Revisional Laparoscopic Sleeve Gastrectomy Research Articles

Two-Year Results of the Banded Versus Non-banded Re-sleeve Gastrectomy as a Secondary Weight Loss Procedure After the Failure of Primary Sleeve Gastrectomy: a Randomized Controlled Trial

BackgroundInsufficient weight loss or weight regain has been reported in up to 30% of patients after laparoscopic sleeve gastrectomy (LSG). Approximately 4.5% of patients who undergo LSG need revisional surgery for a dilated sleeve.MethodsThis randomized controlled trial compared the outcomes between banded (BLSG) and non-banded re-LSG (NBLSG) after weight regain. Percentage excess body weight loss (%EWL), percentage total weight loss (%TWL), associated medical problems, gastric volume measurement, and endoscopy were measured preoperatively and 1 and 2 years postoperatively.ResultsBoth groups (25 patients each) achieved similar % EWL and %TWL at six months, one year, and two years postoperatively (%EWL 46.9 vs. 43.6, 83.7 vs. 86.3, and 85.7 vs. 83.9) (p= > 0.151) (%TWL 23.9 vs. 21.8, 43.1 vs .43.3, 44.2 vs. 42.2) (p=>0.342), respectively. However, the body mass index was significantly lower with BLSG (24.9 vs. NBLSG, 26.9). Both groups showed a significant reduction in stomach volume after two years (BLSG -248.4 mL vs. NBLSG -215.8 mL). Food tolerance (FT) scores were significantly reduced in both groups, whereby BSLG had significantly lower FT with an average of -1.1 point. No significant differences were observed regarding improvement of the associated medical problems after the first and two years after revisional LSG or the postoperative complications between both groups.ConclusionLaparoscopic re-LSG is feasible and safe with satisfactory outcomes in patients with weight regain after LSG who have gastric dilatation without reflux esophagitis. Both groups had comparable significant weight loss effects and improvement of associated medical problems. The BLSG tends to have a more stable weight loss after two years with a significantly lower BMI, lower stomach volume, and less weight regain. Food tolerance decreased in both groups but reduced more in the BLSG group. After a 2-year follow-up, we may regard both procedures are safe, with no significant differences in the occurrence of complications and nutritional deficits.Graphical

Comparison of early post-operative complications in primary and revisional laparoscopic sleeve gastrectomy, gastric bypass, and duodenal switch MBSAQIP-reported cases from 2015 to 2019.

Sleeve gastrectomy (SG) is now the most performed bariatric surgery, though gastric bypass (GB) and duodenal switch (DS) remain common, especially as conversion/revision (C/R) procedures. This analysis compared early postoperative outcomes of primary and C/R laparoscopic SG to DS and GB; and primary procedures of each vs C/R counterparts. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) dataset was queried for SG, GB, and DS cases from 2015 to 2019. Multivariable logistic regression calculated crude and adjusted odds ratios for surgical site infection (SSI), reoperation, and readmission at 30days in two initial comparisons: (1) primary SG vs DS or GB and (2) C/R SG vs DS or GB. A secondary analysis compared primary GS, GB, or DS with C/R counterparts. Models were adjusted for confounding demographics and comorbidities. Of 755,968 primary cases, most were SG (72.8%), followed by GB (26.3%), then DS (0.9%). Compared to SG, GB and DS demonstrated higher odds of SSI (aOR 3.02 [2.84, 3.2]), readmission (aOR 1.97 [1.92, 2.03]), and reoperation (aOR 2.74 [2.62, 2.86]), respectively. Of 68,716 C/R cases, SG was most common (43.2%), followed by GB (37.5%), then DS (19.2%). C/R GB and DS demonstrated greater risk of SSI (aOR 2.28 [1.98, 2.62]), readmission (aOR 2.10 [1.94, 2.27]), and reoperation (aOR 2.3 [2.04, 2.59]) vs SG, respectively. C/R SG and DS demonstrated greater risk of SSI (OR 2.09 [1.66, 2.63]; 1.63 [1.24, 2.14), readmission (OR 1.13 [1.02, 1.26]), and reoperation (OR 1.27 [1.06, 1.52]; 1.58 [1.24, 2.0]), vs primary procedures. C/R DS demonstrated greater risk of SSI (OR 1.23 [1.66, 2.63]). Early complications are comparable between GB and DS, and greater than SG. In C/R procedures, GB and DS demonstrate greater risk than SG. Overall, C/R procedures demonstrate greater risk of most, but not all, early postoperative complications.

