Outcomes Of Laparoscopic Sleeve Gastrectomy Research Articles

Short Term outcome of Laparoscopic Sleeve Gastrectomy versus Gastric Bypass on Body Weight and Common Associated Comorbidities: Randomized Controlled Study

Short Term outcome of Laparoscopic Sleeve Gastrectomy versus Gastric Bypass on Body Weight and Common Associated Comorbidities: Randomized Controlled Study

Comparing the Efficacy of Robotic Versus Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-Analysis.

Laparoscopic sleeve gastrectomy (LSG) has emerged as the predominant metabolic bariatric surgery. With a growing number of studies evaluating the feasibility of robotic sleeve gastrectomy (RSG), it becomes imperative to ascertain whether the outcomes of both techniques are comparable. This study endeavors to synthesize existing evidence and juxtapose the surgical outcomes of LSG and RSG. We collected articles comparing LSG and RSG published between 2011 and 2024. The compiled data included author names, study duration, sample size, average age, gender distribution, geographical location, preoperative body mass index (BMI), bougie diameter, duration of hospitalization, surgical duration, readmission rates, conversion rates, costs, postoperative percentage of excess weight loss (%EWL), postoperative BMI, mortality rates, and complications. We incorporated 21 articles. Both the RSG and LSG cohorts exhibited comparable rates of readmission, conversion, mortality, and incidence of complications (p > 0.05). Moreover, the efficacy of weight loss was similar between RSG and LSG. Nonetheless, RSG was linked to longer operative duration (WMD, -27.50 minutes; 95% confidence interval [CI], -28.82 to -26.18; p < 0.0001), prolonged hospitalization (WMD, -0.15 days; 95% CI, -0.25 to -0.04; p = 0.006), and elevated expenses (WMD, -5830.9 dollars; 95% CI, -8075.98 to -3585.81; p < 0.0001). While both RSG and LSG demonstrated positive postoperative clinical outcomes, RSG patients experienced extended hospital stays, longer operative times, and increased hospitalization costs compared to LSG patients. Using the robotic platform for sleeve gastrectomy (SG) in patients with obesity did not appear to offer any clear benefits.

Comparative Study Between the Outcomes of Laparoscopic Sleeve Gastrectomy and Mini Gastric Bypass for Morbidly Obese Patients

Comparative Study Between the Outcomes of Laparoscopic Sleeve Gastrectomy and Mini Gastric Bypass for Morbidly Obese Patients

Frequency of Early Complications of Laparoscopic Sleeve Gastrectomy Using Four Ports.

Background Laparoscopic sleeve gastrectomy (LSG) has become a widely accepted bariatric procedure for treating morbid obesity and associated comorbidities due to its relatively straightforward technique and positive outcomes in terms of weight loss and metabolic improvement. Objective To investigate the frequency and types of early complications followingLSGusing four ports. Methods This prospective observational study was conducted at Al Hadi International Hospital, Swabi, Pakistan, from January 2022 to December 2022. A total of 369 patients aged 25-65 years with a BMI of 35-55 kg/m2 were included. Data on demographic characteristics, surgery duration, intraoperative blood loss, and hospital stay were collected. Early complications within 30 days post-surgery, including bleeding, infection, and leakage, were documented. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). Results The mean age of patients was 43.6 years (SD = 11.8) and the mean BMI was 42.3 kg/m2 (SD = 6.5). The average surgery duration was 92 minutes (SD = 22) and the mean intraoperative blood loss was 100 mL (SD = 50). Early complications occurred in 18% of patients with bleeding, infection, and leakage each accounting for 5%, 4%, and 3%, respectively. Reoperation was required in 5% of patients due to these complications. Higher BMI (45.2 vs. 41.8 kg/m2, p = 0.04) and longer surgery duration (105 vs. 88 minutes, p = 0.03) were significantly associated with increased complication rates. Comorbidities were present in 60% of patients with complications compared to 34% without complications (p = 0.03). Conclusion The four-port technique in LSG is associated with an 18% early complication rate with significant risk factors being higher BMI and longer surgery duration. Careful patient selection, standardized surgical techniques, and robust postoperative care are essential to minimize complications and improve outcomes in LSG.

