Abstract
Background
Providing bariatric surgery services to an inner-city population is a challenge. Laparoscopic sleeve gastrectomy (LSG) is an effective operation for morbid obesity with a relatively low complication rate. LSG appears to be a suitable alternative procedure for this group of patients.
Methods
This is a retrospective review and analysis of the experience with 185 consecutive LSGs that had completed at least 6 months follow-up. Eleven conversions from LSG to laparoscopic Roux-en-Y gastric bypass were excluded, leaving 174 patients for outcome analysis. Data collected were patient demographics, body mass index (BMI), comorbid conditions, operating time, length of hospital stay, and perioperative complications. Weight loss and resolution/improvement of comorbidities were analyzed.
Results
Mean patient age was 39.58 years and mean BMI was 48.97 kg/m2. The percentage of patients with BMI > 50 kg/m2 was 37.94%. Mean excess weight loss (EWL) was 44.76, 55.52, 59.22, and 58.92% at 6, 12, 24, and 36 months, respectively. Six patients (3.24%) lost less than 25% EWL. Thirteen patients (7.02%) regained an average of 13 lb after reaching a plateau. Resolution/improvement of comorbidities was 84% for diabetes mellitus, 49.99% for hypertension, 90% for asthma, 90.74% for obstructive sleep apnea, and 45.92% for gastroesophageal reflux disease symptoms (GERD). The mortality rate was zero in this series. Perioperative complications occurred in 26 patients (14.05%): four staple-line leaks (2.16%), four bleeds (2.16%), four obstructions (2.16%), five vomiting/dehydration (2.70%), six new onset of GERD symptoms (3.24%), two with pneumonia (1.08%), and one with pulmonary embolism (0.54%).
Conclusion
LSG results in stable and adequate weight loss with resolution/improvement in comorbidities in a high percentage of patients. It can be considered a definitive operation for morbid obesity.
Similar content being viewed by others
References
Hess DS, Hess DW (1998) Biliopancreatic diversion with a duodenal switch. Obes Surg 8:267–282
Ren CJ, Patterson E, Gagner M (2000) Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg 10:514–523; Discussion 524
Johnston D, Dachtler J, Sue-Ling HM, King RF, Martin G (2003) The Magenstrasse and Mill operation for morbid obesity. Obes Surg 13:10–16
Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery (2010) Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis 6:1–5
Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, Gfrerer L, Ludvik B, Zacherl J, Prager G (2010) Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg 20:535–540
D’Hondt M, Vanneste S, Pottel H, Devriendt D, Van Rooy F, Vansteenkiste F (2011) Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss. Surg Endosc 25(8):2498–2504
Himpens J, Dobbeleir J, Peeters G (2010) Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg 252:319–324
Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545
Deitel M, Greenstein RJ (2003) Recommendations for reporting weight loss. Obes Surg 13:159–160
Deitel M (2003) Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obes Surg 13:329–330
Blackburn GL, Walker WA (2005) Science-based solutions to obesity: What are the roles of academia, government, industry, and health care? Am J Clin Nutr 82:207S–210S
Drewnowski A, Specter SE (2004) Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr 79:6–16
New York State Department of Health (2008–2009) Statistics and data, obesity statistics by county. Available at http://www.health.state.ny.us/statistics/prevention/obesity/. Accessed 28 Nov 2011
Martin M, Beekley A, Kjorstad R, Sebesta J (2010) Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis. Surg Obes Relat Dis 6:8–15
Iannelli A, Facchiano E, Gugenheim J (2006) Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg 16:1265–1271
Cable CT, Colbert CY, Showalter T, Ahluwalia R, Song J, Whitfield P, Rodriguez J (2011) Prevalence of anemia after Roux-en-Y gastric bypass surgery: What is the right number? Surg Obes Relat Dis 7(2):134–139
