Outcomes Of Sleeve Gastrectomy Research Articles

Outcomes of Sleeve Gastrectomy in Obese Liver Transplant Candidates.

Morbid obesity (body mass index [BMI] ≥40 kg/m2 ) is a relative contraindication to liver transplantation (LT) at many transplant centers. The safety and efficacy of pre-LT bariatric surgery in morbidly obese LT candidates is unknown. Herein, we describe a cohort study of morbidly obese LT candidates who failed to achieve adequate weight loss through a medically supervised weight loss program and subsequently underwent sleeve gastrectomy (SG) at our institution. In total, 32 LT candidates with a median Model for End-Stage Liver Disease (MELD) score of 12 (interquartile range [IQR], 10-13) underwent SG. All LT candidates had a history of hepatic decompensation, but complications of liver disease were required to be well controlled at the time of SG. Median pre-SG BMI was 45.0 kg/m2 (IQR, 42.1-49.0 kg/m2 ). There were no perioperative deaths or liver-related morbidity. One patient experienced major perioperative morbidity secondary to a gastric leak, which was managed nonoperatively. Median weight loss at 6 and 12 months after SG was 22.0 kg (IQR, 18.9-26.8 kg) and 31.0 kg (IQR, 23.6-50.3 kg), respectively, corresponding to a percentage of excess body weight lost of 33.4% and 52.4%. Within 6 months after SG, 28 (88%) candidates were deemed eligible for LT. Our center's experience highlights the potential option of SG in morbidly obese LT candidates with advanced liver disease who might otherwise be excluded from pursuing LT.

Laparoscopic Sleeve Gastrectomy Outcomes in Patients with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a common disease among the bariatric population. However, there are limited data regarding the impact of laparoscopic sleeve gastrectomy (SG) on these patients. The study was conducted at University Hospital, United States. The purpose of this study was to examine per cent excess body weight loss (%EWL) and diabetes control in patients who have PCOS compared with those without PCOS. A total of 550 female patients underwent SG between December 2011 and October 2016. Retrospective analysis was completed to include follow-up data at 1, 3, 6, and 12 months and yearly after that. Outcomes measured were %EWL and hemoglobin A1c (HgbA1c). The mean and median follow-up for the entire cohort was 21 and 15 months, respectively. Seventy-eight per cent of patients completed at least 12 months of follow-up for %EWL, although only 21 per cent had similar follow-up for HgbA1c. PCOS patients had similar age (36.3 vs 36.2 years, P = 0.90), preoperative BMI (47.2 vs 47.2, P = 0.99), preoperative HgbA1c (6% vs 5.8%, P = 0.31), conversion rate to gastric bypass, and other associated comorbidities compared with non-PCOS comparisons. There was no difference in %EWL at 12-month (49.7% vs 53.1%, P = 0.53) or 24-month (43% vs 49.8%, P = 0.46) postoperative intervals. There was no difference in absolute change of HgbA1c at 12 months (-0.47% vs -0.67%, P = 0.39). SG has equivalent short-term results in %EWL and reduction in HgbA1c for patients who have PCOS and those who do not.

Outcomes of sleeve gastrectomy in patients older than 60 years: a multicenter matched case-control study.

IntroductionThe prevalence of obesity is increasing according to the World Health Organization. Furthermore, global aging is increasing, especially in developed countries in Europe. Whether bariatric surgery should be performed in elderly people is still controversial.AimTo determine the clinical outcomes of sleeve gastrectomies (SG) in older central European patients. We compared the safety and efficacy of SG in patients older than 60 years with younger patients.Material and methodsEighty-nine patients older than 60 years, who underwent SG, were included in the study. Eighty-nine younger patients (aged 18–40 years) were matched according to body mass index (BMI) and comorbidities. The analyzed data included age, sex, total body weight, BMI, length of hospital stay, 30-day complications and improvement in comorbidities.ResultsThere was no significant difference in the complication rate between the 2 age groups (p = 0.59). An improvement in hypertension was observed in 73.1% of older patients and in 69.2% of younger patients (p = 0.67). There was improvement in diabetes mellitus in 40% of older patients and in 31.1% of younger patients (p = 0.25). The ΔBMI after 12, 24 and 36 months was significantly lower in older patients than in younger patients (p = 0.002, p = 0.001; p = 0.043, respectively). Percent excess BMI loss (%EBMIL) after 12, 24, and 60 months was significantly lower in older than in younger patients (p = 0.001, p = 0.001, p = 0.028, respectively).ConclusionsBetter weight loss is achieved in younger than in older patients, while maintaining a similar effect on the risk of complications and improvement in comorbidities. Therefore, SG is safe and effective in older people.