A superior approach? The role of robotic sleeve gastrectomy in patients with super super obesity using the 2019-2022 MBSAQIP database.

Laparoscopic sleeve gastrectomy (LSG) in patients with BMI ≥ 60 presents technical challenges, that might be overcome by robotic surgery, but its effectiveness has not been rigorously evaluated. We compared the 30-day outcomes of LSG and robotic sleeve gastrectomy (RSG) in patients with BMI < 60 versus ≥ 60 and between LSG and RSG in patients with BMI ≥ 60. Patients aged 18-65 years who underwent sleeve gastrectomy were included using the 2019-2022 MBSAQIP database. We performed a Propensity Score Matching analysis, with 21 preoperative characteristics. We compared 30-day postoperative outcomes for patients with BMI < 60 versus ≥ 60 using either a laparoscopic (Analysis 1) or robotic approach (Analysis 2) and compared LSG versus RSG in patients with BMI ≥ 60 (Analysis 3). 297,250 patients underwent LSG and 81,008 RSG. Propensity-matched¸ outcomes in analysis 1 (13,503 matched cases), showed that patients with BMI ≥ 60 had higher rates of mortality (0.1% vs. 0.0%, p=0.014), staple line leak (0.3% vs. 0.2%, p=0.035), postoperative bleeding (0.2% vs 0.1%, p=0.028), readmissions (3.5% vs. 2.4%, p<0.001), and interventions (0.7% vs. 0.5%, p=0.028) when compared to patients with BMI < 60. In analysis 2 (4350 matched cases), patients with BMI ≥ 60 demonstrated longer operative times, length of stay, and higher rates of unplanned ICU when compared to patients with BMI < 60. In analysis 3 (4370 matched cases), patients who underwent RSG had fewer readmissions (2.9% vs. 3.7%, p=0.037), staple line leaks (0.1% vs. 0.3%, p=0.029), and postoperative bleeding (0.1% vs. 0.3%, p=0.045), compared to LSG. Conversely, a longer operative time (92.74 ± 38.65 vs. 71.69 ± 37.45 min, p<0.001) was reported. LSG patients with BMI ≥ 60 have higher rates of complications compared to patients with a BMI < 60. Moreover, some outcomes may be improved with the robotic approach in patients with BMI ≥ 60. These results underscore the importance of considering a robotic approach in this super super obese population.

Robotic Versus Laparoscopic Sleeve Gastrectomy Outcome Trends Over Time: Are We Improving?

Sleeve gastrectomy (SG) is an effective treatment option for patients with obesity. Robotic sleeve gastrectomy (RSG) is reported to have worse short-term patient outcomes compared to laparoscopic SG (LSG), but prior studies may not have accounted for evolving technology, including stapler utilization. This study compared RSG and LSG outcomes over different time periods. Academic Hospital. The 2015 to 2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project (MBSAQIP) databases were used. Matched cohort analyses compared adverse outcomes within 30days for the 2015-2018 and 2019-2021 cohorts. Bivariate and regression models compared cohorts using Stata/MP 17.0. Seven hundred sixty-eight thousand and sixty-nine SG were analyzed. Over the 7-year study period, all patient outcomes, operation length (OL), and length of stay (LOS) trended downward for RSG, except surgical site infection (SSI). In the 2015-2018 cohort, leak was significantly higher with RSG (OR 1.53), and OL and LOS longer (p < 0.001). In the 2019-2021 cohort which corelated with a significant increase in robotic cases, leak (OR 1.36), SSI (OR 1.46), and morbidity (OR 1.11) were higher with RSG. While the mean difference in OL and LOS decreased between the two time periods, they remain longer for RSG (p < 0.001). While RSG and LSG are safe with similar mortality, RSG continues to be associated with higher rates of morbidity, leak, and SSI, as well as longer OL, hospital LOS, and higher cost. The study is limited by the ability to account for the impact of surgeon experience and stapler utilization on outcomes.