Long-Term Matched Comparison of Primary and Revisional Laparoscopic Sleeve Gastrectomy.

Reports of long-term (> 5-15-year) outcomes assessing the safety and efficacy of primary revisional laparoscopic sleeve gastrectomy (LSG) are few. Retrospective long-term comparisons of primary (pLSG) and revisional (rLSG) procedures were matched for gender, age ± 5years, and body mass index (BMI) ± 5kg/m2. Weight loss, associated medical condition status, and patient satisfaction were evaluated. Between May 1, 2006, and December 31, 2016, 194 matched patients with severe obesity (mean BMI 44.1 ± 6.7kg/m2; age 44.2 ± 10.0years, 67.0% female) underwent pLSG (n = 97) or rLSG (n = 97) and were followed for a mean 12.1 ± 1.5 vs 7.6 ± 2.1years. Respective mean weight regain from nadir was 15.0 ± 14.4kg vs 11.9 ± 12.2kg. Respective percent mean total weight loss and excess weight loss were 20.9 ± 12.7% and 51.8 ± 33.1%, and 18.3 ± 12.8% and 43.4 ± 31.6% at last follow-up, with no significant difference between groups. Resolution of type 2 diabetes (HbA1C < 6.5%, off medications) was 23.1% vs 11.1%; hypertension 36.0% vs 16.0%; and hyperlipidemia 37.1% vs 35.3%. Patients in the pLSG group were significantly more satisfied with LSG (59.8% vs 43.3%, p < 0.05) and more likely to choose the procedure again. There were no significant differences in long-term weight loss or associated medical condition outcomes in matched pLSG and rLSG patients.

Short-term outcomes of reinforcement of staple line during revisional laparoscopic sleeve gastrectomy.

Short-term outcomes of reinforcement of staple line during revisional laparoscopic sleeve gastrectomy.

A Comparison of One- and Two-Stage Laparoscopic Sleeve Gastrectomy Following Failed Laparoscopic Adjustable Gastric Banding Using the BAROS Score.

Revision of a failed band can be done by laparoscopic sleeve gastrectomy (LSG). It can be performed synchronously with band removal or during two separate procedures. Comparing single- and two-staged LSG following a failed LAGB in terms of short- and mid-term outcomes, with an emphasis on postoperative quality of life. A retrospective cohort study comparing revisional LSG's safety and efficacy after failed LAGB removal. Data included patients' medical files, as telephone interviews. We compared demographics, weight loss, complications, long-term outcomes, and quality-of-life measures, including the Bariatric Analysis and Reporting Outcome System (BAROS). Ninety-three patients were enrolled, of which 68 (73.1%) underwent a single-stage revisional LSG. Of these, 40 were males (35.1%) with a mean age of 44.9years (± 12.9). The two-staged group were older. The reasons for band removal differed between the groups: whereas in the two-stage surgery, the common causes were slippage (29.2%) or band intolerance (25%); in the single-stage group, it was weight gain (51%). There were no differences in short- and mid-term complications, weight loss, and quality of life. In selected cases, laparoscopic sleeve gastrectomy as a revision of failed gastric banding in one stage is as safe as a two-stage procedure in terms of short- and mid-term complications, weight loss, and quality of life. We believe that there is little benefit in performing elective surgery in two stages unless there are clinical indications. Exceptions for two-stage revision should include cases of band erosion and acute slippage with patient preference for band removal.

