, and the surgical procedure known as laparoscopic sleeve gastrectomy (LSG) is frequently used to help obese patients decrease weight. Objective: To assess and compare these two restrictive approaches. Patients and Methods: A prospective study of 138 LSG patients was conducted, (n=82) and IB (n=56) between 1st January 2016 to 31st December 2021 in private hospitals in Erbil, Iraq. The study retrospectively evaluates patients' demographic information, changes in total body weight (TBW), changes in body mass index (BMI), and percentage of excess weight loss (%EWL), morbidities and change of comorbidities during a year of follow-up, at months 1, 3, 6, and 12 after surgery. Comparative analysis was undertaken for the follow-up results after 6 and 12 months. Results: In the IB group, 12 patients did not tolerate insertion, leaving 56; in the LSG group, 82 patients completed treatment. In terms of age (p=0.121), gender (p=0.242), and BMI (p=0.078), there were no statistical differences between the IB and LSG groups. The LSG group achieved statistically significant superior treatment outcomes in terms of changes in TBW, BMI, and %EWL. Conclusion: Both LSG and IB are beneficial in the short term for helping obese patients lose weight. IB has the benefit of being performed as an outpatient procedure with less complications, but it is less successful in helping people lose weight than LSG. The best options for various patient groups in terms of clinical outcomes and health system effectiveness must be determined through prospective, randomized control studies.

Comparative analysis of different methods of retraction of the left lobe of the liver during laparoscopic sleeve gastrectomy

The global obesity epidemic has led to the increasing popularity of bariatric surgeries. Laparoscopic sleeve gastrectomy is currently the most popular bariatric procedure for obesity. Retracting of the left liver lobe during laparoscopic sleeve gastrectomy is important for achieving an optimal surgical field.&#x0D; Aim. The aim of our study was to evaluate the results of using different methods of retraction of the left liver lobe during laparoscopic sleeve gastrectomy in patients with morbid obesity.&#x0D; Materials and methods. The 86 patients who underwent laparoscopic sleeve gastrectomy were divided into three groups based on the liver retraction method used: group 1 (ENDO RETRACT™ II), group 2 (Nathanson) and group 3 (Clickline Surgical Sponge Holder). All groups were evaluated in terms of demographic characteristics; liver function tests just before surgery and on the 1st and 2nd postoperative day (POD); developing complications and length of hospital stay.&#x0D; Results. The groups did not differ significantly in terms of demographic characteristics (p &gt; 0.05). The Nathanson liver retractor (group 2) caused a significant rise in ALT and AST at POD 1 and POD 2 compared with group 1 and 3 (p &lt; 0.05). The ENDO RETRACT™ II liver retractor (group 1) caused a higher incidence of liver injury than other groups. It led to statistical significance prolonged total operation time (p = 0.003), increased blood loss (p = 0.002) and prolonged postoperative hospital stay (p = 0.001) compared with other groups.&#x0D; Conclusions. The technique of left lobe retraction during laparoscopic sleeve gastrectomy using Clickline Sur- gical Sponge Holder is safe and effective. The use of this technique causes significantly less measurable liver damage and does not lead to an increase in the level of liver enzymes.

Effect of Ultrasound-guided Erector Spinae Plane Block on Recovery After Laparoscopic Sleeve Gastrectomy in Patients With Obesity: A Randomized Controlled Trial

Previous research has not evaluated the potential effect of erector spinae plane block (ESPB) on quality of recovery (QoR) after laparoscopic sleeve gastrectomy. Therefore, we investigated the effect of an ultrasound-guided ESPB performed on patients with obesity who have undergone laparoscopic sleeve gastrectomy, measured using the 15-item QoR (QoR-15) scale. A total of 172 patients were enrolled in the study who were aged 18 to 65 years, had a body mass index ≥30 kg/m², were classified as having American Society of Anaesthesiologists physical status Ⅱ to Ⅲ, and had undergone laparoscopic sleeve gastrectomy. The patients were randomly divided into an ESPB group and a sham group (treated with normal saline). The primary outcome was the QoR-15 score, measured using the questionnaire 24 and 48 hours after surgery. The secondary outcomes were postoperative pain score, postoperative cumulative analgesic drug consumption, number of patient-controlled analgesia (PCA) requests, rate of rescue analgesia required at 48 hours, incidence of respiratory complications, and nerve block-related complications. The time of discharge from the postanesthesia care unit, postoperative activity, and length of stay at the hospital were also recorded. There was no significant difference in the global QoR-15 scores 24 and 48 hours after the operation. However, the groups' subdimension scores for the emotional state in QoR-15 at 24 and 48 hours after surgery were statistically different (P < 0.05). Meanwhile, patients in the ESPB group who indicated they were "feeling rested" at 24 and 48 hours after surgery and "having a feeling of general well-being" at 24 hours after surgery were significantly better than those in the sham group (P < 0.05). Compared with the sham group, participants in the ESPB group had lower resting pain scores at 6 and 12 hours after surgery and lower movement pain scores at 6, 12, 24, and 36 hours after surgery (P < 0.05). There was no statistical difference between the groups in postoperative cumulative analgesic drug consumption, number of PCA requests, incidence of respiratory complications, time of discharge from the postanesthesia care unit, or postoperative activity. Our results indicate that a single ESPB does not improve the global QoR-15 scores after laparoscopic sleeve gastrectomy. However, the visual analog scale score for postoperative pain is reduced.

