The safety of laparoscopic sleeve gastrectomy among diabetic patients

Creange, Collin; Sethi, Monica; Fielding, George; Ren-Fielding, Christine

doi:10.1007/s00464-016-5053-0

Cited by 9 publications

(7 citation statements)

References 28 publications

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“…Similar to our findings, Steele et al demonstrated in their study on 22,288 bariatric cases an increased risk of cardiac, infectious, and renal complications in diabetic patients although patients were not stratified based on insulin requirement status [12]. Some studies have failed to demonstrate increased complications with LSG and LRYGB in diabetics [8,9]. Nevertheless, these studies were smaller and likely underpowered.…”

Section: Discussionsupporting

confidence: 86%

“…Nevertheless, there may be some concerns about the safety of bariatric surgery in diabetic patients since DM has been associated with increased perioperative complications including anastomotic leak as well as mortality [6,7]. This does not seem to be a consistent finding as some studies have failed to demonstrate that increased risk [8,9]. Furthermore, there is paucity of literature on the differences in perioperative outcomes in diabetics who require insulin therapy compared with those who do not.…”

Section: Introductionmentioning

confidence: 99%

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Perioperative Outcomes of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in Patients with Diabetes Mellitus: an Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Database

et al. 2019

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Background The safety and efficacy of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) to treat obesity and associated comorbidities, including diabetes mellitus, is well established. As diabetes may add risk to the perioperative period, we sought to characterize perioperative outcomes of these surgical procedures in diabetic patients. Methods Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, we identified patients who underwent LSG and LRYGB between 2015 and 2017, grouping by non-diabetics (NDM), non-insulindependent diabetics (NIDDM), and insulin-dependent diabetics (IDDM). Primary outcomes included serious adverse events, 30day readmission, 30-day reoperation, and 30-day mortality. Univariate and multivariable analyses were used to evaluate the outcome in each diabetic cohort. Results Multivariable analysis of patients who underwent LSG (with NDM patients as reference) showed higher 30-day mortality (NIDDM AOR = 1.52, p = 0.043; IDDM AOR = 1.91, p = 0.007) and risk of serious adverse events (NIDDM AOR = 1.15, p < 0.001; IDDM AOR = 1.58, p < 0.001) in the diabetic versus NDM groups. Multivariable analysis of patients who underwent LRYGB (with NDM patients as reference) showed higher risk of serious adverse events (NIDDM AOR = 1.09, p = 0.014; IDDM AOR = 1.43, p < 0.001) in the diabetic versus NDM groups. Conclusions Diabetics who underwent LSG and LRYGB had higher rates of several perioperative complications compared with non-diabetics. IDDM had a stronger association with several perioperative complications compared with NIDDM. This increase in morbidity and mortality is modest and should be weighed against the real benefits of bariatric surgery in patient with obesity and diabetes mellitus.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Perioperative Outcomes of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in Patients with Diabetes Mellitus: an Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Database

et al. 2019

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“…In a study by Creange et al[41] based on the American College of Surgeons-National Surgical Quality Improvement Program database of 2012, 941 out of 6062 LSG patients had T2DM (15.5%). As in our study, the T2DM patient group was more likely to be male and older.…”

Section: Discussionmentioning

confidence: 99%

“…In this analysis, type 1 and type 2 diabetes was found as a significant risk factor for 30 d complications. Creange et al[41] state that this difference in results stems from the contribution of type 1 diabetes patients in the Aminian et al[42] report. In our population, all patients with diabetes were diagnosed with T2DM.…”

Section: Discussionmentioning

confidence: 99%

New results on the safety of laparoscopic sleeve gastrectomy bariatric procedure for type 2 diabetes patients

