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Published in: Obesity Surgery 11/2010

01-11-2010 | Clinical Research

Early and Mid-term Outcomes of Single-Stage Laparoscopic Sleeve Gastrectomy

Authors: Sanket Srinivasa, Laura S Hill, Tarik Sammour, Andrew G Hill, Richard Babor, Habib Rahman

Published in: Obesity Surgery | Issue 11/2010

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Abstract

Background

This is the largest single-centre series of single-stage laparoscopic sleeve gastrectomy (LSG) reporting on perioperative outcomes, weight loss, comorbidity resolution including urological outcomes and results in the super obese. Review of prospectively collected data for patients who underwent LSG from March 2007–August 2009.

Methods

There were 253 patients with a mean age of 44 years (SD, 9) and a mean preoperative body mass index (BMI) of 50 kg/m2 (SD, 7). There were 17 (7%) major complications and no deaths. The mean follow-up was 9 months. One hundred and seventy-one patients with a mean follow-up of 12 months had a mean postoperative weight loss of 41 kg (SD, 16) and mean excess BMI (meBMI) loss of 59% (SD, 22).

Results

One hundred fourteen patients were super obese (BMI, >50 kg/m2). The mean weight loss was 45 kg (SD, 18), and the meBMI lost was 49% (SD, 21). Super-obese patients experienced more complications (p = 0.02) and lost less eBMI (49% vs. 61%; p < 0.01). Fifty-three patients (46%) remained morbidly obese (BMI, >40 kg/m2) postoperatively. Hypertension and diabetes improved or resolved in 73 (79%) and 73 (90%) patients, respectively. Stress urinary incontinence was reported preoperatively in 60 (32%) females, and complete resolution or improvement was reported in 54 (90%) patients.