Association between disordered eating and clinical outcomes following a surgical or endoscopic bariatric procedure: A real‐world exploratory study

AbstractProblemDisordered eating, such as binge, graze, and emotional eating, has been strongly linked to weight gain. Improved understanding of disordered eating by adults who elect bariatric weight loss procedures in a real‐world setting is required.PurposeTo determine the association between the number and type of disordered eating patterns (DEPs), as described by healthcare professionals during routine care without standardized assessment, with clinical outcomes in adults who elected a bariatric weight loss procedure.MethodAn observational cohort study recruited laparoscopic sleeve gastrectomy (LSG) and endoscopic sleeve gastroplasty (ESG) patients. DEPs documented in the medical record during routine care were observed and tested for association with events (symptoms, side‐effects, or adverse events), micronutrient deficiencies, weight loss, and attrition. Data were observed up to 12‐month post‐procedure.Results215 LSG and 32 ESG patients were recruited. The mean number of DEPs was 6.4 (SD: 2.1) and 6.4 (SD: 2.1) in the LSG and ESG cohorts, respectively. Night eating was associated with a higher number of events (p &lt; 0.008) in the LSG cohort, and non‐hungry eating was associated with a higher number of events in the ESG cohort (p &lt; 0.001). ESG patients who had a surgical or medical event by 6‐months post‐procedure had mean 1.78 (95%CI: 0.67, 2.89) more DEPs (p = 0.004). DEPs were not associated with weight loss, micronutrient deficiencies, nor attrition.ConclusionThe treating healthcare team believed the LSG and ESG patients experienced a wide variety and high frequency of DEPs requiring multidisciplinary support. Non‐hungry eating and night eating were associated with poorer outcomes following an LSG or ESG.Trial registrationThe study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000332729).

A nomogram model based on the combination of the systemic immune-inflammation index and prognostic nutritional index predicts weight regain after laparoscopic sleeve gastrectomy.

The high rate of weight regain after laparoscopic sleeve gastrectomy is a great challenge. The systemic immune-inflammation index (SII; calculated by neutrophils, lymphocytes, and platelets) and prognostic nutritional index (PNI; calculated by albumin and lymphocytes) are widely used as prognostic factors in various diseases. The objective of this study was to investigate independent the independent risk factors associated with weight regain in patients after laparoscopic sleeve gastrectomy. A single-center retrospective study. Weight regain was defined as the percentage of increase in body weight ≥10% in comparison with the nadir weight postoperatively. Eligible patients admitted to the bariatric center of our hospital were consecutively enrolled and grouped according to the occurrence of weight regain within 5 postoperative years. Univariate and multivariate logistic regression analyses were performed to assess potential risk factors. A nomogram model containing the risk factors was then constructed and evaluated by R. A total of 217 patients were enrolled, and 87 (40.1%) patients experienced weight regain. Univariate and logistic regression analyses indicated that depression (odds ratio [OR]: 2.51, 95% confidence interval [CI]: 1.20-5.22, P = .015), psychological counseling (OR: 2.27, 95% CI: 1.20-4.33, P = .017), preoperative C-reactive protein (OR: 2.20, 95% CI: 1.18-4.13, P = .012), and combination of SII-PNI scores (OR: .45, 95% CI: .31-.67, P < .001) were 4 independent risk factors for postoperative weight regain in laparoscopic sleeve gastrectomy patients. The area under the curve of the constructed nomogram model for predicting weight regain was .706. This study concluded that the combination of the SII-PNI was an independent risk factor for weight regain and that the nomogram model based on the combination of the SII-PNI had a good predictive value.

Ligamentum Teres Cardiopexy Might Not Prevent Gastro-esophageal Reflux After Laparoscopic Sleeve Gastrectomy: Case Series.

