Improved Obesity Reduction and Co-morbidity Resolution in Patients Treated with 40-French Bougie Versus 50-French Bougie Four Years after Laparoscopic Sleeve Gastrectomy. Analysis of 294 Patients
ABSTRACT We compared percent excess body mass index loss (%EBMIL) and resolution of dyslipidaemia, hypertension, and type 2 diabetes mellitus in the 4 years following laparoscopic sleeve gastrectomy (LSG) between patients calibrated with a 40-French (40F) or a 50-French (50F) bougie.
We conducted a longitudinal retrospective descriptive study of routinely collected pre- and post-surgical data from 294 patients who underwent LSG at a single surgical centre (50F--n = 106, 40F--n = 185). Obesity measurements were taken prior to surgery and at regular intervals until 48 months post-surgery. Co-morbidity resolution was also assessed across the 48-month observation period. Multivariate regression modelling was used to control analyses for baseline obesity and sociodemographic variables.
At 48 months post-surgery mean (±SD) %EBMIL was 60.2 ± 27.6% and 45.4 ± 38.4% for those treated with the 40F and 50F bougie, respectively. After controlling for sociodemographic variables and baseline excess weight, mean %EBMIL was 15.5% greater with a 40F bougie compared with a 50F bougie at the end of follow-up. The likelihood of dyslipidaemia resolution within 48 months post-LSG was 19.0 times greater (p = 0.006), hypertension resolution 3.6 times greater (p = 0.005) and type 2 diabetes mellitus resolution 5.2 times greater (p = 0.034) by 4 years post-surgery in patients treated with the 40F bougie compared with a 50F bougie.
Improved obesity reduction and resolution of dyslipidaemia, hypertension and type 2 diabetes mellitus is experienced during the 4 years following surgery by patients treated with a 40F bougie compared with the 50F. These findings remain when controlling for potential confounding clinical and sociodemographic factors.
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ABSTRACT: Sleeve gastrectomy constitutes an effective surgical procedure for the treatment of morbid obesity in humans and rodents with diet-induced obesity. The aim of the present study was to establish the effects of sleeve gastrectomy on weight loss and cardiovascular parameters in genetically obese (fa/fa) Zucker rats. Eleven-week-old male obese (fa/fa) (n = 20) Zucker rats were assigned to three alternative procedures (sham operation, sleeve gastrectomy, or pair-fed to the amount of food eaten by sleeve-gastrectomized animals) and compared with lean Zucker (Fa/Fa) rats (n = 9). Systolic (SBP), diastolic (DBP), and mean (MBP) blood pressure values as well as heart rate (HR) were recorded in conscious, resting animals by non-invasive tail-cuff plethysmography before and 3 weeks after the surgical interventions. Sleeve-gastrectomized rats experienced a reduction in body weight (P < 0.01), total adiposity amounts (P < 0.001), together with an increased excess weight loss (%EWL) (P < 0.05) compared with sham-operated and pair-fed animals 3 weeks after the surgical interventions. Rats with sleeve gastrectomy exhibited reduced (P < 0.01) blood pressure values (ΔSBP = -11 ± 8 mmHg; ΔDBP = -6 ± 4 mmHg; ΔMBP = -8 ± 6 mmHg) compared with the control group, but no changes were observed in HR (P = 0.560). Sham-operated and pair-fed groups did not alter their cardiovascular variables. Our findings provide evidence of the beneficial effects of sleeve gastrectomy on blood pressure values in addition to the weight loss in obese (fa/fa) Zucker rats independently of surgical trauma and food intake reduction.Obesity Surgery 11/2011; 22(2):309-15. DOI:10.1007/s11695-011-0562-3 · 3.74 Impact Factor
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ABSTRACT: Laparoscopic sleeve gastrectomy (LSG) is a relatively new bariatric surgical procedure associated with an acceptable weight loss and a relatively low morbidity. There is existing evidence suggesting bariatric surgery resolves or improves hypertension. The purpose of this study is to systematically review the effect of LSG on hypertension. An electronic search method was primarily used for identification of the studies. We performed a comprehensive search of all electronic databases (MEDLINE, PubMed, Embase, Scopus, Dare, Clinical Evidence, BIOSIS, Previews, TRIP, Web of Science, Health Technology Database, Conference abstracts, clinical trials, and the Cochrane Library database) using broad search terms. All human studies from August 2000 to September 2011 were included. After an initial screening, a total of 326 studies were identified. After assessment of these studies based on our exclusion criteria, 222 studies were considered for the abstract review. A total of 33 studies were identified after a careful screening, involving a total of 3,997 patients. The mean pre-operative body mass index (BMI) was 49.1 ± 7.5 kg/m(2) (range 37-68). The average follow-up time was 16.9 ± 9.8 months (range 12-48). The mean post-operative BMI was 36 ± 7.0 kg/m(2) (range 25.6-54). LSG resulted in resolution of hypertension in 58% of patients. On average, 75% of patients experienced resolution or improvement of their hypertension. Based on our systematic review, LSG has a significant effect on hypertension, inducing resolution or improvement in the majority of cases. Therefore, LSG remains a viable surgical option in obese patients with hypertension.Obesity Surgery 02/2012; 22(5):832-7. DOI:10.1007/s11695-012-0615-2 · 3.74 Impact Factor
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ABSTRACT: BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) remains under scrutiny as a stand-alone bariatric procedure. The most feared complication after LSG is staple line leak. METHODS: Eight bariatric centers in Israel participated in this study. A retrospective analysis was performed by querying all the LSG cases performed between June 2006 and June 2010. The data collected included patient demographics, anthropometrics, and operative and perioperative parameters. RESULTS: Among the 2,834 patients who underwent LSG, 44 (1.5 %) with gastric leaks were identified. Of these 44 patients, 30 (68 %) were women. The patients had a mean age of 41.5 years and a body mass index (BMI) of 45.4 kg/m(2). Intraoperative leak tests and routine postoperative swallow studies were performed with 33 patients, and all but one patient (3 %) failed to detect the leaks. Leaks were diagnosed at a median of 7 days postoperatively: early (0-2 days) in nine cases (20 %), intermediately (3-14 days) in 32 cases (73 %), and late (>14 days) in three cases (7 %). For 38 patients (86 %), there was clinical suspicion, later confirmed by imaging or operative findings. Computed tomography, swallow studies, and methylene blue tests were performed for 37, 21, and 15 patients, respectively, and the results were positive, respectively, for 31 (84 %), 11 (50 %), and 9 (60 %) of these patients. Reoperation was performed for 27 of the patients (61 %). Other treatment methods included percutaneous drainage (n = 28, 63.6 %), endoscopic placement of stents (n = 11, 25 %), clips (n = 1, 2.3 %), and fibrin glue (n = 1, 2.3 %). In 33 of the patients (75 %), the leak site was found in the upper sleeve near the gastroesophageal junction. The median time to leak closure was 40 days (range, 2-270 days), and the overall leak-related mortality rate was 0.14 % (4/2,834). CONCLUSION: Gastric leak is the most common cause of major morbidity and mortality after LSG. Routine tests to rule out leaks seem to be superfluous. Rather, selective utilization is recommended. Management options vary, depending mainly on patient disposition. An accepted algorithm for the diagnosis and treatment of gastric leak has yet to be proposed.Surgical Endoscopy 06/2012; 27(1). DOI:10.1007/s00464-012-2426-x · 3.31 Impact Factor