Short-Term Outcomes of Sleeve Gastrectomy plus Jejunojejunal Bypass: a Retrospective Comparative Study with Sleeve Gastrectomy and Roux-en-Y Gastric Bypass in Chinese Patients with BMI ≥ 35kg/m2.

Bariatric surgery represents the most effective treatment for obesity and its related comorbidities. The present study aims to evaluate the efficacy and safety of sleeve gastrectomy plus jejunojejunal bypass (SG + JJB). This retrospective study included 244 obese patients with BMI ≥ 35kg/m2 undergoing SG + JJB (n = 83), SG (n = 82), and Roux-en-Y gastric bypass (RYGB) (n = 79). Postoperative weight loss, metabolic outcomes, nutrition status, and patients' complaints at 1-year follow-up were compared. Subgroup analyses (36 pairs of SG + JJB/SG and 37 pairs of SG + JJB/RYGB) were performed to compare weight loss and lipid profiles after matching with gender, age, and BMI. In subgroup case-matched study, SG + JJB exhibited superior weight loss effect to SG regarding total weight loss (38.8 ± 8.7% vs 35.0 ± 6.1%, P = 0.011) and excessive weight loss (95.3 ± 20.4% vs 86.9 ± 13.7%, P = 0.033) at 1-year follow-up. The postoperative metabolic outcomes, nutritional status, and patients' complaints were similar between SG + JJB and SG. SG + JJB yielded similar weight loss, T2DM remission, and hypertension resolution to RYGB at 1-year follow-up, but less postoperative complications than RYGB regarding anemia (4.8% vs 22.8%), vitamin D deficiency (47.0% vs 65.8%), vitamin B12 deficiency (8.4% vs 25.3%), hypoalbuminemia (1.2% vs 8.9%), diarrhea (6.0% vs 21.5%), dumping syndrome (0 vs 7.6%), and fatigue (25.3% vs 40.5%) (P < 0.05). In subgroup case-matched study, RYGB improved total cholesterol and low-density lipoprotein better than SG + JJB (P < 0.05). In short-term follow-up, SG + JJB offered better weight loss than SG and similar weight loss to RYGB. SG + JJB resulted in less postoperative nutritional deficiency and complications than RYGB except for lipid and hypertension improvement.

Robotic Surgery is More Expensive with Similar Outcomes in Sleeve Gastrectomy: Analysis of the NIS Database

The aim of this study was to compare postoperative outcomes after robotic-assisted and laparoscopic bariatric sleeve gastrectomy (SG). Sleeve gastrectomy is traditionally performed using laparoscopic techniques. Robotic-assisted surgery enables surgeons to perform minimally invasive SG, but with unknown benefits. Using a national database, we compared postoperative outcomes after laparoscopic SG and robotic-assisted SG. National data from individuals undergoing elective SG in the National Inpatient Sample database between 2011 and 2013 were analyzed. Propensity score matching was used to match robotic and laparoscopic groups by demographics, comorbidities, and hospital characteristics. The matching cohorts were compared. A total of 26,195 patients who underwent elective SG for morbid obesity were included. Of these, 25,391 (96.9%) were completed via laparoscopy, whereas 804 (3.1%) were performed with robotic assistance. There were no significant differences in demographics and subsequent postoperative complications. The inhospital mortality was similar. Length of hospital stay was statistically different, with a mean of 1.88 in laparoscopic versus 2.08 days in robotic (P < 0.001). Higher total hospital charges were noted in the robotic-assisted SG group (median US$38,569 vs US$54,658, P < 0.001). These differences were evident even after adjusting for confounding factors: wound infection, atelectasis, bowel obstruction, pneumonia, and bowel obstruction (P < 0.001).

