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Liu Z, Wang H, Fan D, Xu T, Wan F, Xia Q. Asia's Growing Contribution to Obesity Surgery Research: A 40-year Bibliometric Analysis. Obes Surg 2024; 34:2139-2153. [PMID: 38448708 PMCID: PMC11127875 DOI: 10.1007/s11695-024-07138-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
Bariatric metabolic surgery's global research interest is growing, particularly in Asia due to its high obesity rates. This study focuses on Asia, especially China, analyzing 3904 publications (1221 from China) from 1980 to 2022. Research output accelerated until the COVID-19 pandemic, driven by economic growth and rising obesity rates. China led contributions from 2010, but Western Asia led when adjusted for population. An intra-regional research collaboration network emerged, driven by geographic proximity and similar economic environments. Keyword analysis highlighted emerging topics like "laparoscopic sleeve gastrectomy" and "non-alcoholic fatty liver disease," indicating a shift in focus. The study recommends disseminating research in top-tier journals to enhance visibility and impact.
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Affiliation(s)
- Ziyun Liu
- International Business School Suzhou, Xi'an Jiaotong-Liverpool University, Suzhou, Jiangsu, People's Republic of China
| | - Haiqin Wang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dazhi Fan
- Foshan Fetal Medicine Research Institute, Affiliated Foshan Women and Children Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
- Department of Obstetrics, Affiliated Foshan Women and Children Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Tingting Xu
- Department of Health Management and Policy, School of Public Health, Capital Medical University, Beijing, 100069, China
- School of Public Health, Peking University, Beijing, 100083, China
| | - Fuzhen Wan
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Qing Xia
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
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2
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Jiang Z, Zhang Z, Feng T, Cheng Y, Zhang G, Zhong M, Hu S. Trocar number and placement for laparoscopic sleeve gastrectomy and comparison of single-incision and conventional laparoscopic sleeve gastrectomy: a systematic review and meta-analysis. Int J Surg 2023; 109:1783-1795. [PMID: 37068794 PMCID: PMC10389429 DOI: 10.1097/js9.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/06/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Conventional laparoscopic sleeve gastrectomy (CLSG) has been conducted in multiple centers for treating morbid obesity, however, there are no standard criteria for (1) placing the trocar; and (2) how many trocars should be used. Single-incision laparoscopic sleeve gastrectomy (SLSG), a newly emerged technique in 2008, has been proposed as an alternative to CLSG in recent years, however, there is no definite evidence for this. MATERIALS AND METHODS A systematic literature search was performed using the PubMed, Embase, Web of Science, and Cochrane Library databases for laparoscopic sleeve gastrectomy cases from January 2006 to October 2022. We then summarized the trocar numbers and placement patterns among these studies. A meta-analysis was conducted to compare the difference between SLSG and CLSG in the perioperative and postoperative indices. RESULTS A total of 61 studies involving 20 180 patients who underwent laparoscopic sleeve gastrectomy for treating morbid obesity were included in the systematic review, including 11 on SLSG, 35 on CLSG, and 15 studies comparing SLSG and CLSG. A systematic review showed that the trocar number varied in different CLSG studies, mainly using four or five trocars. The trocars were mainly placed in position, presenting an inverted trapezoid pattern and a left-predominant pattern. Meta-analysis showed that the operative time in the SLSG was significantly higher than that in the CLSG, and the pain Visual Analog Scale rating on postoperative day 1 in the CLSG was significantly higher than in the SLSG. There were no statistical significances in the other complications or surgical efficiency. CONCLUSIONS In the CLSG, the majority of the trocars were arranged in an inverted trapezoid pattern and were of the left-predominant type. Although SLSG is a feasible technique in selected patients, there is insufficient evidence to recommend its widespread use compared with CLSG. High-quality randomized controlled trials with large study populations and long follow-up periods will be required in the future.
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Affiliation(s)
- Zhengchen Jiang
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
| | - Zhao Zhang
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
| | - Tianyi Feng
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
| | - Yugang Cheng
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Guangyong Zhang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Mingwei Zhong
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Sanyuan Hu
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
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Nedelcu M, Carandina S, Noel P, Mercoli HA, Danan M, Zulian V, Nedelcu A, Vilallonga R. The Utility of Video Recording in Assessing Bariatric Surgery Complications. J Clin Med 2022; 11:jcm11195573. [PMID: 36233435 PMCID: PMC9572461 DOI: 10.3390/jcm11195573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/28/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Recording every procedure could diminish the postoperative complication rates in bariatric surgery. The aim of our study was to evaluate the correlation between recording every bariatric surgery and their postoperative analysis in relation to the early or late postoperative complications. Methods: Seven hundred fifteen patients who underwent a bariatric procedure between January 2018 and December 2019 were included in a retrospective analysis. There were: 589 laparoscopic sleeve gastrectomies (LSGs); 110 Roux-en-Y bypasses (RYGBs) and 16 gastric bands (LAGBs). The video recording was systematically used, and all patients were enrolled in the IFSO registry. Results: There were 15 patients (2.1%) with surgical postoperative complications: 5 leaks, 8 hemorrhages and 2 stenosis. Most complications were consequent to LSG, except for two, which occurred after RYGB. In four cases a site of active bleeding was identified. After reviewing the video, in three cases the site was correlated with an event which occurred during the initial procedure. Three out of five cases of leak following sleeve were treated purely endoscopically, and no potential correlated mechanism was identified. Two other possible benefits were observed: a better evaluation of the gastric pouch for the treatment of the ulcer post bypass and the review of one per operative incident. Two negative diagnostic laparoscopies were performed. The benefit of the systematic video recording was singled out in eight cases. All the other cases were completed by laparoscopy with no conversion. Conclusion: To record every bariatric procedure could help in understanding the mechanism of certain complications, especially when the analysis is performed within the team. Still, recording the procedure did not prevent the negative diagnostic laparoscopy, but it could play a significant role for the medico-legal aspect in the future.
