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: 3.38). 01/2009; 145(1):106-13. DOI: 10.1016/j.surg.2008.07.013
Source: PubMed


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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Available from: Pierre J Verhaeghe, Mar 02, 2014
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    • "L'hé morragie sur la ligne d'agrafage gastrique apparaıˆt dans moins de 1,5 % des cas [18]. Devant le succè s de cette technique avec une duré e d'hospitalisation moyenne de 3 jours dans notre service [15] et profitant du savoir-faire et de l'expé rience de notre e ´ quipe dans ce domaine par la ré alisation de plus de mille sleeve gastrectomies, nous supposons que sa ré alisation dans le cadre d'une chirurgie ambulatoire n'entraıˆnerait pas de risque chirurgical ni anesthé sique plus important pour le patient a ` partir du moment où il est sé lectionné et motivé pour ce type de prise en charge. Les bé né fices attendus pour le patient sont inté ressants par la dé dramatisation de l'acte opé ratoire, en entraıˆnant peu de modifications dans sa vie quotidienne et de son entourage tout en diminuant le risque des infections nosocomiales et des complications thromboemboliques. "
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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.
    Full-text · Article · Oct 2014 · Annales francaises d'anesthesie et de reanimation
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    • "Aucune ré admission en urgence n'a e ´ té observé e. Les complications sé rieuses e ´ taient chirurgicales type fistule et plicature gastrique qui se sont manifesté es a ` partir du 4 e jour postopé ratoire. Ce qui ne mettait pas en cause la procé dure ambulatoire car nous ne pouvions pas exclure qu'une procé dure conventionnelle aurait pu e ´ viter ses complications qui sont connues [14] [15] [16] [17] [18] [19] [20] [21] [22] [23]. Par consé quent, du fait de protocoles d'intervention et de surveillance stricts que nous avons e ´ tablis, de telles complications ne remettaient pas en cause la poursuite de ce programme de chirurgie bariatrique par laparoscopie en ambulatoire. "
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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. Methods This prospective observational study was conducted from May 2011 to June 2013. The procedure was proposed for patients undergoing LSG who were predetermined inclusion criteria. Following preoxygenation, anaesthesia was induced with propofol and sufentanil. Tracheal intubation was facilitated with rocuronium. Anaesthesia was maintained with desflurane and remifentanil target-controlled infusion. Antiemetic prophylaxis was supplied with intravenous (IV) droperidol and dexamethasone; postoperative pain prophylaxis was IV paracetamol, nefopam, tramadol, and ropivacaine infiltration. The patients were extubated in the operating room and kept in the postoperative care unit. A water-soluble contrast examination was performed in the output of the postoperative care unit. Oral feeding was resumed immediately in the absence of fistula on this leak test in an ambulatory surgical unit. When the patient has satisfied the modified Post-Anaesthesia Discharge Scoring System (PADSS) criteria, he or she can then be discharged and sent home. Results Among 280 patients operated on for obesity by laparoscopic sleeve gastrectomy during the study period, 68 (24.2 %) underwent ambulatory procedure. Of the 68 obese patients, 94.1 % were female. Mean age was 34.4 years (22–55). Mean preoperative BMI was 42.6 kg/m2. Thirteen patients (19.1 %) had HTN; 7 (10.2 %) had dyslipidemia and 6 (8.8 %) had diabetes not requiring treatment. The mean operating time was 60 minutes (range, 45–95) and there were no conversions to open surgery. No intra-operative anesthetic or surgical complications occurred. Mean time in the recovery room was 86.5 minutes (35–240). The overall satisfaction rate was 92.6 % (n = 63). No patients were admitted because of nausea or inadequate pain control. There were no re-admissions or hospitalizations were reported. We recorded five surgical complications including two case of gastric fistula, one case of gastric stenosis, one case of scar dehiscence and one case of splenic upper pole ischemia. Its complications have arisen from the fourth postoperative day. This does not undermine the ambulatory procedure. Conclusion The laparoscopic sleeve gastrectomy in ambulatory is feasible with a dedicated anesthesiological concept in an expert surgical team. Appropriate patient selection is important in order to secure safety and quality of care within outpatient program. The risk versus benefit must be adequately evaluated on an individual basis.
    Full-text · Article · Sep 2014 · Annales francaises d'anesthesie et de reanimation
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    • "It is considered that SG results in fewer complications than the duodenal switch [5] or Roux-en-Y gastric bypass (RYGB) [6] due to the absence of an anastomosis. However, the literature on the complication rate is derived from small series (fewer than 200 patients) [7] [8] or from a meta-analysis [9] of centers that differed in terms of the surgeons' experience, SG technique, and surgical equipment. The objective of the "
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    ABSTRACT: Background: Reports on the postoperative outcomes of sleeve gastrectomy (SG) have only been from small, single-center series and meta-analyses of studies with variable SG management. The objective of this study was to evaluate post-SG outcomes in a specialized bariatric surgery center with a routinely performed standardized procedure. Methods: The postoperative complication rate, operating times, and postoperative data were evaluated from all patients undergoing a primary SG between November 2004 and February 2012. Results were analyzed for 3 separate surgical periods, which differed with perioperative management. Results: Of 600 patients (mean age: 41.8±11.3; mean body mass index [BMI]: 47.2±16 kg/m²; 80% were women who underwent primary SG), 26.8% had a BMI≥50 kg/m². The mean operating time was 84 minutes. The rate of conversion was 1%. There were no postoperative deaths. The overall complication rate was 8.5%; the major complication rate was 5.6%; the revisional surgery rate was 4.6% and the gastric leak rate was 2.5%. Over the course of the 3 study periods, the operating time fell from 91±32 to 79±22 minutes (P≤.001); the length of hospital stay decreased from 4.5±4.9 to 3.4±4.3 days (P = .02); the major complication rate fell from 6.4% to 5.5% (P = NS); and the gastric fistula rate decreased from 4.6% to 1.9% (P = NS). Conclusion: In a specialist bariatric surgery center, SG had an acceptable complication rate. Modifications in the perioperative management of SG were associated with a shorter mean operating time and hospital stay and did not increase the major complication or gastric fistula rates.
    Full-text · Article · Sep 2014 · Surgery for Obesity and Related Diseases
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