Conclusions

LSG provides satisfactory weight loss and resolution of comorbidities in the short- and medium-term with inferior, though acceptable, results in the super obese.
Literature
1.
go back to reference Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5:469–75.CrossRefPubMed Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5:469–75.CrossRefPubMed
2.
go back to reference Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery. Updated Position Statement on Sleeve Gastrectomy as a Bariatric Procedure. Surg Obes Relat Dis. 2010;6(1):1–5.CrossRef Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery. Updated Position Statement on Sleeve Gastrectomy as a Bariatric Procedure. Surg Obes Relat Dis. 2010;6(1):1–5.CrossRef
3.
go back to reference Akkary E, Duffy A, Bell R. Deciphering the sleeve: technique, indications, efficacy, and safety of sleeve gastrectomy. Obes Surg. 2008;18:1323–9.CrossRefPubMed Akkary E, Duffy A, Bell R. Deciphering the sleeve: technique, indications, efficacy, and safety of sleeve gastrectomy. Obes Surg. 2008;18:1323–9.CrossRefPubMed
4.
go back to reference Frezza EE. Laparoscopic vertical sleeve gastrectomy for morbid obesity. The future procedure of choice? Surg Today. 2007;37:275–81.CrossRefPubMed Frezza EE. Laparoscopic vertical sleeve gastrectomy for morbid obesity. The future procedure of choice? Surg Today. 2007;37:275–81.CrossRefPubMed
5.
go back to reference Frezza EE, Chiriva-Internati M, Wachtel MS. Analysis of the results of sleeve gastrectomy for morbid obesity and the role of ghrelin. Surg Today. 2008;38:481–3.CrossRefPubMed Frezza EE, Chiriva-Internati M, Wachtel MS. Analysis of the results of sleeve gastrectomy for morbid obesity and the role of ghrelin. Surg Today. 2008;38:481–3.CrossRefPubMed
6.
go back to reference Frezza EE, Wozniak SE, Gee L, et al. Is there any role of resecting the stomach to ameliorate weight loss and sugar control in morbidly obese diabetic patients? Obes Surg. 2009;19:1139–42.CrossRefPubMed Frezza EE, Wozniak SE, Gee L, et al. Is there any role of resecting the stomach to ameliorate weight loss and sugar control in morbidly obese diabetic patients? Obes Surg. 2009;19:1139–42.CrossRefPubMed
7.
go back to reference Fetner R, McGinty J, Russell C, et al. Incretins, diabetes, and bariatric surgery: a review. Surg Obes Relat Dis. 2005;1:589–97.CrossRefPubMed Fetner R, McGinty J, Russell C, et al. Incretins, diabetes, and bariatric surgery: a review. Surg Obes Relat Dis. 2005;1:589–97.CrossRefPubMed
8.
go back to reference Frezza EE, Wei C, Wachtel MS. Is surgery the next answer to treat obesity-related hypertension? J Clin Hypertens. 2009;11:284–8.CrossRef Frezza EE, Wei C, Wachtel MS. Is surgery the next answer to treat obesity-related hypertension? J Clin Hypertens. 2009;11:284–8.CrossRef
9.
go back to reference Kueper MA, Kramer KM, Kirschniak A, et al. Laparoscopic sleeve gastrectomy: standardized technique of a potential stand-alone bariatric procedure in morbidly obese patients. World J Surg. 2008;32:1462–5.CrossRefPubMed Kueper MA, Kramer KM, Kirschniak A, et al. Laparoscopic sleeve gastrectomy: standardized technique of a potential stand-alone bariatric procedure in morbidly obese patients. World J Surg. 2008;32:1462–5.CrossRefPubMed
10.
go back to reference Sanchez-Santos R, Masdevall C, Baltasar A, et al. Short- and mid-term outcomes of sleeve gastrectomy for morbid obesity: the experience of the Spanish national registry. Obes Surg. 2009;19:1203–10.CrossRefPubMed Sanchez-Santos R, Masdevall C, Baltasar A, et al. Short- and mid-term outcomes of sleeve gastrectomy for morbid obesity: the experience of the Spanish national registry. Obes Surg. 2009;19:1203–10.CrossRefPubMed
11.
go back to reference Stroh C, Birk D, Flade-Kuthe R, et al. Results of sleeve gastrectomy-data from a nationwide survey on bariatric surgery in Germany. Obes Surg. 2009;19:632–40.CrossRefPubMed Stroh C, Birk D, Flade-Kuthe R, et al. Results of sleeve gastrectomy-data from a nationwide survey on bariatric surgery in Germany. Obes Surg. 2009;19:632–40.CrossRefPubMed
12.
go back to reference Langer FB, Bohdjalian A, Felberbauer FX, et al. Does gastric dilatation limit the success of sleeve gastrectomy as a sole operation for morbid obesity? Obes Surg. 2006;16:166–71.CrossRefPubMed Langer FB, Bohdjalian A, Felberbauer FX, et al. Does gastric dilatation limit the success of sleeve gastrectomy as a sole operation for morbid obesity? Obes Surg. 2006;16:166–71.CrossRefPubMed
13.