Analysis of the Association between Eating Behaviors and Weight Loss after Laparoscopic Sleeve Gastrectomy

Setting: In a private medical center, 300 patients who underwent a laparoscopic sleeve gastrectomy (LSG) were classified into 4 groups according to their eating behaviors (EB) preoperatively. During a 3-year postoperative follow-up, dietary changes in relation to weight loss were studied. Objectives: To explore the influence of abnormal EB on the outcome of sleeve gastrectomy. Background: Patients with morbid obesity often suffer from abnormal EB. After LSG, the outcome depends largely on improvement of the feeding behaviors acquired. Methods:This prospective study includes 300 patients who underwent LSG from 2013 to 2014, divided into the following 4 groups: binge eaters, snack eaters, sweet eaters, and volume eaters. Results: The average age was 41.65 years, the ratio of male to females was 1 to 2. The average baseline body mass index (BMI) was 42.02. After 3 years, no significant change was found in the number of binge eaters (p = 0.396), but there was an 8.9% increase in snack eaters (p < 0.001), a 12.9% increase in sweet eaters (p < 0.001), and 17.2% increase in healthy eating habits (p < 0.001). Sixty-five (24.8%) patients did not experience changes in their eating patterns. However, after surgery, 24.6% of the patients continued with the same EB and 125 (49.5%) patients changed from one EB to another unhealthy EB. Weight loss, measure as ΔBMI, was similar in each group after 3 years, with a mean BMI of 29.8. When eating habits were related to different features such as gender, sports practice, type of work, smoking, marital status, comorbidities, no influence on the operative results were found. Conclusion: LSG promotes the reduction of overeaters; however, it promotes a switch between other unhealthy EB. The significant increase in snack eaters and sweet eaters is outstanding, although it did not affect weight loss in the midterm follow-up. Worsening of eating habits after LSG is a common fact.

A287 - MBSAQIP National Registry Study of Sleeve Gastrectomy Outcomes in Patients Age 70 and Older

Background: The number of patients over age 70 undergoing bariatric surgery is increasing. We investigated whether age>70 affects the safety of sleeve gastrectomy (SG) performed as the primary bariatric procedure.

Role of Helicobacter Pylori Infection in Laparoscopic Sleeve Gastrectomy Outcomes

Role of Helicobacter Pylori Infection in Laparoscopic Sleeve Gastrectomy Outcomes

The effects of provider-prescribed obesogenic drugs on post-laparoscopic sleeve gastrectomy outcomes: a retrospective cohort study.

Background:Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedures and has proven effective in providing weight loss. However, considerable variance has been noted in the degree of weight loss. Physician prescription practices may be negatively affecting weight loss post-LSG and, thus, contributing to the broad range of weight loss outcomes. The aim of our study was to determine whether commonly prescribed obesogenic medications negatively affect weight loss outcomes post-LSG.Subjects/Methods:This single center retrospective cohort study performed at a University hospital included 323 patients (≥18 years) within University California, San Diego Healthcare System who underwent LSG between 2007 and 2016. We identified a list of 32 commonly prescribed medications that have weight gain as a side effect. We compared the percent excess weight loss (%EWL) of patients divided into two groups based on post-LSG exposure to obesogenic medications. A linear regression model was used to analyze %EWL at 12 months post-LSG while controlling for age, initial body mass index (BMI), and use of leptogenic medications.Results:150 patients (Meds group) were prescribed obesogenic medications within the one-year post-LSG follow up period, whereas 173 patients (Control group) were not prescribed obesogenic medications. The Meds group lost significantly less weight compared to the Control group (%EWL ± SEM at 12 months 53.8 ± 2.4 n=78, 65.0 ± 2.6, n=84 respectively, P = 0.002). This difference could not be attributed to differences in age, gender, initial BMI, co-morbidities, or prescription of leptogenic medications between the two groups.Conclusions:The use of provider-prescribed obesogenic medications was associated with worse weight loss outcomes post-LSG. Closer scrutiny of patient medications may be necessary to help improve outcomes of weight loss treatments.

Long-term weight change and health outcomes for sleeve gastrectomy (SG) and matched Roux-en-Y gastric bypass (RYGB) participants in the Longitudinal Assessment of Bariatric Surgery (LABS) study