Guetta

Vakhrushev

Dukhno

et al. 2019

WJD

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BACKGROUNDIt has been established that bariatric surgery, including laparoscopic sleeve gastrectomy (LSG), has a positive impact on type 2 diabetes mellitus (T2DM). However, less frequently T2DM is reported as a risk factor for complications with this type of surgery.AIMTo evaluate the safety of LSG in T2DM.METHODSA retrospective cohort study was conducted over patients admitted for LSG from January 2008 to May 2015. Data was collected through digitized records. Any deviation from normal postoperative care within the first 60 d was defined as an early complication, and further categorized into mild or severe.RESULTSNine hundred eighty-four patients underwent LSG, among these 143 (14.5%) were diagnosed with T2DM. There were 19 complications in the T2DM group (13.3%) compared to 59 cases in the non-T2DM (7.0%). Out of 19 complications in the T2DM group, 12 were mild (8.4%) and 7 were severe (4.9%). Compared to the non-T2DM group, patients had a higher risk for mild complications (Odds-ratio 2.316, CI: 1.163-4.611, P = 0.017), but not for severe ones (P = 0.615). An increase of 1% in hemoglobin A1c levels was associated with a 40.7% increased risk for severe complications (P = 0.013, CI: 1.074-1.843) but not for mild ones.CONCLUSIONOur data suggest that LSG is relatively safe for patients with T2DM. Whether pre-operative control of hemoglobin A1c level will lower the complications rate has to be prospectively studied.

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“…Obesity is a potential risk factor for leaks, mostly in the super-obese population (BMI > 50 kg/m 2 ). 9,54,113 Diabetes is also linked to higher rates of leak after gastrointestinal surgeries in some studies, [114][115][116] but other studies failed to show an association. 129 Sleep apnea and male gender were associated with higher leak rates in one study.…”

Section: Nonsurgical Risk Factorsmentioning

confidence: 99%

A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks

Gjeorgjievski¹,

Imam

Cappell

et al. 2020

Journal of Clinical Gastroenterology

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Background: Bariatric surgery leaks result in significant morbidity and mortality. Experts report variable therapeutic approaches, without uniform guidelines or consensus.Objective: To review the pathogenesis, risk factors, prevention, and treatment of gastric sleeve leaks, with a focus on endoscopic approaches. In addition, the efficacy and success rates of different treatment modalities are assessed.Design: A comprehensive review was conducted using a thorough literature search of 5 online electronic databases (PubMed, PubMed Central, Cochrane, EMBASE, and Web of Science) from the time of their inception through March 2020. Studies evaluating gastric sleeve leaks were included. MeSH terms related to "endoscopic," "leak," "sleeve," "gastrectomy," "anastomotic," and "bariatric" were applied to a highly sensitive search strategy. The main outcomes were epidemiology, pathophysiology, diagnosis, treatment, and outcomes.Results: Literature search yielded 2418 studies of which 438 were incorporated into the review. Shock and peritonitis necessitate early surgical intervention for leaks. Endoscopic therapies in acute and early leaks involve modalities with a focus on one of: (i) defect closure, (ii) wall diversion, or (iii) wall exclusion. Surgical revision is required if endoscopic therapies fail to control leaks after 6 months. Chronic leaks require one or more endoscopic, radiologic, or surgical approaches for fluid collection drainage to facilitate adequate healing. Success rates depend on provider and center expertise. Conclusion:Endoscopic management of leaks post sleeve gastrectomy is a minimally invasive and effective alternative to surgery. Their effect may vary based on clinical presentation, timing or leak morphology, and should be tailored to the appropriate endoscopic modality of treatment.

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The safety of laparoscopic sleeve gastrectomy among diabetic patients

Abstract: Laparoscopic sleeve gastrectomy is a safe procedure for type 2 diabetics with regard to early postoperative complications.

Cited by 9 publications

References 28 publications

Perioperative Outcomes of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in Patients with Diabetes Mellitus: an Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Database

Perioperative Outcomes of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in Patients with Diabetes Mellitus: an Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Database

New results on the safety of laparoscopic sleeve gastrectomy bariatric procedure for type 2 diabetes patients

A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks

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