Long-term outcomes of sleeve gastrectomy as a revisional procedure after failed gastric band: a multicenter cross-matched cohort study

Laparoscopic adjustable gastric band (LAGB) is the bariatric procedure most likely subject to revisional surgery. Both laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB) represent viable options, but the long-term results are still lacking. In 2014, we published the 2-year follow-up of our multicenter cohort of revisional LSG after failed LAGB. Evaluate the long-term follow-up (median 9.3 years) of the same cohort of patients. University and primary-care hospitals, Italy. We retrospectively examined a prospectively maintained database of the previously published multicenter cohort of 56 patients who underwent LSG after failed LAGB between 2008–2011. The control group included cross-matched non-revisional LSGs. The primary endpoint was weight loss, secondary endpoints co-morbidities, and the need for further bariatric surgery. The study group included 44 patients and the control group 56. We found %EWL 53% Vs. 67% (p = .021), %EBMIL (54 Vs. 68%, p = .018), %TWL (26 Vs. 34%, p = .002). We also found more severe GERD (gastroesophageal reflux disease) symptoms in the revisional than in the primary group (9.0 vs. 1.8% mild and 23.0 vs. 3.0% severe). Ten patients from the revisional group (22.7%) vs. eight in the primary group (13%) underwent further bariatric surgery (LRYGB). Our results showed less favorable weight loss in revisional than primary LSG after LABG, higher prevalence of GERD, and a more frequent need for further revisional surgery. Despite the study’s limitations, the present data suggest that the long-term outcomes may offset the possible reduced short-term complication rate after revisional sleeve gastrectomy for a failed LABG.

Challenges in the Diagnosis of Leak After Sleeve Gastrectomy: Clinical Presentation, Laboratory, and Radiological Findings

BackgroundThe presentation of leak after laparoscopic sleeve gastrectomy (LSG) is variable. A missed or delayed diagnosis can lead to severe consequences. This study presents our experience: the clinical presentations, laboratory, and radiological findings in patients with leak after LSG.MethodsA retrospective review of patients who were diagnosed and treated as leak after LSG at our center (January 2012–November 2019).ResultsEighty patients developed leak: 68 (85%) after primary LSG, 6 (7.5%) after Re-LSG and 6 (7.5%) after band removal to revisional LSG. Mean age 35.9 ± 10 years. The diagnosis was within 18 ± 14 days after surgery. Five (6.3%) patients were diagnosed during the same admission. Only 29.3% of patients were diagnosed correctly from the first visit to the ER. Most were misdiagnosed as gastritis (49%) and pneumonia (22.6%). Thirty-four patients (45.3%) were diagnosed correctly at the third visit. The most common presenting symptoms were abdominal pain (90%), tachycardia (71.3%), and fever (61.3%). The mean white blood cells (WBCs) count was 14700 ± 5900 (cells/mm3), c-reactive protein (CRP) 270 ± 133 mg/L, lactic acid 1.6 ± 0.85 mmol/L, and albumin 30.3 ± 6.6 g/L. The abdominal CT scans revealed intraabdominal collection in 93.7% of patients, extravasation of contrast in 75%, and pleural effusion in 52.5%. Upper gastrointestinal contrast study (UGIC) showed extravasation of contrast in 77.5% of patients.ConclusionAbdominal pain, tachycardia, or fever after LSG should raise the suspicion of a leak. CT scan of the abdomen and UGIC study detected leaks in 75% and 77.5% consecutively. Only 29.3% of patients were diagnosed correctly as a leak from the first visit to the ER.

Management of leak after sleeve gastrectomy: outcomes of 73 cases, treatment algorithm and predictors of resolution.

