Laparoscopic Sleeve Gastrectomy Changes in the Last Decade: Differences in Morbidity and Weight Loss

Balla, Andrea; Quaresima, Silvia; Leonetti, Frida; Paone, Emanuela; Brunori, Marco; Messina, Teresa; Seitaj, Ardit; Paganini, Alessandro M.

doi:10.1089/lap.2017.0059

Cited by 14 publications

(20 citation statements)

References 23 publications

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“…In addition, we examined how the results of each analysis changed if we removed follow-up censoring due to switching to a different procedure. Finally, because the SG technique evolved rapidly during the study period (26, 27), we examined whether 1-year weight loss for SG patients differed by year of surgery.…”

Section: Methodsmentioning

confidence: 99%

Comparative Effectiveness and Safety of Bariatric Procedures for Weight Loss

et al. 2018

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Background: There has been a dramatic shift in use of bariatric procedures, but little is known about their long-term comparative effectiveness. Objective: To compare weight loss and safety among bariatric procedures. Design: Retrospective observational cohort study, January 2005 to September 2015. (ClinicalTrials.gov: ) Setting: 41 health systems in the National Patient-Centered Clinical Research Network. Participants: 65 093 patients aged 20 to 79 years with body mass index (BMI) of 35 kg/m2 or greater who had bariatric procedures. Intervention: 32 208 Roux-en-Y gastric bypass (RYGB), 29 693 sleeve gastrectomy (SG), and 3192 adjustable gastric banding (AGB) procedures. Measurements: Estimated percent total weight loss (TWL) at 1, 3, and 5 years; 30-day rates of major adverse events. Results: Total numbers of eligible patients with weight measures at 1, 3, and 5 years were 44 978 (84%), 20 783 (68%), and 7159 (69%), respectively. Thirty-day rates of major adverse events were 5.0% for RYGB, 2.6% for SG, and 2.9% for AGB. One-year mean TWLs were 31.2% (95% CI, 31.1% to 31.3%) for RYGB, 25.2% (CI, 25.1% to 25.4%) for SG, and 13.7% (CI, 13.3% to 14.0%) for AGB. At 1 year, RYGB patients lost 5.9 (CI, 5.8 to 6.1) percentage points more weight than SG patients and 17.7 (CI, 17.3 to 18.1) percentage points more than AGB patients, and SG patients lost 12.0 (CI, 11.6 to 12.5) percentage points more than AGB patients. Five-year mean TWLs were 25.5% (CI,25.1% to 25.9%) for RYGB, 18.8% (CI, 18.0% to 19.6%) for SG, and 11.7% (CI, 10.2% to 13.1%) for AGB. Patients with diabetes, those with BMI less than 50 kg/m2, those aged 65 years or older, African American patients, and Hispanic patients lost less weight than patients without those characteristics. Limitation: Potential unobserved confounding due to nonrandomized design; electronic health record databases had missing outcome data. Conclusion: Adults lost more weight with RYGB than with SG or AGB at 1, 3, and 5 years; however, RYGB had the highest 30-day rate of major adverse events. Small subgroup differences in weight loss outcomes were observed. Primary Funding Source: Patient-Centered Outcomes Research Institute.

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Section: Methodsmentioning

confidence: 99%

Comparative Effectiveness and Safety of Bariatric Procedures for Weight Loss

et al. 2018

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“…The size of the gastric remnant is calibrated around a bougie tube placed in the stomach at the time of resection, leaving behind a narrow tube-shaped stomach. 62,66,67 Expected imaging appearance following SG UGI examinationSG Imaging is not routinely performed after SG surgery. UGI with water-soluble contrast may be used when there is concern for complication in the early post-operative period, including suspected leak or obstruction.…”

Section: Pouch Dilatation With Band Slippagementioning

confidence: 99%

Imaging following bariatric surgery: roux-en-Y gastric bypass, laparoscopic adjustable gastric banding and sleeve gastrectomy

Clayton

Carucci

2018

BJR

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Morbid obesity is an increasing health problem, and bariatric surgery is a popular treatment option. Radiologists must be familiar with performing and interpreting studies in this patient population. The typical post-operative findings of the Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric banding (LAGB) and sleeve gastrectomy (SG) procedures on upper gastrointestinal (UGI) series and computerized tomography (CT) are presented. An overview of the potential complications is provided in addition to a description of potential pitfalls in interpreting these studies.

