Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity.

Federation of Digestive Diseases, Amiens North Hospital, University of Picardy, Amiens, France.
Surgery (Impact Factor: 3.37). 01/2009; 145(1):106-13. DOI: 10.1016/j.surg.2008.07.013
Source: PubMed

ABSTRACT Sleeve gastrectomy is a new restrictive bariatric procedure increasingly indicated in the treatment of morbid obesity. The authors report their experience of laparoscopic sleeve gastrectomy (LSG), evaluate the efficacy of this procedure on weight loss, and analyze the short-term outcome.
The data of 135 consecutive patients undergoing LSG between July 2004 and October 2007 were analyzed prospectively. LSG was indicated only for weight reduction with a body mass index (BMI) > 40 or > 35 kg/m(2) associated with severe comorbidity. Study endpoints included mean BMI, comorbidity, operative data, conversion to laparotomy, intraoperative complications, major and minor complication rates, excess weight loss, follow-up, and duration of hospital stay. Possible risk factors for postoperative gastric fistula (PGF) were investigated.
This series comprised 113 females and 22 males with a mean age of 40 years (range, 18-65). Mean weight was 132 kg (range, 94-186), and mean preoperative BMI was 48.8 kg/m(2) (range, 37-72). The mean operating time was 103 minutes (range, 30-550). No patients required conversion to laparotomy, and 96% of patients did not require drainage. The nasogastric tube was removed on postoperative day 1. The postoperative course was uneventful in 94.9% of cases, and the median duration of hospital stay was 3.8 days. The median follow-up was 12.7 months. The mean postoperative BMI decreased to 39.8 kg/m(2) at 6 months (P < .001). Average excess body weight loss was 38.6% and 49.4% at 6 months and 1 year, respectively. There was no mortality, and the major complication rate, corresponding to gastric fistula (PGF) in every case, was 5.1% (n = 7). Management of PGF required reoperation, radiologic and endoscopic procedures, and fibrin glue; the median hospital stay was 47 days. BMI > 60 kg/m(2) appears to be a risk factor for PGF.
LSG is a reproducible and seems to be an effective treatment to achieve significant weight loss after 12 months follow-up. LSG can be used as a standalone operation to obtain weight reduction. Management of PGF remains a major issue.

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    ABSTRACT: The development of outpatient surgery is one of the major goals of the public health policy in 2010. The purpose of this observational study is to evaluate the feasibility of the laparoscopic sleeve gastrectomy (LSG) in ambulatory.
    Annales francaises d'anesthesie et de reanimation 10/2014; · 0.77 Impact Factor
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    ABSTRACT: Gastric sleeve gastrectomy has become a frequent bariatric procedure. Its apparent simplicity hides a number of serious, sometimes fatal, complications. This is more important in the absence of an internationally adopted algorithm for the management of the leaks complicating this operation. The debates exist even regarding the definition of a leak, with several classification systems that can be used to predict the cause of the leak, and also to determine the treatment plan. Causes of leak are classified as mechanical, technical and ischemic causes. After defining the possible causes, authors went into suggesting a number of preventive measures to decrease the leak rate, including gentle handling of tissues, staple line reinforcement, larger bougie size and routine use of methylene blue test per operatively. In our review, we noticed that the most important clinical sign or symptom in patients with gastric leaks are fever and tachycardia, which mandate the use of an abdominal computed tomography, associated with an upper gastrointrstinal series and/or gastroscopy if no leak was detected. After diagnosis, the management of leak depends mainly on the clinical condition of the patient and the onset time of leak. It varies between prompt surgical intervention in unstable patients and conservative management in stable ones in whom leaks present lately. The management options include also endoscopic interventions with closure techniques or more commonly exclusion techniques with an endoprosthesis. The aim of this review was to highlight the causes and thus the prevention modalities and find a standardized algorithm to deal with gastric leaks post sleeve gastrectomy.
    World journal of gastroenterology : WJG. 10/2014; 20(38):13904-13910.
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    ABSTRACT: INTRODUCTION Gastric fistulas post sleeve gastrectomy is one of the most severe complications and can be found up to 5,3%. Surgical therapies to persistent gastric fistulas are technically difficult and some times inefficient. Therefore, new endoscopic techniques have been increasingly being researched in order to treat this surgical complication. Our study aims to describe a case report which the patient presented a gastric fistula post SG. This complication was treated by endoscopic approach.CASE REPORT A 39 year old caucasian male underwent videolaparascopic cholecistechtomy and SG, in april 2012 in a large hospital in Curitiba. Regarding the pre operation evalution, the patient presented a BMI of 50,15 associated with hepatic steatosis and cholelithiasis. In the 43th day PO, an upper endoscopic was performed and visualized and gastric fistula of 0,5 cm in proximal anterior wall, right above the cardia. 04 upper endoscopies were performed in order to reduce the fistula. The procedure was successful and the fistula was completely closed.CONCLUSION The upper digestive endoscopy represent a reliable and effective method not only to diagnose but also to treat possible complication, even when they occur in infrequent anatomic areas like the one we presented in this case report.
    Journal of Surgery. 12/2014; 02(2).


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May 22, 2014