IntroductionGastric leak post laparoscopic sleeve gastrectomy (LSG) is a severe complication that has been reported in 1.5–3% of cases. Management algorithms of leak exist; however, no known factors predict the time to resolution. This study aims to share outcomes of our management algorithm of post LSG leak, including the rate of resolution, complications, admission to the intensive care unit, conversion to other techniques, and mortality. To determine if any factors can predict the resolution time.MethodsA retrospective analysis of patients who had LSG leaks and was managed in the main tertiary center in Qatar (January 2012–December 2017).ResultsA total of seventy-three patients had post LSG leaks. Fifty-six (76.7%) underwent LSG outside our center. Thirteen leaks (17.8%) were after revisional LSG. Laparoscopic exploration was performed in twenty patients (27.4%) and feeding jejunostomy in nine patients (12.3%). Patients were followed up for 12 months. All healed within 8.8 ± 0.72 weeks. The resolution rate was (97.1%) without surgical conversion, while two patients required fistulo-jejunostomy. No patient died. Complications occurred; re-leak (14.9%) and splenic abscess (2.9%). Patients on jejunal feeding had shorter resolution time (HR = 2.7, P = 0.018), while patients on total parenteral nutrition and post-endoscopic dilatation had 66% and 50% increases in the resolution time; (HR = 0.34, P = 0.026) and (HR = 0.5, P = 0.047), respectively.ConclusionManagement of post-LSG leak is multimodal. Our clinical experience demonstrated less urge to perform extensive surgical interventions. Patients on enteral feeding had shorter resolution time while patients with sleeve stricture had a longer time to resolution.

Long-term outcomes of laparoscopic sleeve gastrectomy from the Indian subcontinent.

Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed metabolic surgery worldwide. There are few mid- to long-term studies for LSG, especially from the Indian subcontinent. The primary outcome of the study was percent total weight loss (%TWL), and secondary outcomes included type 2 diabetes mellitus remission (T2DM) rates, comorbidity resolution rates, revisional surgeries, and complications related to LSG, 3 and 5years after surgery. The study was a single-center, retrospective analysis from patients who underwent primary as well as revisional LSG between January 2012 and December 2013 from a tertiary care center in India. We included patients who completed a minimum follow-up of 5years. Details of the patients were collected from outpatient and inpatient case sheet records, during their follow-up. Out of a total of 284 patients, 57% were females. Mean baseline body mass index (BMI) was 44.9 ± 7.9kg/m2. The diabetic population comprised 14.8% of the total patients. Mean %TWL at 5years was 26.0 ± 9.9%. T2DM remission at 1, 3, and 5years were 78.5%, 71.4%, and 66.6%, respectively. Preoperative BMI (p= 0.02), glycosylated hemoglobin (HbA1c) (p= 0.04), duration of diabetes in years (p = 0.04), and preoperative insulin usage (p= 0.04) were the preoperative predictors for T2DM remission. Early (< 30days) and late (> 30days) complications were seen in 4.5% and 0.7% of the population, respectively. Weight loss after LSG was maintained in the majority of the patients, while a small proportion has significant weight regain at 5years. T2DM resolution and other comorbidity resolutions were well supported after LSG.

Efficiency of Laparoscopic One-Step Revision of Failed Adjusted Gastric Banding to Gastric Sleeve: a Retrospective Review of 101 Consecutive Patients.

Until recently, laparoscopic adjustable gastric banding (LAGB) was one of the most commonly performed bariatric surgeries worldwide. Today, its high rate of complications and failure rates up to 70% requires revisional surgery. The one-stage conversion from LAGB to laparoscopic sleeve gastrectomy (LSG) has been shown to be safe, although there are some concerns on efficacy and long-term weight loss. To demonstrate that one-step revision of LAGB to another restrictive procedure, such as LSG, might have efficient long-term outcomes. The charts from 133 revisional LSGs for failed or complicated LAGB were retrospectively reviewed for the period between January 2010 and August 2017. Thirty-two patients were excluded for loss to follow-up. Demographics, complications, and percentage of excess weight loss (%EWL) were determined. One hundred one patients were included (85 women and 16 men), with a mean age of 48.5years, and a mean body mass index of 47.1kg/m2. During the follow-up, 15 patients (15%) underwent a second revisional surgery for weight loss failure (8 Roux-en-Y gastric bypass (RYGBP), 3 biliopancreatic diversion, 3 single anastomosis duodenal-ileal bypass, 1 revisional LSG). Ten patients (10%) had long-term complications (8 severe reflux and 2 stenosis) during this period and underwent a second revisional surgery (10 RYGBP). The remaining 76 had a mean follow-up of 4.3years and a mean %EWL of 53.2%. Single-stage conversion to LSG is a safe and appropriate solution for failed or complicated LAGB with good long-term weight loss.