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“…At admission, the patients were assessed according to National and International Guidelines [ 19 ], as previously reported [ 20 ], and included in the study. Exclusion criteria were body mass index (BMI) < 35 kg/m 2 , patients at prohibitively high risk for general anesthesia and induction of pneumoperitoneum, hiatus area > 4 cm 2 , sweet eaters, pregnancy, alcohol or drug consumption, and severe psychiatric disorders.…”

Section: Methodsmentioning

confidence: 99%

“…The second and third 12 mm trocars were placed along the left and right pararectal lines, two fingerbreadths below the costal arches. A fourth 5 mm trocar was placed in a subxiphoid position, right of the midline, and a fifth 5 mm trocar was placed in the left hypochondrium, along the anterior axillary line [ 20 ]. The first step of the procedure was the division of the gastric greater curvature attachments to the greater omentum by means of a radiofrequency (LigaSure™ tissue fusion, Covidien, Mansfield, Massachusetts, USA) or ultrasonic (Ultracision, harmonic scalpel, Ethicon Endo-Surgery, Cincinnati, Ohio, USA) device, starting 5 cm from the pylorus and proceeding orally up to the angle of His.…”

Section: Methodsmentioning

confidence: 99%

Hiatoplasty with Crura Buttressing versus Hiatoplasty Alone during Laparoscopic Sleeve Gastrectomy

Balla

Quaresima

Ursi

et al. 2017

Gastroenterology Research and Practice

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Introduction In obese patients with hiatal hernia (HH), laparoscopic sleeve gastrectomy (LSG) with cruroplasty is an option but use of prosthetic mesh crura reinforcement is debated. The aim was to compare the results of hiatal closure with or without mesh buttressing during LSG. Methods Gastroesophageal reflux disease (GERD) was assessed by the Health-Related Quality of Life (GERD-HRQL) questionnaire before and after surgery in two consecutive series of patients with esophageal hiatus ≤ 4 cm2. After LSG, patients in group A (12) underwent simple cruroplasty, whereas in group B patients (17), absorbable mesh crura buttressing was added. Results At mean follow-up of 33.2 and 18.1 months for groups A and B, respectively (p = 0.006), the mean preoperative GERD-HRQL scores of 16.5 and 17.7 (p = 0.837) postoperatively became 9.5 and 2.4 (p = 0.071). In group A, there was no difference between pre- and postoperative scores (p = 0.279), whereas in group B, a highly significant difference was observed (p = 0.002). The difference (Δ) comparing pre- and postoperative mean scores between the two groups was significantly in favor of mesh placement (p = 0.0058). Conclusions In obese patients with HH and mild-moderate GERD, reflux symptoms are significantly improved at medium term follow-up after cruroplasty with versus without crura buttressing during LSG.

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Laparoscopic Sleeve Gastrectomy Changes in the Last Decade: Differences in Morbidity and Weight Loss

Abstract: LSG is a safe and effective procedure. In the postoperative course, meticulous alertness to early warning signs of sepsis and aggressive patient management are mandatory to prevent mortality. The use of a larger bougie size was associated with weight regain.

Cited by 14 publications

References 23 publications

Comparative Effectiveness and Safety of Bariatric Procedures for Weight Loss

Comparative Effectiveness and Safety of Bariatric Procedures for Weight Loss

Imaging following bariatric surgery: roux-en-Y gastric bypass, laparoscopic adjustable gastric banding and sleeve gastrectomy

Hiatoplasty with Crura Buttressing versus Hiatoplasty Alone during Laparoscopic Sleeve Gastrectomy

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