Data from a US multicenter longitudinal study of bariatric surgery were used to compare weight change (primary outcome) and comorbidities (secondary outcome) in patients who underwent sleeve gastrectomy versus Roux-en-Y gastric bypass. This study includes participants who underwent sleeve gastrectomy and matched participants who underwent Roux-en-Y gastric bypass from the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study. Adults undergoing initial bariatric surgical procedures between 2006 and 2009 were enrolled. Participants who underwent sleeve gastrectomy were high-risk or superobese and intended to have a second-stage procedure. Mixed models were used to evaluate percent weight change from baseline through 7 years, and diabetes, dyslipidemia, and hypertension prevalence through 5 years. Fifty-seven of 59 participants who underwent sleeve gastrectomy were matched one to one. Most were female (68%) and white (81%), and had a median age of 49 (37-56) years and median body mass index of 56.4 (35.5-76.8) kg/m2 presurgery. Weight loss was significantly less 1 to 7 years after sleeve gastrectomy versus matched Roux-en-Y gastric bypass (eg, year 7 mean weight loss was 23.6% vs 30.4%, respectively; P = .001). For both surgical groups, prevalence of diabetes, low high-density lipoprotein, and hypertension were significantly (P < .05) lower 5 years postsurgery versus baseline. Higher-risk or super-obese participants after sleeve gastrectomy lost less weight than did matched Roux-en-Y gastric bypass counterparts throughout 7 years. Both groups exhibited improvements in comorbidities from presurgery through 5 years.

Midterm outcomes of sleeve gastrectomy in the elderly

BackgroundThe increase in life expectancy presents health systems with a growing challenge in the form of elderly obesity. Bariatric surgery has been shown to be a safe and effective treatment for obesity with reduction of excess weight and improvement in obesity-related co-morbidities. However, only recently have surgeons begun performing these operations on elderly patients on a larger scale, making data regarding mid- and long-term outcomes scarce. The objective of this study was to evaluate the safety and midterm efficacy of laparoscopic sleeve gastrectomy (LSG) in patients aged ≥60 years. MethodsAll patients aged ≥60 years who underwent LSG between 2008 and 2014 and achieved ≥24-month follow-up were retrospectively reviewed. Demographic characteristics and perioperative data were analyzed. Weight loss parameters and co-morbidity resolution rates were compared with preoperative data. ResultsIn total 55 patients aged ≥60 years underwent LSG. Mean patient age was 63.9 ± 3.2 years (range, 60–75.2), and mean preoperative body mass index was 43 ± 6.0 kg/m2. Perioperative morbidity included 5 cases of hemorrhage necessitating operative exploration, 2 cases of reduced hemoglobin levels treated with blood transfusion, and 1 case of portal vein thrombosis managed with anticoagulation. There were no mortalities. Mean follow-up time was 48.6 (range, 25.6–94.5) months. Mean percentage of excess weight loss was 66.4 ± 19.7, 67.5 ±1 6.4, 61.4 ± 18.3, 66.7 ± 25.6, 50.7 ± 21.4 at 12, 24, 36, 37 to 60, and 61 to 96 months, respectively. Statistically significant improvement of type 2 diabetes, hypertension, and dyslipidemia were observed at the latest follow-up (P < .01). ConclusionLSG offers an effective treatment of obesity and its co-morbidities in patients aged ≥60 years, albeit with a high perioperative bleeding rate at our center; efficacy is maintained for at least 4.5 years.

Outcomes of Sleeve Gastrectomy in Septuagenarians.

Few previous studies have assessed the safety of bariatric surgery in septuagenarians. A retrospective analysis of all patients 70years or older who underwent laparoscopic sleeve gastrectomy at our institution between 2012 and 2017 was performed. This group was compared to a matched cohort of younger LSG patients (18-50years) who were operated during the same time period. Thirty septuagenarian LSG patients were compared to 60 younger patients. Gender distribution, preoperative weight, and preoperative body mass index (BMI) were comparable, although patients in the older age group suffered from more preoperative comorbidities (100 vs. 51.7%, p < 0.001). Operative time was longer (77.2 vs. 57.3min, p = 0.005) and more hiatal hernias were repaired (46.7 vs. 8.3%, p < 0.001) in the older age group. Intraoperative complications occurred more in the older age group (6.7 vs. 0%, p = 0.04) but the overall complication rate (13.3 vs. 5.0%, p = 0.17) and the postoperative complication rate (10.0 vs. 5.0%, p = 0.38) were comparable. After a mean follow-up period of 31.3 and 33.5months, the percentage of total body weight loss was 24.6 and 28.3% for the older and younger patients, respectively (p = 0.11). Rates of improvement/remission of comorbidities were comparable between the groups. In a carefully selected group of severely obese patients ≥ 70years old, LSG may be safe, with acceptable postoperative complication rates, weight loss results, and improvement in comorbidities.

Weight Loss and Comorbidity Resolution 3Years After Bariatric Surgery-an Indian Perspective.