Early postoperative diet after bariatric surgery: impact on length of stay and 30-day events.

Pathways for enhanced recovery after surgery (ERAS) have been shown to improve length-of-stay (LOS) and post-operative complications across various surgical fields, however there is a lack of evidence-based studies in bariatric surgery. Specifically, the value of early feeding within an ERAS program in bariatric surgery is unclear. The objective of the current study was to determine the effect of early feeding on LOS for patients who underwent primary or revisional laparoscopic sleeve gastrectomy (LSG) and Roux-en-y gastric bypass (RYGB). Retrospective single institution study of implementation of a new diet protocol in which initiation of oral intake changed from post-operative day 1 to day 0. LOS and 30-day events were compared. Patients were excluded if they were planned for 23-h stay, had significant intra-operative complications, or required reoperation within the same admission. Mann-Whitney U tests were done to compare LOS and chi-squared tests to compare 30-day events pre- and post-intervention. A total of 244 patients were included; 84.4% were primary cases. 50.8% of cases occurred prior to early feeding implementation. Median age was 43.5years (IQR 33-53) and majority of patients were female (78.7%). Median LOS was 32.6 (IQR 30.0-50.6). Median LOS across the whole sample was shorter in the early feeding group (36.2 vs. 31.0h; p < 0.001). This difference remained statistically significant for primary, but not revisional cases. Post-operative events at 30days were similar between pre- and post-intervention groups. Early feeding the day of surgery is associated with significantly shorter LOS for patients who undergo bariatric surgery with no difference in 30-day readmissions.

The Birmingham experience of high-pressure methylene blue dye test during primary and revisional bariatric surgery: A retrospective cohort study.

IntroductionLeak following bariatric surgery continues to be associated with morbidity and rarely mortality. With improvement in surgical techniques and stapler design, leak rates have reduced drastically. Intra-operative high pressure Methylene blue leak test (HPMB) is one of the techniques employed to confirm integrity of anastomoses and staple lines. Despite this, evidence for its use remains limited. We evaluated the role of HPMB in detecting and preventing leaks.MethodsA retrospective cohort of consecutive patients who underwent primary or revisional Laparoscopic Sleeve Gastrectomy (SG) or Laparoscopic Roux-en-Y Gastric bypass (RYGB) under the care of five surgeons in three centres across Birmingham, UK, between 2012 and 2016 were assessed. All patients had routine HPMB at the end of the procedure. Demographics, HPMB positivity, and post operative leaks were recorded.Results924 patients underwent bariatric surgery: 696(75.3%) RYGB, and 225(24.3%) SG. 85(9.2%) were revisional procedures.Two HPMB were positive, which necessitated staple or suture line reinforcement with sutures intra-operatively. The patients had an uneventful recovery. 5 patients had postoperative leaks, all of whom had negative intraoperative HPMB: 3 SG patients; and 2 RYGB patients (gastro-jejunostomy anastomotic leaks). There was no statistically significant relationship between positive HPMB and anastomotic leak (Fishers exact test; p = 1).ConclusionDespite routine use of methylene blue dye test in 924 patients, there were only two positive tests. Whilst HPMB may demonstrate technical failure, this study suggests that there is no role for its routine use in primary bariatric surgery. Discontinuation of this practice would reduce risk of anaphylaxis to the dye, cost, and intra-operative time.