Vilarrasa N, San José P, García I, Gómez-Vaquero C, Medina Miras P, de Gordejuela AG, Masdevall C, Pujol J, Soler J, Gómez JM (2011) Evaluation of bone mineral density loss in morbidly obese women after gastric bypass: 3-year follow-up. Obes Surg 21:465–472
Favretti F, O’Brien PE, Dixon JB (2002) Patient management after LAP-BAND placement. Am J Surg 184:38S–41S
Freeman JB, Burchett H (1983) Failure rate with gastric partitioning for morbid obesity. Am J Surg 145:113–119
Halverson JD, Zuckerman GR, Koehler RE, Gentry K, Michael HE, DeSchryver-Kecskemeti K (1981) Gastric bypass for morbid obesity: a medical–surgical assessment. Ann Surg 194:152–160
Oria HE, Moorehead MK (2009) Updated Bariatric Analysis and Reporting Outcome System (BAROS). Surg Obes Relat Dis 5:60–66
Srinivasa S, Hill LS, Sammour T, Hill AG, Babor R, Rahman H (2010) Early and mid-term outcomes of single-stage laparoscopic sleeve gastrectomy. Obes Surg 20:1484–1489
Arias E, Martínez PR, Ka Ming Li V, Szomstein S, Rosenthal RJ (2009) Mid-term follow-up after sleeve gastrectomy as a final approach for morbid obesity. Obes Surg 19:544–548
Meguid MM, Glade MJ, Middleton FA (2008) Weight regain after Roux-en-Y: a significant 20% complication related to PYY. Nutrition 24:832–842
Magro DO, Geloneze B, Delfini R, Pareja BC, Callejas F, Pareja JC (2008) Long-term weight regain after gastric bypass: a 5 year prospective study. Obes Surg 18:648–651
Skrekas G, Lapatsanis D, Stafyla V, Papalambros A (2008) One year after laparoscopic “tight” sleeve gastrectomy: technique and outcome. Obes Surg 18:810–813
Gill RS, Birch DW, Shi X, Sharma AM, Karmali S (2010) Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surg Obes Relat Dis 6:707–713
Nocca D, Krawczykowsky D, Bomans B, Noël P, Picot MC, Blanc PM, de Hons C, Millat B, Gagner M, Monnier L, Fabre JM (2008) A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obes Surg 18:560–565
Lee CM, Cirangle PT, Jossart GH (2007) Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc 21:1810–1816
Yehoshua RT, Eidelman LA, Stein M, Fichman S, Mazor A, Chen J, Bernstine H, Singer P, Dickman R, Beglaibter N, Shikora SA, Rosenthal RJ, Rubin M (2008) Laparoscopic sleeve gastrectomy–volume and pressure assessment. Obes Surg 18:1083–1088
Braghetto I, Lanzarini E, Korn O, Valladares H, Molina JC, Henriquez A (2010) Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients. Obes Surg 20:357–362
Keidar A, Appelbaum L, Schweiger C, Elazary R, Baltasar A (2010) Dilated upper sleeve can be associated with severe postoperative gastroesophageal dysmotility and reflux. Obes Surg 20:140–147
Himpens J, Dapri G, Cadière GB (2006) A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg 16:1450–1456
Cottam D, Qureshi FG, Mattar SG, Sharma S, Holover S, Bonanomi G, Ramanathan R, Schauer P (2006) Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc 20:859–863
Melissas J, Koukouraki S, Askoxylakis J, Stathaki M, Daskalakis M, Perisinakis K, Karkavitsas N (2007) Sleeve gastrectomy: A restrictive procedure? Obes Surg 17:57–62
Braghetto I, Davanzo C, Korn O, Csendes A, Valladares H, Herrera E, Gonzalez P, Papapietro K (2009) Scintigraphic evaluation of gastric emptying in obese patients submitted to sleeve gastrectomy compared to normal subjects. Obes Surg 19:1515–1521
Bernstine H, Tzioni-Yehoshua R, Groshar D, Beglaibter N, Shikora S, Rosenthal RJ, Rubin M (2009) Gastric emptying is not affected by sleeve gastrectomy—scintigraphic evaluation of gastric emptying after sleeve gastrectomy without removal of the gastric antrum. Obes Surg 19:293–298
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737
Disclosures
Dr. Ajay Chopra is a surgical consultant for Ethicon Endo-Surgery, Cincinnati, OH. Dr. Edward Chao, Dr. Yana Etkin, Dr. Jayne Lieb, Dr. Harry Delany, and Lynn Merklinger have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chopra, A., Chao, E., Etkin, Y. et al. Laparoscopic sleeve gastrectomy for obesity: can it be considered a definitive procedure?. Surg Endosc 26, 831–837 (2012). https://doi.org/10.1007/s00464-011-1960-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-011-1960-2