Roux-en-Y gastric bypass (RYGB) is considered the gold standard procedure in patients with obesity and gastroesophageal reflux (GERD), but in patients with preoperative hiatal hernia (HH) or GERD, who are unfit for RYGB, there are no clear guidelines. Ligamentum teres cardiopexy (LTC) has been proposed as an effective alternative. The purpose of this study was to analyze medium-term results of LTC procedure associated with laparoscopic sleeve gastrectomy (LSG) in patients with GERD or HH, according to the absence of pathologic acid reflux in esophageal 24 h pH monitoring test, symptom release, or PPI reduction. Five patients underwent LSG-LTC between March 2018 and October 2019. In one patient, the effectiveness of LTC as an anti-reflux procedure could not be assessed because of conversion to RYGB was required. After a follow-up period of 30 [24-42] months and excessive BMI loss of 62.74 ± 18.18%, GERD recurrence was observed in 75% of patients. The study was discontinued due to unsatisfactory preliminary results with LTC. Our results suggest that LTC might not prevent GERD after LSG in patients with preoperative GERD or HH.

Comparison of Sleeve Volume Between Banded and Non-banded Sleeve Gastrectomy: Midterm Effect on Weight and Food Tolerance—a Retrospective Study

BackgroundSleeve dilatation after laparoscopic sleeve gastrectomy (LSG) causes weight regain (WR). Banded sleeve gastrectomy (BSG) was proposed to prevent dilatation and reduce WR.MethodsA retrospective cohort study on patients who underwent BSG and LSG and completed 4 years of follow-up from 2016 to 2021 was included. Body mass index (BMI), percentage of excess weight loss (%EWL), percentage of total weight loss (%TWL), and FT scores were calculated at 1, 2, 3, and 4 years. The sleeve volume was estimated at 6 months, 1 year, and 4 years. Multi-variate analysis was conducted to assess correlations between covariates. WR was calculated as weight gain > 10%, > 10 kg above the nadir, or BMI increase of ≥ 5 kg/m 2 above the nadir.ResultsThis study included LSG 1279 patients and BSG 132 patients. Mean %EWL at 1 year was 83.87 ± 17.25% in LSG vs. 85.71 ± 7.92% in BSG and was 83.47 ± 18.87% in LSG and 85.54 ± 7.48% in BSG at 4 years. Both had significant weight loss over time (p. < 0.001) with no significant main effect of surgery (p.0.438). Mean sleeve volume at 6 months was 102.32 ± 9.88 ± 10.28 ml in LSG vs. 101.89 ± 10.019 ml in BSG and at 4 years was 580.25 ± 112.25 ml in LSG vs. 157.94 ± 12.54 ml in BSG (p. < 0.001).WR occurred in 136 (10.6%) and 4 (3.1%) (p.0.002) in LSG and BSG patients, 90 (7%) vs. zero (0%) (p.0.002) and 31 (2.4%) vs. zero (0%) (p.0.07) using the > 10%, > 10 kg increase above the nadir and the ≥ 5 kg/m 2 BMI increases above the nadir formulas, respectively.ConclusionBSG had significantly lower sleeve volume, significantly lower WR, and significantly lower FT scores than LSG after 4 years from surgery; however, volume changes were not correlated with weight loss.Graphical

Surgical Complication Risk Factor Identification Using High-Dimensional Hospital Data: An Illustrative Example in Hemostasis-Related Complications.

To describe an approach wherein high-dimensional hospital data can be used to identify generalizable risk factors for surgical complications for which there may be limited prior knowledge, as illustrated in the context of hemostasis-related complications (HRC). This was a retrospective study of the Premier Healthcare Database. Patients included for the study underwent video-assisted thoracoscopic lobectomy (VATL), laparoscopic right colectomy (LRC), or laparoscopic sleeve gastrectomy (LSG) on an inpatient setting between Oct-2015 and Feb-2020 (first = index). The outcome, HRC, comprised hemorrhage, control of bleeding, and acute posthemorrhagic anemia. For each cohort, a high-dimensional dataset (ie, comprising 1000s of candidate risk factors) was constructed using taxonomies from the Clinical Classification Software Refined (CCSR). Candidate risk factors were fed into logistic regression models with a 70%/30% train/test split for each cohort; clinically plausible risk factors that were consistently significant predictors of HRC across the 3 training models were then used in a final parsimonious model including sex, age, race, and payor; finally, the parsimonious model was applied to the test data to compare predicted risk with observed incidence of HRSC. The study included 11,141 VATL, 20,156 LRC, and 121,547 LSG patients, in whom 7.5%, 7.8%, and 1.2% experienced HRSC, respectively. Ultimately, 6 clinically plausible CCSR categories were identified as being statistically significant predictors across all 3 cohorts (eg, coagulation and hemorrhagic disorders, malnutrition, alcohol-related disorders, among others). In the parsimonious model applied to the test data, the observed incidence of HRSC was substantially higher in the top quintile vs bottom quintile of predicted risk: LSG 2.05% vs 0.53%, LRC 13.30% vs 4.11%, VATS 12.49% vs 5.04%. High-dimensional real-world data can be useful to identify risk factors for outcomes that generalize across multiple cohorts. The risk factors identified herein should be considered for inclusion in future studies of hemostasis-related complications.