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Surgical Endoscopy
Published in: Surgical Endoscopy 2/2017

01-02-2017

The safety of laparoscopic sleeve gastrectomy among diabetic patients

Authors: Collin Creange, Monica Sethi, George Fielding, Christine Ren-Fielding

Published in: Surgical Endoscopy | Issue 2/2017

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Abstract

Aims

Laparoscopic sleeve gastrectomy (LSG) is a commonly performed bariatric procedure. Although bariatric surgery is becoming increasingly recognized as a treatment option for diabetes, there remain concerns about the operative risks faced by diabetic patients. This study’s objective was to determine the safety of bariatric surgery in diabetic patients, specifically the type 2 diabetic (T2DM) population.

Methods

Patients over 18 years of age with a body mass index (BMI) ≥ 35 kg/m2 who underwent LSG in 2012 in the ACS-NSQIP database were identified. Emergency cases were excluded from analysis. Data included patient demographics, comorbidities, length of stay, and 30-day complications. The primary outcome was 30-day overall complication rate, and secondary outcomes included major complications and reoperation rates.

Results

There were 6399 LSG in the NSQIP database in 2012. Three hundred and twenty-two patients were excluded for BMI < 35, and 15 cases were deemed emergencies and excluded. Of the 6062 LSG who met the study criteria, 4726 (78 %) of patients were non-diabetic, 941 (15.5 %) had T2DM, and 395 (6.5 %) had T1DM. T2DM patients were more likely to be male (28.9 vs. 19.3 %, p < 0.001), were older (47.6 years vs. 42.5 years, p < 0.001), and had a higher BMI (46.4 vs. 45.7 kg/m2, p = 0.027) compared with non-diabetics. The overall 30-day complication rate did not differ between groups (6.5 % T2DM vs. 5.6 % non-diabetic, p = 0.292). After controlling for possible confounders, T2DM remained at no increased risk of 30-day complications (OR 1.16, 95 % CI 0.87–1.55, p = 0.301). In sub-analyses of specific complications, T2DM had a slightly higher rate of blood transfusions (1.8 vs. 1.0 %, p = 0.037). Other postoperative complications did not differ between groups. The 30-day complication rate for type 1 diabetics was greater than for T2DM (9.9 vs. 6.5 %, p = 0.031) and non-diabetics (9.9 vs. 5.6 %, p < 0.001).

Conclusion

Laparoscopic sleeve gastrectomy is a safe procedure for type 2 diabetics with regard to early postoperative complications.
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Metadata
Title
The safety of laparoscopic sleeve gastrectomy among diabetic patients
Authors
Collin Creange
Monica Sethi
George Fielding
Christine Ren-Fielding
Publication date
01-02-2017
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 2/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-5053-0

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