Evaluating Laparoscopic Sleeve Gastrectomy for Morbid Obesity: A Prospective Follow-Up Study.

Background Laparoscopic sleeve gastrectomy (LSG) has become a primary option within bariatric surgery (BS), exhibiting favorable outcomes in terms of weight reduction and improvement of associated health conditions. This study was conducted to assess the outcomes of LSG in morbid obesity (MO) in terms of weight reduction and improvement of comorbidities. Materials and methods A prospective follow-up study was conducted from January 2021 to January 2023 at the Department of Surgery, 7 Air Force Hospital, Kanpur. The study was approved by the institutional ethical committee with protocol no. IEC/612/2020, including 25 patients diagnosed with MO (BMI >40kg/m2) who underwent LSG. Patients were followed up at 1, 3, 6, and 12 months after surgery to track improvements in comorbidities and weight loss. Pre- and post-operative photos were taken, and any complications during the follow-up period were noted. Results Most participants in the study were middle-aged individuals, and 84% of the cohort had common comorbidities such as hypertension (HTN) and diabetes mellitus (DM). LSG led to significant and sustained weight loss, with patients achieving an average reduction of 31.56 kg by the 12th month following the surgery. Moreover, substantial improvements in comorbidities, particularly HTN (76.9%) and DM (80%), were observed. However, not all comorbidities exhibited similar rates of recovery, highlighting the need for tailored management strategies. Using a correlation test, no significant correlation was found between the percentage over ideal body weight (IBW) and the reduction in excess weight, as indicated by a p-value exceeding 0.05. Conclusion LSG is an effective treatment for severe obesity, delivering significant weight loss and notable improvements in metabolic health and overall quality of life.

Two-year results of laparoscopic sleeve gastrectomy and Roux-En-Y Gastric Bypass in patients with morbid obesity

Objective: To compare the long-term results of LSG and RYGB with a fixed restrictive component in patients with morbid obesity in terms of weight loss, control of associated diseases and the development of long-term complications, including sarcopenia.Materials and methods: our study included the results of treatment of 251 patients (153 LSG and 98 RYGB). The follow-up period was at least 24 months (median follow-up 38 months). The restrictive component was assessed 12 months after surgery using CT-volumetry. The size of the gastroenetroanastomosis was additionally measured using fibrogastroscopy in the RYGB group. The bioelectrical impedance analysis (BIA) was used to assess body composition and determine the skeletal muscle mass index (SMMI) initially and during control examinations in the postoperative period.Results: both groups obtained good results in terms of weight loss and control of associated diseases, however, RYGB shows some advantages in these parameters. On the other hand, in the RYGB group a higher rate of progression of signs of sarcopenia was detected (8.2% (including 3% of severe sarcopenia) vs 3.3% in the LSG group). Most patients who progressed to sarcopenia were older, had type 2 diabetes mellitus (T2DM), or had mild sarcopenia at baseline.Conclusions: RYGB demonstrates better results in terms of weight loss and control of associated diseases compared to LSG, however, in elderly patients, as well as in the presence of T2DM or signs of sarcopenia, it is advisable to choose operations without a pronounced malabsorptive effect.

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.

Long-term outcomes of laparoscopic sleeve gastrectomy in Denmark from 2010 to 2016: a nationwide cohort study

