Prognostic Factors for Morbimortality in Sleeve Gastrectomy. The Importance of the Learning Curve. A Spanish-Portuguese Multicenter Study

Sánchez-Santos, Raquel; Codina, Ricard Corcelles; Vilallonga, Ramón; Rivilla, Salvadora Delgado; Valls, José Vicente Ferrer; Corvinos, Javier Foncillas; Noguera, Carlos Masdevall; Macías, M. Socas; Gomes, Pedro; Ponz, Carmen Balaguè; Palacios, Jorge de Tomás; Sebastián, Sergio Ortiz; Sánchez‐Pernaute, Andrés; Puche, José; Déjardin, Daniel del Castillo; Vega, Julen Abasolo; Mans, E.; Navarro, Ana García; Escribano, Carlos Duran; Fernández, Norberto Cassinello; Climent, Nieves Perez; Solanas, José Antonio Gracia; Nisa, Francisca García‐Moreno; Matías, Alberto Hernández; Azcárate, Víctor Valentí; Folqués, José Eduardo Pérez; Garcia, Inmaculada Navarro; Lanuza, E Domínguez-Adame; Botello-Martinez, Francisco; Fernández, Jesús González

doi:10.1007/s11695-016-2229-6

Cited by 26 publications

(17 citation statements)

References 43 publications

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“…The lack of adherence to follow-up was reported previously, and it can be related to several issues, including the distance to the medical office and a lack of trust or rapport with the surgeon or the medical team[46]. However, the most relevant strength of this study is that all patients underwent a standardized LSG operative technique, first, because surgeon expertise is a key issue to lower the complications rate[13,24] and second, because there were no technical differences that may influence the weight loss results. We always tried to perform a more restrictive LSG by using a thinner bougie and beginning the dissection 3 cm from the pylorus to achieve greater weight loss, as suggested by Baltasar et al[8,31].…”

Section: Discussionmentioning

confidence: 93%

“…However, LSG can be a very difficult procedure even for laparoscopic surgeons with advanced skills. The surgeon’s experience and some technical aspects, such as the bougie size (less than 40 F) and the distance to the pylorus being less than 4 cm from the first stapling, have been previously reported as risk factors for the development of complications after a LSG[13]. …”

Section: Discussionmentioning

confidence: 99%

“…The number of LSGs performed worldwide has grown exponentially over the last decade, because it appears to be an easier and safer technique[10-13]. Many surgeons now perform LSG as their standard bariatric operation[3].…”

Section: Introductionmentioning

confidence: 99%

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Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity: A prospective study

Hoyuela¹

2017

WJGS

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AIMTo prospectively evaluate the postoperative morbi-mortality and weight loss evolution of patients who underwent a laparoscopic sleeve gastrectomy (LSG) as a primary bariatric procedure during 5 years of follow-up.METHODSSince 2006, data from patients undergoing a highly restrictive primary LSG have been prospectively registered in a database and analysed. Preoperative co-morbid conditions, operating time, hospital stay, early and late complications rate and evolution of weight loss after 5 years of follow-up were analysed.RESULTSA total of 156 patients were included, 74.3% of whom were women. The mean age was 43.2 ± 13.1 years and the mean body mass index (BMI) was 41.5 ± 7.9 kg/m2. Seventy patients (44.8%) presented a BMI under 40 kg/m2. The mortality rate was 0%. The leakage rate was 1.2%, and the total 30-d morbidity rate was 5.1% (8/156). With a mean follow-up of 32.7 ± 28.5 (range 6-112) mo, the mean percent of excess of weight loss (%EWL) was 82.0 ± 18.8 at 1 year, 76.7 ± 21.3 at 3 years and 60.3 ± 28.9 at 5 years. The mean percent of excess of BMI loss (%EBMIL) was 94.9 ± 22.4 at 1 year, 89.4 ± 27.4 at 3 years and 74.8 ± 29.4 at 5 years. Patients with preoperative BMI less than 40 kg/m2 achieved greater weight loss than did the overall study population. Diabetes remitted in 75% of the patients and HTA improved in 71.7%. CPAP masks were withdrawn in all patients with obstructive sleep apnoea.CONCLUSIONLSG built with a narrow 34 F bougie and starting 3 cm from the pylorus proved to be safe and highly effective in terms of weight loss as a stand-alone procedure, particularly in patients with a preoperative BMI lower than 40 kg/m2.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity: A prospective study

Hoyuela¹

2017

WJGS

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“…The reason for this increase is multi-factorial. It is perceived as a less technically demanding procedure to perform and to learn [ [11] , [12] , [13] , [14] ] although two recent studies have suggested the true learning curve may be up to 100 cases [ 45 , 46 ]. LSG avoids the need for intestinal anastomosis and allows full endoscopic access to the duodenum and biliary tree after surgery.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Roux-en-Y gastric bypass is as safe as laparoscopic sleeve gastrectomy. Results of a comparative cohort study