go back to reference Tagaya N, Kasama K, Kikkawa R, et al. Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity. Obes Surg. 2009;19:1371–6.CrossRefPubMed Tagaya N, Kasama K, Kikkawa R, et al. Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity. Obes Surg. 2009;19:1371–6.CrossRefPubMed
14.
go back to reference Powers PS, Rosemurgy A, Boyd F, et al. Outcome of gastric restriction procedures: weight, psychiatric diagnoses, and satisfaction. Obes Surg. 1997;7:471–7.CrossRefPubMed Powers PS, Rosemurgy A, Boyd F, et al. Outcome of gastric restriction procedures: weight, psychiatric diagnoses, and satisfaction. Obes Surg. 1997;7:471–7.CrossRefPubMed
16.
go back to reference Richter HE, Burgio KL, Clements RH, et al. Urinary and anal incontinence in morbidly obese women considering weight loss surgery. Obstet Gynecol. 2005;106:1272–7.PubMed Richter HE, Burgio KL, Clements RH, et al. Urinary and anal incontinence in morbidly obese women considering weight loss surgery. Obstet Gynecol. 2005;106:1272–7.PubMed
17.
go back to reference Sugerman H, Windsor A, Bessos M, et al. Intra-abdominal pressure, sagittal abdominal diameter and obesity comorbidity. J Int Med. 1997;241:71–9.CrossRef Sugerman H, Windsor A, Bessos M, et al. Intra-abdominal pressure, sagittal abdominal diameter and obesity comorbidity. J Int Med. 1997;241:71–9.CrossRef
18.
go back to reference Uustal Fornell E, Wingren G, Kjolhede P. Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study. Acta Obstet Gynecol Scand. 2004;83:383–9.CrossRefPubMed Uustal Fornell E, Wingren G, Kjolhede P. Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study. Acta Obstet Gynecol Scand. 2004;83:383–9.CrossRefPubMed
19.
go back to reference Bump RC, Sugerman HJ, Fantl JA, et al. Obesity and lower urinary tract function in women: effect of surgically induced weight loss. Am J Obstet Gynecol. 1992;167:392–7. discussion 7–9.PubMed Bump RC, Sugerman HJ, Fantl JA, et al. Obesity and lower urinary tract function in women: effect of surgically induced weight loss. Am J Obstet Gynecol. 1992;167:392–7. discussion 7–9.PubMed
20.
go back to reference Burgio KL, Richter HE, Clements RH, et al. Changes in urinary and fecal incontinence symptoms with weight loss surgery in morbidly obese women. Obstet Gynecol. 2007;110:1034–40.PubMed Burgio KL, Richter HE, Clements RH, et al. Changes in urinary and fecal incontinence symptoms with weight loss surgery in morbidly obese women. Obstet Gynecol. 2007;110:1034–40.PubMed
21.
go back to reference Sugerman H, Windsor A, Bessos M, et al. Effects of surgically induced weight loss on urinary bladder pressure, sagittal abdominal diameter and obesity co-morbidity. J Obes Relat Metab Disord. 1998;22:230–5.CrossRef Sugerman H, Windsor A, Bessos M, et al. Effects of surgically induced weight loss on urinary bladder pressure, sagittal abdominal diameter and obesity co-morbidity. J Obes Relat Metab Disord. 1998;22:230–5.CrossRef
22.
go back to reference Ministry of Health. A Portrait of Health: Key results of the 2006/07 New Zealand Health Survey. Wellington: Ministry of Health; 2008. Ministry of Health. A Portrait of Health: Key results of the 2006/07 New Zealand Health Survey. Wellington: Ministry of Health; 2008.
23.
go back to reference Sammour T, Hill AG, Singh P, Ranasinghe A, Babor R, Rahman H. Laparoscopic sleeve gastrectomy as a single-stage bariatric procedure. Obes Surg. 2010;20(3):271–5.CrossRefPubMed Sammour T, Hill AG, Singh P, Ranasinghe A, Babor R, Rahman H. Laparoscopic sleeve gastrectomy as a single-stage bariatric procedure. Obes Surg. 2010;20(3):271–5.CrossRefPubMed
24.
go back to reference Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.CrossRefPubMed Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.CrossRefPubMed
25.
go back to reference Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMed Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMed
26.
go back to reference Thomas TM, Plymat KR, Blannin J, et al. Prevalence of urinary incontinence. Br Med J. 1980;281:1243–5.CrossRefPubMed Thomas TM, Plymat KR, Blannin J, et al. Prevalence of urinary incontinence. Br Med J. 1980;281:1243–5.CrossRefPubMed
27.
go back to reference Fried M, Hainer V, Basdevant A, et al. Interdisciplinary European guidelines for surgery for severe (morbid) obesity. Obes Surg. 2007;17:260–70.CrossRefPubMed Fried M, Hainer V, Basdevant A, et al. Interdisciplinary European guidelines for surgery for severe (morbid) obesity. Obes Surg. 2007;17:260–70.CrossRefPubMed
28.
go back to reference Bohdjalian A, Langer F, Shakeri-Leidenmühler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20:535–40.CrossRefPubMed Bohdjalian A, Langer F, Shakeri-Leidenmühler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20:535–40.CrossRefPubMed