Fistula Following Laparoscopic Sleeve Gastrectomy: a Proposed Classification and Algorithm for Optimal Management.

Laparoscopic sleeve gastrectomy (LSG) is an accepted restrictive procedure with a hormonal component. There is no definitive course of treatment for post-LSG fistula; it remains a feared complication. We aimed to classify post-LSG fistulas and propose an algorithm to optimize their treatment. Following primary and revisional LSG in obese patients, a retrospective observational study of fistulas was undertaken. Radiological studies were performed to identify anatomically distinct types of fistulas. An algorithm was elaborated for the classification and evolving treatment of each type of fistula. Twenty post-LSG fistulas were studied (13 [2.5%] from our center, 7 referred) with a mean body mass index of 43.1±10.2kg/m2 (32.0-76.0) and mean age of 33.1±11.4years (20.0-56.0). In all cases, the clinically suspected diagnosis was radiologically confirmed by water-soluble upper gastrointestinal series and double-contrast abdomino-pelvic CT scan. Three anatomical fistula types were characterized: type I, a small leak with no collection; type II, a leak with associated intra-abdominal abscess; and type III, a leak with multiple internal or external abscesses, a complex fistula. In accord with our algorithm, patients without sepsis received conservative treatment initially; this was sufficient for type I leaks. Type II abscesses received internal or external percutaneous drainage, and in some cases, stenting or endoprosthesis. Surgery was reserved for failure of conservative options and type III fistula. In cases of sepsis, surgery was mandatory. A radiologically defined, anatomically based classification system and treatment algorithm proved effective in clinical management of post-LSG fistula.

Revisional Surgery After Failed Laparoscopic Sleeve Gastrectomy: Retrospective Analysis of Causes, Results, and Technical Considerations

A failed laparoscopic sleeve gastrectomy (LSG) presents a challenging problem for bariatric surgeons. The aim of this study was to evaluate the indications, treatment strategies, and surgical outcomes of patients who underwent a revisional surgery after a failed LSG. This retrospective study included the outcomes of 32 patients who required a revisional surgery from a series of 500 primary LSGs. The patients' demographic data, indications for revisional surgery, perioperative complications, and postoperative outcomes were recorded. A total of 500 patients underwent primary LSGs during the study period, and 32 of these patients were subjected to revisional bariatric surgery after a failed LSG. Weight regain, poor weight loss, and gastroesophageal reflux disease (GERD) were the most common causes of revision. A revisional LSG (r-LSG) was performed in 23 patients, while 9 patients received a revisional laparoscopic Roux-en-Y gastric bypass (r-LRYGB). There were complete sleeve pouch dilations in 10 patients. A residual fundus and antrum dilation was detected in 5 and 8 patients, respectively. The r-LRYGB procedure was performed for GERD-related symptoms in 6 patients and 3 other patients underwent r-LRYGB due to the intake of high-caloric foods. The mean operative time, length of hospital stay, and complication rates of revisional surgeries were significantly higher than the total cohort. Although r-LSG and r-LRYGB seem to be safe and effective treatment options after a failed LSG, revisional procedures were associated with an increased complication rate. Attention to technical details of the primary LSG may reduce the revision requirements.

Roux-En-Y Gastric Bypass versus Sleeve Gastrectomy as Revisional Procedure after Adjustable Gastric Band: a Systematic Review and Meta-Analysis.

We aim to review the available literature on obese patients treated with laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) after failed laparoscopic adjustable gastric banding (LAGB), in order to compare the clinical outcomes of the two methods. A systematic literature search was performed in PubMed, CENTRAL, and Scopus databases, in accordance with the PRISMA guidelines. Eight studies met the inclusion criteria incorporating 635 patients. Both procedures are associated with comparable complications, conversions, mean hospital stay, and weight loss at 6 and 12months. In the LRYGB group, % excess weight loss (%EWL) and BMI reduction after 24months were increased. Well-designed, randomized controlled studies, comparing revisional LRYGB and LSG, are necessary to further assess their outcomes.