Lynn

Ilczyszyn

Davids

et al. 2018

Annals of Medicine and Surgery

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BackgroundA meta-analysis and six randomized controlled trials show higher 30-day complication rates with laparoscopic Roux-en-Y gastric bypass (LRYGB) than with laparoscopic sleeve gastrectomy (LSG).AimTo identify any difference in 30-day outcomes of patients treated with LRYGB or LSG when a standardized technique and identical post-operative protocol was followed with all procedures being conducted either by or under the supervision of a single consultant surgeon who had significant experience in bariatric surgery prior to commencing independent practice.MethodsA prospectively collected database of all patients under primary LRYGB or LSG, between March 2010 and February 2017, was analyzed. Data on demographics, length-of-stay (LOS), conversion to open, 30-day complications and mortality were reviewed.ResultsOver a seven-year period, 485 patients (LRYGB-279 and LSG-206) were included. There were no significant demographic differences and no difference in the pre-operative risk scoring [American Society of Anesthesiologists (ASA) and obesity surgery mortality risk score (OSMRS)] between the groups. There was no significant difference between the groups in terms of LOS (p = 0.275), complications (p = 0.920), re-admissions (p = 0.593) or re-operations (p = 0.366) within 30-days. There were no conversions to open or in-patient mortality in either group.ConclusionsUnlike previous studies, we found no difference in early complication rates between LRYGB and LSG in a comparable cohort when performed by a surgeon with sufficient experience in bariatric surgery.

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“…Una posible explicación seria que el presente trabajo solo consideró pacientes con comorbilidades (DM2, dislipidemia, hipertensión arterial) independientemente del tipo de obesidad. Sanchez et al (33) encontraron que algunos de estos factores como diabetes condicionan peores resultados ponderales de los pacientes sometidos a cirugía bariátrica.…”

Section: Agradecimientosunclassified

El índice Homa-ir como factor predictor de reducción de peso en pacientes con un IMC ≥ 35 sometidos a cirugía Bariátrica según la técnica Manga gástrica entre los años 2014-2017 en la clínica de día Avendaño.

Tapia¹,

Carmen²

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Introducción: La cirugía bariátrica es considerada la herramienta más efectiva para el tratamiento de obesidad severa. No es claro si los pacientes con resistencia a la insulina responden igual que otras personas. Nuestro objetivo es evaluar asociación entre el índice HOMA-IR preoperatorio con el porcentaje de sobrepeso perdido (%PSP) un año post-cirugía bariátrica usando la técnica manga gástrica (MG). Materiales y Métodos: Cohorte retrospectiva incluyendo pacientes ≥18 años con IMC ≥35 Kg/m2 intervenidos por primera vez con MG entre 2014–2017 en la Clínica Avendaño, Perú. Se incluyó solo aquellos con diabetes mellitus tipo 2, hipertensión arterial o dislipidemia. Un %PSP al año ≥60% fue considerado satisfactorio. Se usó regresión Lineal y de Poisson con varianza robusta en forma cruda y ajustada para evaluar asociaciones con %PSP. Resultados: La muestra de 91 pacientes tuvo una mediana de 34 años y 57,1% fueron mujeres. 85,7% presentaron resistencia a la insulina según HOMA-IR. Al año post cirugía, 76,9% tuvo un %PSP satisfactorio. En el modelo lineal ajustado, por cada año de edad adicional hubo 0,29% menos %PSP (p=0,019), y por cada punto extra del HOMA-IR hubo 0,93% más %PSP (p=0,004). La regresión de Poisson ajustada mostró 2% menos éxito por cada año de edad adicional (p=0,050) y 2% más éxito por cada punto adicional de HOMA-IR (p=0,038). Conclusiones: Se encontró asociación entre mayor valor pre-quirúrgico de HOMA-IR con un mayor %PSP al año post-cirugía. Es posible que la insulino resistencia no reduzca los resultados de la cirugía bariátrica MG.

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Prognostic Factors for Morbimortality in Sleeve Gastrectomy. The Importance of the Learning Curve. A Spanish-Portuguese Multicenter Study

Cited by 26 publications

References 43 publications

Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity: A prospective study

Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity: A prospective study

Laparoscopic Roux-en-Y gastric bypass is as safe as laparoscopic sleeve gastrectomy. Results of a comparative cohort study

El índice Homa-ir como factor predictor de reducción de peso en pacientes con un IMC ≥ 35 sometidos a cirugía Bariátrica según la técnica Manga gástrica entre los años 2014-2017 en la clínica de día Avendaño.

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