BackgroundBariatric surgery is the most effective treatment of morbid obesity and obesity-related conditions. Laparoscopic sleeve gastrectomy (LSG) has become increasingly popular in Denmark and worldwide. ObjectiveTo evaluate long-term outcomes including postoperative complications after LSG. SettingUniversity Hospitals, Denmark. MethodsThis was a nationwide multicenter cohort study including all patients who underwent LSG during 2010 to 2016 in Denmark. Data were collected from the Danish Obesity Surgery Registry and medical records. Representatives from all public bariatric centers in Denmark registered information on demography, indication, preoperative tests, operative information, weight loss, status of co-morbidities, and early and late complications. ResultsIn total, 541 patients were included in the study. Median follow-up was 6 years, and 536 patients (99%) were available at the end of follow-up. The patients achieved a persistent weight loss. Quality of life significantly improved after both 12 and 24 months. Overall, 3% of the patients had a major complication ≤30 days after the procedure and 3% underwent reoperation. One in 5 patients (22%) had an early minor complication. In the long term, 3% of the patients had a major complication and 24% of the patients had ≥1 minor complication. The most common surgery-related healthcare contacts addressed gastroesophageal reflux, weight recurrence, and stenosis symptoms. ConclusionsPatients after LSG achieved sufficient weight loss and improved quality of life. The procedure was safe with low risk of early and late major complications. However, there was a high frequency of early and late minor complications in 22% and 24% of the patients, respectively.

Does Omentopexy Make a Difference in Laparoscopic Sleeve Gastrectomy for Obesity Treatment? A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aimed to evaluate the comparative outcomes of laparoscopic sleeve gastrectomy with omentopexy (LSGO) versus conventional laparoscopic sleeve gastrectomy (LSG) for obesity treatment. A systematic online search was conducted using the available online databases, and Revman software was used for data analysis. Twenty-two eligible comparative studies were included (n = 9,321). LSGO showed a significantly lower rate of gastric leak (P = 0.0001), staple line bleeding (P = 0.00001), and gastric torsion (P = 0.002) in comparison to the LSG group. Operative time was significantly shorter in the LSG group (P = 0.00001); however, the length of hospital stay was in favour of the LSGO (P = 0.00001). Compared to LSG without omentopexy, LSG with omentopexy provides a significantly lower rate of postoperative complications and shorter LOS at the expense of operative time.

The Outcomes of Laparoscopic Sleeve Gastrectomy for the Treatment of Obesity: A Single-Center Experience

The Outcomes of Laparoscopic Sleeve Gastrectomy for the Treatment of Obesity: A Single-Center Experience

Surgical outcomes of laparoscopic sleeve gastrectomy by single surgeon: Before and after learning curve in a non-tertiary low volume bariatric center.

In Korea, the need for bariatric surgery (BS) is increasing because of the increasing incidence of morbid obesity. There is no special training program for BS, and most BS are conducted in non-tertiary hospitals in capital area. We evaluated the surgical outcomes of laparoscopic sleeve gastrectomy (LSG) before and after the learning curve (LC) to prove that the barrier of entry for LSG is not very high. We retrospectively analyzed the data of patients who underwent LSG in a secondary hospital without the supervision of an experienced surgeon between April 2019 and August 2022. We compared the surgical outcomes and changes in body measurements before the LC (BL) and after the LC (AL) after 1 year of follow-up. The duration of operation for BL and AL were 118.4 and 61.9min (p=0.000), respectively. No mortality was observed. There were four and eight cases of morbidity; the weight loss after 1 year was 90.6 and 89.7kg (p=0.804); changes in body mass index (BMI) were 10.3 and 10.2kg/m2 (p=0.928); excess weight loss after 1 year was 93.0 and 89.3% (p=0.762); and excess BMI loss after 1 year was 92.7 and 89.5% (p=0.807) in the BL and AL groups, respectively. %Total weight loss was 26.8 and 23.7 in the BL and AL group. There was no statistical significance of all parameters of body measurements between two groups. LSG can be safely and effectively performed by novice bariatric surgeons in non-tertiary hospitals if patients are cautiously selected. Surgical outcomes of BL and AL is not different, except for the operation time.

