Laparoscopic sleeve gastrectomy in morbidly obese patients. Technique and short term results

Abstract

OBJECTIVE: To evaluate the efficacy of Laparoscopic Sleeve Gastrectomy (LSG) as a definitive procedure for morbidly obese patients. DESIGN: This constitutes a prospective study carried out in a tertiary care private hospital and included 15 morbidly obese patients who underwent LSG. The operation was performed through two 12 mm and two 5 mm ports, using the Endo-GIA stapler to create a lesser curve gastric tube over a 36-Fr bougie. RESULTS: Operative time, complication rates, hospital length of stay, Body Mass Index (BMI), % of Excess Weight Loss (EWL) and appetite were evaluated. There were six females and nine males, aged (mean±SD) 40.5±10.5 yrs and preoperative BMI 47.8±7.5 kg/m². The operative time was 147.7±43.2 min. There was one conversion to open surgery and one gastric leak with haemorrhage that led to gastric tube stenosis, ultimately requiring revision surgery. All patients, except these two, were discharged on the 2 nd postoperative day after an upper GI series and the initiation of a clear liquid diet. At the follow-up (7.5±4.4 months post operatively), the % EWL was 35.7±10.1. Eight patients who received regular postoperative dietician counselling at follow-up did better than the others who did not (% EWL 40.4±3.8 vs 30.2± 4.1, respectively). All patients reported significant loss of appetite. CONCLUSIONS: Although the number of patients is relatively small, the data of this study indicate that laparoscopic sleeve gastrectomy is effective in weight reduction, being an acceptable surgical option for morbidly obese patients. A higher number of patients and longer follow-up period will be necessary to evaluate long-term efficacy.

Clinical Practice Guidelines For The Perioperative Nutritional, Metabolic, And Nonsurgical Support Of The Bariatric Surgery Patient2013 Update: Cosponsored By American Association Of Clinical Endocrinologists, The Obesity Society, And American Society For Metabolic & Bariatric Surgery

“…Because nearly 80% of the stomach is transected and nutrients rapidly pass through a gastric conduit, increased GLP-1 and PYY 3–36 and decreased ghrelin levels result, producing key metabolic effects (78 [EL 1, RCT]; 82 [EL 1, RCT]; 83 [EL 2, PCS]; 84 [EL 2, NRCT]; 88 [EL 1, RCT]). In addition to many recently published case series reporting the short- and medium- term safety and efficacy (weight loss and glycemic status) of the SG, the majority of which were performed laparoscopically (89 [EL 3, SS]; 90 [EL 3, SS]; 91 [EL 2, PCS]; 92 [EL 3, SS]; 93 [EL 3, SS]; 94 [EL 3, SS]; 95 [EL 2, PCS]; 96 [EL 3, SS]; 97 [EL 2, PCS]; 98 [EL 2, PCS]; 99 [EL 3, SS]; 100 [EL 3, SS]; 101 [EL 3, SS]; 102 [EL 2, PCS]), there are now several comparative studies (103 [EL ]; 104 [EL ]; 105 [EL ]; 106 [EL ]; 107 [EL ]; 108 [EL ]; 109 [EL ]; 110 [EL ]; 111 [EL ]; 112 [EL ]; 113 [EL ]; 114 [EL ]; 115 [EL ]), 6 randomized controlled trials (78 [EL 1, RCT]; 82 [EL 1, RCT]; 116 [EL 1, RCT]; 117 [EL 1, RCT]; 118 [EL 1, RCT]; 119 [EL 1, RCT]), and meta-analyses (120 [EL 2, MNRCT]; 121 [EL 2, MNRCT]) demonstrating equivalency or superiority to other accepted procedures (RYGB and LAGB). Analyses of outcomes from large prospective databases have revealed a risk/benefit profile for LSG that is positioned between the LAGB and RYGB (122 [EL 3, SS]; 123 [EL 3, SS]).…”

Update on Metabolic Bariatric Surgery for Morbidly Obese Adolescents

“…Metabolically, it is assumed that resection of the gastric fundus also extensively removes ghrelin production. Since ghrelin induces feelings of hunger in the central nervous system (arcuate nucleus), the removal of ghrelin-producing cells induces changes in the eating behavior [ 23 , 24 , 25 ]. Valid studies have shown that it is almost as effective as RYGB in inducing weight loss and improving co-morbidities [ 26 ].…”

Bariatrische Chirurgie bei extremer Adipositas im Kindes- und Jugendalter

“…Das Verfahren ist komplett irreversibel. Randomisierte, kontrollierte Studien zur perioperativen und langfristigen Komplikationsrate fehlen bisher sowohl für Erwachsene als auch für Kinder und Jugendliche, weshalb dieses Verfahren sehr kontrovers diskutiert wird [18,19,21,22,23]. Es führt jedoch -nach bisheriger Studienlage -zu einem signifikanten Gewichtsverlust, der auf restriktiven als auch endokrinen Mechanismen beruht.…”

“…Erste Einzelfallberichte existieren über die laparoskopische Schlauchmagenoperation (LSG) im Jugend- [18,19] sowie im Erwachsenenalter [21,22,23]. Die Ergebnisse bis zu drei Jahren nach Operation sind vielversprechend, Langzeitergebnisse liegen aber bisher noch nicht vor.…”