Bariatric surgery has seen a sharp rise in India in the last decade. India is one of the 10 most obese nations of the world, ranking second in number of type 2 diabetics. To evaluate clinical outcomes of bariatric surgery after 3years of follow-up in terms of weight loss, co-morbidity resolution, complaints of gastroesophageal reflux disease and weight regain. All patients who underwent bariatric surgery from January to December 2013 with a minimum follow-up of 3years were included in the study. Their demographic, preoperative, and postoperative data were prospectively maintained on Microsoft Office Excel and analyzed statistically. One hundred seventy-eight patients (157 lap. sleeve gastrectomy and 21 patients lap. RYGB) completed 3years of follow-up. In the LSG group, patients had a pre-operative BMI 44.8 ± 8.33kg/sq. m (mean ± S.D.) and excess body weight 52.3 ± 23.0kg. In the RYGB group, pre-operative BMI was 42.7 ± 8.82kg/sq. m and excess body weight 45 ± 18.7kg. In the LSG group, % excess weight loss (EWL) at 1year was 87.6 ± 24.4% and 3years was 71.8 ± 26.7%. In the RYGB group, % EWL at 1year was 97.2 ± 27.3% and at 3years was 85.8 ± 25.3%. Diabetes resolution was seen in 32 (80%) in LSG group and 11 (91.7%) in RYGB group (Figs. 1, 2, 3, and 4). Our study reflects that there is no statistically significant difference between outcomes of sleeve gastrectomy and Roux-en-Y gastric bypass surgery in terms of weight loss and diabetes resolution at 3years.

Comparing the Outcomes of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass for Severe Obesity

Comparing the Outcomes of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass for Severe Obesity

Thirty-day outcomes of sleeve gastrectomy versus Roux-en-Y gastric bypass: first report based on Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database

BackgroundAccording to recent American Society for Metabolic and Bariatric Surgery estimates, sleeve gastrectomy (SG) is now the most commonly performed procedure in the United States (~53.8% of all bariatric procedures), followed by Roux-en-Y gastric bypass (RYGB; 23.1% of all procedures). ObjectivesThe objective of this study was to evaluate outcomes and safety of these 2 procedures in the first 30 days postoperatively using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. SettingUniversity health network, United States. MethodsWe reviewed all SG and RYGB cases entered between January 1 and December 31, 2015 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. Demographic characteristics and 30-day outcomes were analyzed based on separate Mann-Whitney rank sums tests, χ2, or Fisher's exact tests as appropriate, with P<.05 denoting statistical significance and no adjustment for multiple testing. ResultsA total of 141,646 patients were analyzed; 98,292 underwent SG and 43,354 underwent RYGB. Average age was 44.5 and 45.4 years for SG and RYGB, respectively. Preoperative body mass index was 45.1 and 46.1 for SG and RYGB, respectively. The 30-day mortality was .1% for SG and .2% for RYGB (P<.05). The incidence of unplanned intensive care unit admission after RYGB was twice as high compared with SG (1.3% versus .6%, respectively, P<.05). The incidence of at least 1 intervention or reoperation after RYGB was significantly higher compared with SG (2.8% and 2.5% for GB versus 1.2% and 1% for SG, P<.05). After RYGB, .4% of patients had a drain left in place at 30 days postoperatively versus .3% for SG (P<.05). The incidence of readmission was 2.8% for RYGB and 1.2% for SG (P<.05). ConclusionsThe incidence of postoperative complications in the first 30 days after surgery is low for both RYGB and SG. However, SG seems to have a better safety profile in the first 30 days postoperatively compared with RYGB. These findings should be considered in the preoperative evaluation and counseling of bariatric patients. Long-term follow-up is needed to compare safety and efficacy of SG versus RYGB.

Sleeve Gastrectomy Outcomes in Patients with BMI Between 30 and 35\u20133 Years of Follow-Up