Long-term Outcomes of Laparoscopic Sleeve Gastrectomy as a Revisional Procedure Following Adjustable Gastric Banding: Variations in Outcomes Based on Indication

BackgroundSignificant controversy exists regarding the indications and outcomes after laparoscopic adjustable gastric banding (LAGB) conversions to laparoscopic sleeve gastrectomy (LSG).AimTo comprehensively determine the long-term outcomes of sleeve gastrectomy as a revisional procedure after LAGB across a range of measures and determine predictors of outcomes.MethodsSix hundred revision LSG (RLSG) and 1200 controls (primary LSG (PLSG)) were included. Patient demographics, complications, follow-up, and patient-completed questionnaires were collected.ResultsRLSG vs controls; females 87% vs 78.8%, age 45 ± 19.4 vs 40.6 ± 10.6 years, p = 0.561; baseline weight 119.7 ± 26.2 vs 120.6 ± 26.5 kg p = 0.961). Follow-up was 87% vs 89.3%. Weight loss in RLSG at 5 years, 22.9% vs 29.6% TBWL, p = 0.001, 10 years: 19.5% vs 27% TBWL, p = 0.001. RLSG had more complications (4.8 vs 2.0% RR 2.4, p = 0.001), re-admissions (4.3 vs 2.4% RR 1.8, p = 0.012), staple line leaks (2.5 vs 0.9%, p = 0.003). Eroded bands and baseline weight were independent predictors of complications after RLSG. Long-term re-operation rate was 7.3% for RLSG compared to 3.2% in controls. Severe oesophageal dysmotility predicted poor weight loss. RLSG reported lower quality of life scores (SF-12 physical component scores 75.9 vs 88%, p = 0.001), satisfaction (69 vs 93%, p = 0.001) and more frequent regurgitation (58% vs 42%, p = 0.034).ConclusionRLSG provides long-term weight loss, although peri-operative complications are significantly elevated compared to PLSG. Longer-term re-operation rates are elevated compared to PLSG. Four variables predicted worse outcomes: eroded band, multiple prior bands, severe oesophageal dysmotility and elevated baseline weight.Graphical

Long-term outcomes of laparoscopic sleeve gastrectomy in those with class I obesity: safety, efficacy, and quality of life.

Class I obesity carries significant morbidity and mortality risk similar to higher grades of obesity, and persons with class I obesity have a high risk of progression to class II and III obesity. While bariatric surgery has made strides in safety and efficacy, it remains inaccessible for persons with class I obesity (body mass index [BMI] of 30-35 kg/m2). To assess safety, weight loss durability, co-morbidity resolution, and quality of life after laparoscopic sleeve gastrectomy (LSG) in persons with class I obesity. Multidisciplinary medical center that specializes in obesity management. A longitudinal prospective single-surgeon registry was queried for data pertaining to persons with class I obesity who underwent primary LSG. Primary endpoint was weight loss. Secondary endpoints included change in obesity-related co-morbidities, adverse events, and post hoc analysis of symptoms of gastroesophageal reflux disease (GERD) and Bariatric Analysis and Reporting Outcome System results. Follow-up was divided into short- (1-3 yr), intermediate- (4-7 yr), and long-term (8-12 yr). We evaluated percent excess weight loss (%EWL) using linear mixed models adjusting for age, sex, years since operation, and baseline BMI. Least-squares means estimates and 95% confidence intervals (CI) were generated. Of 13,863 bariatric procedures, a total of 1851 patients were included. Mean baseline BMI, age, and male:female ratio were 32.6 ± 2.1 kg/m2, 33.7 ± 9.2 years, and 1:5, respectively. Adjusted mean %EWL (95% CI) at short-, intermediate-, and long-term follow-up were 111% (95% CI, 91%-131%), 110% (95% CI, 89%-131%), and 141% (95% CI, 57%-225%), respectively. Of 195 patients with type 2 diabetes, 59% experienced complete remission, and of 168 patients with hypertension, 43% experienced complete remission. Being on oral antidiabetes medication was a significant predictor of sustained remission compared with being on insulin or combination therapy (P < .001). Sixty-nine patients had symptoms of GERD before surgery, which improved in 55 (79.7%). Thirty-three patients developed de novo symptoms of GERD. The average Bariatric Analysis and Reporting Outcome System score was 4.5 ± 1.7, with 83% of participants rating their quality of life after surgery as good, very good, or excellent. Those with class I obesity who undergo LSG experience normalization of weight, sustained remission of co-morbidity, and good quality of life without significant risk of morbidity or mortality.