Revisional Laparoscopic Sleeve Gastrectomy in failed gastric banding and effects of exercise and frequent sweet-eating on its outcome.

Objective:To find out effectiveness of revisional laparoscopic sleeve gastrectomy (RLSG) in the patients who had laparoscopic adjustable gastric banding (LAGB) and failed to reduce or regained the weight and effectiveness of sweet abstaining and exercise on postoperative weight loss.Methods:This retrospective observational study was conducted at AlMoosa Hospital, Al-Ahsa, Kingdom of Saudi Arabia from December 2011 to November 2016. The patients who failed to reduce, regained the weight or had complications after LAGB, were performed RLSG. They were followed-up at three, six, twelve and twenty-four months intervals. Their weight, percent excess weight loss (%EWL) and body mass index (BMI) at pre-RLSG were compared with post-RLSG. The data was recorded in SPSS 22 and analyzed.Results:Thirty-six patients with male/female ratio of 1:5 underwent RLSG. Twelve (33.3%) were frequent sweet-eaters and twenty-four (66.7%) were not. Fourteen (38.88%) did not have exercise, while twenty-two (61.11%) had daily regular exercise. Their mean pre-RLSG weight, percent excess weight loss (%EWL)and BMI were compared with post-RLSG at the period of three, six, twelve and twenty-four months. Their mean weight reduced from 111.69 kilograms to 96.94, 87.25, 79.56 and 76.11 kilograms respectively. Their mean of the percent excess weight loss (%EWL) reduced to 22.08, 45.75, 59.64 and 66.42 kilograms respectively. Their mean pre-RLSG BMI was 43.50 kg.m-2, which reduced to the mean of 37.79, 34.02, 30.97 and 29.70 respectively. There were no post-operative complications in thirty (83.3%), mild like wound infection and seroma in four (11.1%) and bleeding in two (5.6%) patients. None of the patients had leakage. The patients who kept themselves abstained from sweet consumption and performed regular postoperative exercise had better results. They also had considerable reduction in appetite after RLSG.Conclusion:RLSG is an effective procedure after failed LAGB in terms of weight loss having minimal rate of complications. Moreover, abstaining from sweet consumption and continuing exercise postoperatively has better results.

Revisional laparoscopic sleeve gastrectomy after primary obesity surgery endolumenal (POSE)

Obesity has now become a worldwide problem, with numbers continuously rising. While conservative weight loss measures can be beneficial for some people, bariatric surgeries have opened up a new frontier for the management of obesity in a certain subset of patients eligible for it. Multiple bariatric procedures are currently available, and the choice of surgery is dependent on the individual patient’s specifications.

Long-term outcome after laparoscopic sleeve gastrectomy in patients over 65 years old: a retrospective analysis

BackgroundBariatric surgery has been proven to be a safe and effective treatment for obesity with BMI (body mass index) reduction, and resolution or lowering of obesity-related co-morbidities. The relative age limit for bariatric surgery has gradually been increased to 60 years of age and above. ObjectivesThe aim of this study was to assess the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) performed in older patients (≥65 years old). SettingUniversity hospital. MethodsBetween May 1, 2007 and November 30, 2013, 30 consecutive patients≥65 years old were included in this retrospective study of our prospectively collected bariatric database. ResultsA total of 27 (90%) primary LSG and 3 revisional LSG (10%) were performed. Mean patient age was 67.2 (range: 65–74) years, and mean preoperative BMI (±standard deviation [SD]) was 44.1±5.6 kg/m2. Thirty-day morbidity included 3 cases of self-limiting nausea and vomiting and 1 case of gastric sleeve stenosis necessitating conversion to gastric bypass. No mortality reported. The overall mean percentage of excess weight loss (±SD) and percentage of total weight loss (±SD) at 12 months were 53.8±19.8 and 23.9±8.4; 52.9±21.8 and 24±9.9 at 36 months, respectively. No patients were lost to follow-up but 5 were excluded because they underwent revisions.Age-adjusted mixed model analyses revealed that baseline BMI (P = .018), BMI>45 kg/m2 (P = .001), and having diabetes (P = .030) were associated with excess weight loss<50% across follow-up. ConclusionLSG seems to be effective and safe for patients≥65 years old. Obesity related co-morbidities have improved across follow-up. BMI>45 kg/m2 and diabetes is associated with insufficient weight loss or weight regain.

