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Chirurgie 1. Jänner 2012

Technique and results of single-step laparoscopic sleeve resection*

BACKGROUND: The epidemic of obesity assumes vast proportions with approximately estimated 2.3 billion overweight adults and more than 700 millions defined as obese according to the World Health Organization in 2015. The close relation between obesity and its co-morbidities such as hypertension, insulin resistance and diabetes mellitus type 2 are well documented. Laparoscopic sleeve gastrectomy (LSG) was initially described as a first-step procedure followed by either biliopancreatic diversion with duodenal switch (BPD-DS) or Roux-en-Y gastric bypass (RYGBP) in super-super obese patients (i.e. BMI>60 kg/m2) or in high-risk patients. On the other hand the role of LSG as a single procedure is yet unclear and controversial. METHODS: We report about 83 patients enrolled for LSG as single bariatric procedure and a follow-up period of 12 months or more. Follow-up was performed continuously every 3 months and data regarding weight loss, GERD and subjective well-being as well as blood samples were collected. Mean preoperative BMI was 49 kg/m2 (range 38–74). RESULTS: Within 12 months patients reached a mean EWL of 63% (31–90%). 22 patients, who suffered preoperatively from diabetes mellitus type 2 showed amelioriation of the disease. Hba1c levels dropped from 6.2% to 5.3%. In 2 (2.4%) cases patients had to be reoperated because of bleeding. 1 (1.2%) patient underwent reoperation because of leakage of the staple line. 13 (15.7%) patients complained about GERD symptoms. Some patients showed occasional symptoms, others could be treated conservatively. CONCLUSIONS: Single-step LSG is very well accepted by patients and seems to be efficient regarding weight loss, although large studies concerning long-term results are still rare. In our patients there are some cases of GERD, which seem to ameliorate in the course of time, but objective data are still lacking and further evaluation is necessary.

A. Abrahim, C. Sperker, M. Kees-Belyus, J. Brix, H. P. Kopp, M. Schermann, R. Roka, European Surgery 1/2012

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