Long-Term Results of Laparoscopic Sleeve Gastrectomy: a Review of Studies Reporting 10+ Years Outcomes.

Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure worldwide. Systematic search of Pubmed, Cochrane, and Embase was performed in order to find all the articles reporting 10+ years of LSG results. Eleven studies including 1020 patients met the inclusion criteria. Overall weighted mean %TWL was 24.4% (17-36.9%), and remission rates from TD2M to HTN were 45.6% (0-94.7%) and 41.4% (0-78.4%), respectively. De novo GERD had an overall prevalence of 32.3% (21.4-58.4%), and five cases (0.5%) of Barrett's disease were reported. Revisional surgery was required for 19.2% (1-49.5%) of patients, Roux-en-Y gastric bypass being the most common secondary procedure.

The impact of the bougie size and the extent of antral resection on weight-loss and postoperative complications following sleeve gastrectomy: results from the Scandinavian Obesity Surgery Registry

BackgroundThe optimal sleeve diameter and distance from the pylorus to the edge of the resection line in laparoscopic sleeve gastrectomy (LSG) remain controversial. ObjectivesTo evaluate the influence of bougie size and antral resection distance from the pylorus on postoperative complications and weight-loss results in LSG. SettingNationwide registry-based study. MethodsThis study included all LSGs performed in Sweden between 2012 and 2019. Data were obtained from the Scandinavian Obesity Surgery Registry. Reference bougie size of 35–36 Fr and an antral resection distance of 5 cm from the pylorus were compared to narrower bougie size (30–32 Fr), shorter distances (1–4 cm), and extended distances (6–8 cm) from the pylorus in assessing postoperative complications and weight loss as the outcomes of LSG. ResultsThe study included 9,360 patients with postoperative follow-up rates of 96%, 79%, and 50% at 30 days, 1 year, and 2 years, respectively. Narrow bougie and short antral resection distance from the pylorus were significantly associated with increased postoperative weight loss. Bougie size was not associated with increased early or late complications. However, short antral resection distance was associated with high risk of overall early complications [odds ratio: 1.46 (1.17–1.82, P = .001)], although no impact on late complications at 1 and 2 years was observed. ConclusionsUsing a narrow bougie and initiating resection closer to the pylorus were associated with greater maximum weight loss. Although a closer resection to the pylorus was associated with an increased risk of early postoperative complications, no association was observed with the use of narrow bougie for LSG.

Weight Loss After Laparoscopic Sleeve Gastrectomy in Children and Adolescents.

For children and adolescents with severe obesity, metabolic and bariatric surgery including laparoscopic sleeve gastrectomy (LSG) is increasingly used to facilitate weight loss and reduce associated medical problems. Outcomes of LSG are understudied among patients under age 15years. We sought to examine surgical complications and weight loss outcomes among children and adolescents who underwent LSG. This is a single-center retrospective cohort analysis at a high-volume metropolitan children's hospital in the northeast USA between 2011 and 2021. Weight loss was assessed at routine follow-up appointments for up to 36months postoperatively. There were 12 patients under 13years of age (< 13), 45 from 13 up to 15years of age (13-14), and 57 patients aged 15years or over (≥ 15). Among all patients, 70% were female, 41% were Hispanic, and 18% were non-Hispanic Black. There were no operative mortalities. Two patients had surgical complications requiring reoperation. Follow-up beyond 6months occurred for 62% of patients. Weight loss was evident for each group at all time points, and there was no statistically significant difference among groups at any time point. BMI Z-score reduction at 6months was 1.53 for the < 13 group, 0.89 for the 13-14 group, and 0.86 for the ≥ 15 group and at 36months was 1.79, 1.50, and 1.16, respectively. These results support that LSG is a safe and effective method of achieving weight loss for young adolescents with severe obesity. Strategies to promote postoperative follow-up are needed.