Impact of the Surgical Experience on Leak Rate After Laparoscopic Sleeve Gastrectomy.

Laparoscopic sleeve gastrectomy (LSG) has become one of the most commonly performed bariatric procedures, largely due to several advantages it carries over more complex bariatric procedures. LSG is generally considered a straightforward procedure, but one of the major concerns is a staple line leak. The objectives of this study are to evaluate the correlation between surgeon's experience and leak rate and to assess the different risk factors for developing a gastric leak after LSG. Private hospital, France. The analysis of a single surgeon's yearly leak rate since the introduction of LSG for possible risk factors was done. A total of 2012 LSGs were performed in between September, 2005 and December, 2014. Twenty cases (1%) of gastric leak were recorded. Of these, 17 patients were women (94.4%) with a mean age of 39.4years (range 22-61) and mean body mass index (BMI) 41.2kg/m(2) (range 34.8-57.1). On a yearly basis, the leak rate was 4.8% (2006), 5.7% (2007), 0 (2008), 2.6% (2009), 2% (2010), 0.8% (2011), 0.6% (2012), 0.2% (2013), and 0 (2014). In the first 1000 cases (group A), there were 18 cases of gastric leak and in the last 1000 cases, there were 800 with GORE® SEAMGUARD® Bioabsorbable Staple Line Reinforcement (group B) 2 cases of gastric leak (p = 0.009). A revisional LSG, 395 patients after gastric banding and 61 patients re-sleeve gastrectomy, was performed in 456 cases (22.7%). There were 3 cases of leak (0.65%). There were two deaths. LSG can be performed with a low complication rate. This large series of a single surgeon's experience demonstrated that the leak rate after LSG could be significantly decreased over time with changes in techniques.

Fully Ambulatory Laparoscopic Sleeve Gastrectomy: 328 Consecutive Patients in a Single Tertiary Bariatric Center.

Laparoscopic sleeve gastrectomy (LSG) is becoming one of the most popular bariatric procedures because of its short operative time, good resolution of comorbidities, excellent weight loss, and low complications rate. However, the safety of LSG as a day-surgery procedure has not yet been widely documented. A retrospective analysis of a prospectively collected bariatric database, in a single institution, between August 2012 and February 2015, yielded 980 patients who underwent LSG; 328 patients (33.5%) responded to established criteria and were operated on a 1-day surgery basis (length of stay < 12h). There were 258 (78%) primary LSG and 70 revisional LSG (22%) performed on 284 females and 44 males, with a mean age (±SD) of 38 ± 9years. Mean (±SD) preoperative body mass index (BMI) was 45 ± 6kg/m(2). Operative time was 68 ± 17min (mean ± SD). There were no deaths. A total of 322 patients (98.2%) were discharged home the day of surgery. There were 6 (1.8%) unplanned overnight hospitalization, and 28 patients (8.5%) were readmitted between days 1 and 30. Most patients (25/34, 73%) were hospitalized for minor problems, such as pain, nausea, and/or vomiting. There were two cases of (0.6%) gastric staple line leaks, three (0.9%) of intra-abdominal hematomas, two (0.6%) of pneumonia, one (0.3%) of acute pancreatitis, and one (0.3%) of urinary tract infection. All patients recovered well. LSG can be performed as an outpatient procedure in selected patients, with acceptable results in terms of retention, readmission, and complication rates.