29.
go back to reference Gumbs AA, Gagner M, Dakin G, et al. Sleeve gastrectomy for morbid obesity. Obes Surg. 2007;17:962–9.CrossRefPubMed Gumbs AA, Gagner M, Dakin G, et al. Sleeve gastrectomy for morbid obesity. Obes Surg. 2007;17:962–9.CrossRefPubMed
30.
go back to reference Dixon JB, O’Brien PE. Lipid profile in the severely obese: changes with weight loss after lap-band surgery. Obes Res. 2002;10:903–10.CrossRefPubMed Dixon JB, O’Brien PE. Lipid profile in the severely obese: changes with weight loss after lap-band surgery. Obes Res. 2002;10:903–10.CrossRefPubMed
31.
go back to reference Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247:401–7.CrossRefPubMed Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247:401–7.CrossRefPubMed
32.
go back to reference Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. [Summary for patients in Ann Intern Med. 2005 Apr 5;142(7):I55; PMID: 15809458]. Ann Int Med. 2005;142:547–59.PubMed Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. [Summary for patients in Ann Intern Med. 2005 Apr 5;142(7):I55; PMID: 15809458]. Ann Int Med. 2005;142:547–59.PubMed
33.
go back to reference Piazza L, Pulvirenti A, Ferrarra F, et al. Laparoscopic biliopancreatic diversion: our preliminary experience with 201 consecutive cases. Chir Ital. 2009;61:143–48.PubMed Piazza L, Pulvirenti A, Ferrarra F, et al. Laparoscopic biliopancreatic diversion: our preliminary experience with 201 consecutive cases. Chir Ital. 2009;61:143–48.PubMed
34.
go back to reference McCarty TM, Arnold DT, Lamont JP, et al. Optimizing outcomes in bariatric surgery: outpatient laparoscopic gastric bypass. Ann Surg. 2005;242:494–8. discussion 8–501.PubMed McCarty TM, Arnold DT, Lamont JP, et al. Optimizing outcomes in bariatric surgery: outpatient laparoscopic gastric bypass. Ann Surg. 2005;242:494–8. discussion 8–501.PubMed
36.
go back to reference Frezza E, Shebani K, Robertson J, et al. Morbid obesity causes chronic increase of intraabdominal pressure. Dig Dis Sci. 2007;52:1038–41.CrossRefPubMed Frezza E, Shebani K, Robertson J, et al. Morbid obesity causes chronic increase of intraabdominal pressure. Dig Dis Sci. 2007;52:1038–41.CrossRefPubMed
37.
go back to reference Baltasar A, Serra C, Pérez N, et al. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg. 2005;15:1124–8.CrossRefPubMed Baltasar A, Serra C, Pérez N, et al. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg. 2005;15:1124–8.CrossRefPubMed
38.
go back to reference Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg. 2006;16:1138–44.CrossRefPubMed Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg. 2006;16:1138–44.CrossRefPubMed
39.
go back to reference DeMaria EJ, Portenier D, Wolfe L. Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Surg Obes Rel Dis. 2007;3:134–40.CrossRef DeMaria EJ, Portenier D, Wolfe L. Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Surg Obes Rel Dis. 2007;3:134–40.CrossRef
40.
go back to reference Flancbaum L, Belsley S. Factors affecting morbidity and mortality of Roux-en-Y gastric bypass for clinically severe obesity: an analysis of 1,000 consecutive open cases by a single surgeon. J Gastrointest Surg. 2007;11:500–7.CrossRefPubMed Flancbaum L, Belsley S. Factors affecting morbidity and mortality of Roux-en-Y gastric bypass for clinically severe obesity: an analysis of 1,000 consecutive open cases by a single surgeon. J Gastrointest Surg. 2007;11:500–7.CrossRefPubMed
41.
go back to reference Sanchez-Santos R, de Gordejuela AG Ruiz, Gomez N, et al. Factors associated with morbidity and mortality after gastric bypass. Alternatives for risk reduction: sleeve gastrectomy. Cirugia Espanola. 2006;80:90–5.CrossRefPubMed Sanchez-Santos R, de Gordejuela AG Ruiz, Gomez N, et al. Factors associated with morbidity and mortality after gastric bypass. Alternatives for risk reduction: sleeve gastrectomy. Cirugia Espanola. 2006;80:90–5.CrossRefPubMed
42.
go back to reference Cummings JM, Rodning CB. Urinary stress incontinence among obese women: review of pathophysiology therapy. Int Urogynecol J. 2000;11:41–4.CrossRef Cummings JM, Rodning CB. Urinary stress incontinence among obese women: review of pathophysiology therapy. Int Urogynecol J. 2000;11:41–4.CrossRef
Metadata
Title
Early and Mid-term Outcomes of Single-Stage Laparoscopic Sleeve Gastrectomy
Authors
Sanket Srinivasa
Laura S Hill
Tarik Sammour
Andrew G Hill
Richard Babor
Habib Rahman
Publication date
01-11-2010
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 11/2010
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-010-0267-z

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