Long-Term Outcome of Laparoscopic Sleeve Gastrectomy (LSG) on Weight Loss in Patients with Obesity: a 5-Year and 11-Year Follow-Up Study

BackgroundBariatric surgery is the most efficient treatment for patients with clinically severe obesity who have failed to obtain satisfactory weight loss through lifestyle modification and medical treatments. This study aimed to present our long-term laparoscopic sleeve gastrectomy (LSG) efficacy in terms of weight loss and obesity-related complications resolution.Patients and MethodsThis is a retrospective study that was based on prospectively collected data from patients undergoing LSG by the same surgeon from July 2011 to the end of August 2022. The LSG-associated short-term (at 3 months, 6 months, and 1 year postoperatively) and long-term (at 5 years and 11 years postoperatively) weight loss, and the short-term (6 months postoperatively) and long-term (5 and 11 years postoperatively) rates of obesity-related complications were assessed.ResultsThis study included 892 patients who underwent LSG over 11 years. At the 1-year follow-up, data on 860 patients were available, while at the 5-year and 11-year follow-ups, data on 193 patients and 48 patients, respectively, were available. The mean EBWL% was 84.57 ± 18.41%, 64.22 ± 15.53%, and 66.01 ± 8.66% at the 1-year, 5-year, and 11-year follow-ups, respectively.ConclusionThis study adds new evidence concerning the short-term efficacy of LSG. The long-term assessment showed relatively sustainable weight loss and obesity-related complications resolution, with a regression of the short-term gains that was still far from the baseline burden.Graphical

Comparative outcomes of bariatric surgery in patients with ESRD on dialysis in the modern era of renal transplantation: analysis using the 2015-2020 MBSAQIP database.

Severe obesity is a relative contraindication for renal transplantation, therefore bariatric surgery is an important option as a pre-kidney transplant weight loss strategy. However, comparative data regarding postoperative outcomes of laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients with or without ESRD on dialysis are scarce. Patients between 18- and 80-year-old who underwent LSG and RYGB were included. To determine the outcomes of patient who underwent bariatric surgery with ESRD on dialysis, a 1:4 PSM was performed between the patients with ESRD on dialysis and those without renal disease. The PSM analyses in both groups were performed using 20 preoperative characteristics. Then 30-day postoperative outcomes were assessed. The operative time and postoperative-LOS were significantly longer in ESRD patients on dialysis compared to those with no renal disease either for LSG (82.37 ± 40.42 vs. 73.62 ± 38.65; P < 0.001, 2.22 ± 3.01 vs. 1.67 ± 1.90; P < 0.001) or for LRYGB (129.13 ± 63.20 vs. 118.72 ± 54.16; P = 0.002, 2.53 ± 1.74 vs. 2.00 ± 1.68; P < 0.001). In the LSG cohort (2137 vs. 8495 matched cases), patients with ESRD on dialysis showed significant increase in mortality (0.7% vs 0.3%; P = 0.019), unplanned ICU admission (3.1% vs 1.3%; P < 0.001), blood transfusions (2.3% vs 0.8%; P 0.001), readmissions (9.1% vs. 4.0%; P < 0.001), reoperations (3.4% vs. 1.2%; P < 0.001), interventions (2.3% vs. 1.0%; P = 0.006). In the LRYGB group (443 vs. 1769 matched cases), patients with ESRD on dialysis showed a significantly higher need for unplanned ICU admission (3.8% vs. 1.4%; P = 0.027), readmissions (12.4% vs. 6.6%; P = 0.011), and interventions (5.2% vs. 2.0%; P = 0.050). Bariatric surgery is a safe procedure for patients with ESRD on dialysis to help them get a kidney transplant. Even though this group experienced a higher incidence of postoperative complications compared to those without kidney disease, the absolute complication rates are low and not associated with bariatric-specific complications. Therefore, ESRD should not be perceived as contraindications to bariatric surgery.