Introduction and PurposeLaparoscopic sleeve gastrectomy (LSG) in patients with a BMI between 30 and 35 kg/m2 plus comorbidities has shown to be safe and effective. The purpose of this study is to describe our outcomes in this group of patients after 3 years of follow-up.Materials and MethodsRetrospective descriptive analysis of patients with initial BMI between 30 and 35 kg/m2 plus comorbidities were submitted to LSG between 2006 and 2013. We analyzed gender, age, comorbidities, BMI, total weight loss (%TWL), excess weight loss (%EWL), comorbidity resolution, morbidity, and mortality. Postoperative success was defined as %TWL over 20% and EWL% over 50% maintained for at least 1 year and comorbidity remission with no need of medication.ResultsOf the patients, 477 underwent a LSG in the above period and 252 met inclusion criteria; 188 (75%) were female and 64 (25%) were male. Median age was 39 years (15–70). Three-year follow-up was 43.9% (111 patients). Median preoperative BMI was 32.3 kg/m2 (30–34.3). Median postoperative %TWL was 12.9, 23.2, 28.2, 24.3, and 22.1% at 1, 6, 12, 24, and 36 months, respectively. %EWL was 42.88, 77.44, 98.42, 83.2, and 75.8%. Median surgical time was 86.9 min (40–120). There was comorbidity remission at 36 months. Insulin resistance was remitted in 89.4%, dyslipidemia 52%, non-alcoholic fatty liver disease 84.6%, hypertension 75%, and GERD 65%. T2DM had 60% of complete remission and 40% improvement. There were morbidity in six patients (2.4%), two reoperations, no leaks, and no mortality.ConclusionsPerforming LSG in patients with grade I obesity is safe and effective. BMI should not be the only indicator to consider bariatric and metabolic surgery. We still require further studies and longer follow-up.

Obesogenic Drugs and their Effects on Post-Laparoscopic Sleeve Gastrectomy Outcomes

Obesogenic Drugs and their Effects on Post-Laparoscopic Sleeve Gastrectomy Outcomes

Laparoscopic Sleeve Gastrectomy Outcomes of 750 Patients: A 2.5-Year Experience at a Bariatric Center of Excellence.

Laparoscopic sleeve gastrectomy (LSG) is gaining popularity worldwide. This retrospective cohort study evaluated the outcomes of a large cohort of patients with obesity who underwent LSG in a Bariatric Center of Excellence. All consecutive patients who underwent LSG between July 2013 and April 2016 were identified retrospectively. Preoperative and postoperative variables and comorbidities were recorded. The study consisted of 750 patients. Their mean age was 37.4 years; 72% were women, and the mean body mass index was 42.8 kg/m. The most common preoperative comorbidities were diabetes (23.3%), hyperlipidemia (21.9%), hypertension (21.1%), and obstructive sleep apnea (21.1%). The rates of comorbidity resolution during follow-up were 80.6%, 74.4%, 82.9%, and 94.3%, respectively. The percentage average excess weight loss 1, 3, and 6 months and 1 and 2 years after surgery was 29.4%±11.3%, 54.4%±17.7%, 76.9%±20.9%, 85.5%±23.6%, and 89.7%±27.6%, respectively. There was no mortality. LSG effectively and safely induced weight loss and comorbidity resolution.

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.

Effect of Surgeon Volume on Sleeve Gastrectomy Outcomes.

Prior studies have shown a relationship between surgeon volume and patient outcomes in Roux-en-Y gastric bypass (RYGB) patients. Laparoscopic sleeve gastrectomy (SG) is now the most common bariatric procedure, but there is a little data on surgeon volume and outcomes after SG. We examined the relationship between annual surgeon bariatric volume and 30-day complication rate after SG. The Bariatric Outcomes Longitudinal Database for 2011 was used for this study. Using 50 annual cases as a cutoff point, surgeons were classified as low (LV-SG) or high volume SG (HV-SG) and low (LV-RYGB) or high volume RYGB (HV-RYGB) providers. Multivariable logistic regression models were used to examine the effect of surgeon volume on 30-day readmissions, reoperations, and complications following SG while controlling for patient demographics and comorbidities. We identified 16,547 SG patients. After controlling for baseline characteristics, HV-SG surgeons had lower rates of 30-day complications (OR 0.80, 95% CI 0.64-0.92), reoperation (OR 0.69, 95% CI 0.52-0.90), and readmission (OR 0.73, 95% CI 0.61-0.88) compared to LV-SG surgeons. HV-RYGB surgeons had lower 30-day complication rates (OR 0.80, 95% CI 0.69-0.92), but were without differences in reoperation (OR 0.82, 95% CI 0.61-1.10) or readmission (OR 1.06, 95% CI 0.88-1.27) compared to LV-RYGB surgeons. High SG volume is associated with improved 30-day readmission, reoperation, and complication rates. Concurrent RYGB volume impacts the 30-day complication rate after SG, but does not affect the readmission or reoperation rate. Our findings suggest that SG-specific volume is important for optimal safety outcomes in SG patients.