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Affiliation(s)
- Marius Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obesite, 83000 Toulon, France
- ELSAN, Clinique Bouchard, 13000 Marseille, France
- Correspondence: ; Tel.: +33-695950965
| | - Sergio Carandina
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obesite, 83000 Toulon, France
| | - Patrick Noel
- ELSAN, Clinique Bouchard, 13000 Marseille, France
- Emirates Specialty Hospital, Dubai 505240, United Arab Emirates
| | | | - Marc Danan
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obesite, 83000 Toulon, France
| | - Viola Zulian
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obesite, 83000 Toulon, France
| | - Anamaria Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obesite, 83000 Toulon, France
| | - Ramon Vilallonga
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obesite, 83000 Toulon, France
- Universitat Autònoma de Barcelona, 08028 Barcelona, Spain
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Hospital Vall d’Hebron, 08023 Barcelona, Spain
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4
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Chen IS, Tsai MS, Chen JH, Chen CY, Chen IL, Tai CM. The utility of intraoperative endoscopy to assist novice surgeons in the detection of gastric stenosis during laparoscopic sleeve gastrectomy. BMC Surg 2022; 22:323. [PMID: 35999623 PMCID: PMC9396827 DOI: 10.1186/s12893-022-01772-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a commonly performed bariatric surgery. Gastric stenosis and leaks are 2 major complications associated with LSG and revision surgery might be needed. Herein, we report our experience of intraoperative endoscopy (IOE) to evaluate stenosis and leaks during LSG. METHODS LSG was performed by three surgeons. Patients who underwent LSG and IOE between January 2016 and March 2020 were enrolled and assigned to two groups: group 1 (1st-30th LSG case for each surgeon) and group 2 (> 30th LSG for each surgeon). Patients' anthropometric and biochemical data pre- and post-LSG, as well as IOE findings and follow-up esophagogastroduodenoscopy records were reviewed. RESULTS In total, 352 patients were enrolled including 90 patients in group 1 and 262 patients in group 2. Three out of 352 patients (0.9%) were found to have stenosis by IOE, which was related to tightly gastropexy stitch or reinforcement stitch, all of which were in group 1. Stenosis was resolved after removal of the stitch during LSG. The incidence of gastric stenosis detected by IOE was 3.3% (3/90) and 0% (0/262) in group 1 and group 2, respectively (P = 0.003). No leakage was found in this study and no patient developed clinical or endoscopic stenosis after LSG. CONCLUSIONS The existing evidence showed that IOE can help detect gastric stenosis during LSG, especially for novice surgeons, and the stenosis could be resolved during operation.
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Affiliation(s)
- I-Sung Chen
- Department of Gastroenterology and Hepatology, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Ming-Shian Tsai
- Department of Surgery, Jiaan-Ren Hospital, Kaohsiung, Taiwan
| | - Jian-Han Chen
- Bariatric and Metabolic International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chung-Yen Chen
- Bariatric and Metabolic International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - I-Lin Chen
- Department of Gastroenterology and Hepatology, E-Da Hospital, Kaohsiung, Taiwan
| | - Chi-Ming Tai
- Department of Gastroenterology and Hepatology, E-Da Hospital, Kaohsiung, Taiwan. .,Bariatric and Metabolic International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan. .,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
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5
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Gil PJ, Ruiz-Manzanera JJ, Ruiz de Angulo D, Munitiz V, Ferreras D, López V, Conesa A, Ortiz Á, Martínez de Haro LF, Ramírez P. Learning Curve for Laparoscopic Sleeve Gastrectomy: a Cumulative Summation (CUSUM) Analysis. Obes Surg 2022; 32:2598-2604. [PMID: 35687255 DOI: 10.1007/s11695-022-06145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Bariatric surgery is currently considered the most effective and durable treatment option for morbid obesity. Laparoscopic sleeve gastrectomy (LSG) has become a popular technique and may currently be the most frequently practiced surgical operation to treat obesity. However, no objective analyses of its learning curve have been reported. OBJECTIVE to analyze the learning curve for LSG. MATERIALS AND METHODS We included all LSGs performed in our hospital (University Hospital, Spain; Public Practice) from April 2013 to February 2016. The learning curve for LSG was evaluated using cumulative sum (CUSUM) analysis. All variables among the learning curve phases were compared. RESULTS According to the CUSUM analysis, the learning curve was divided into three unique phases: early learning (the initial 26 patients), acquisition of skills (the middle 30 patients), and mastery of technique (the final 56 patients). The operative time and gastric stenosis significantly decreased with progression of the learning curve without differences in the 30-day postoperative complication rate, postoperative stay, or weight loss. CONCLUSION According to this study, the learning curve for LSG can be divided into 3 distinct phases, and about 25 patients are needed to demonstrate an improvement in surgical skill.
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Affiliation(s)
- Pedro J Gil
- General Surgery Service, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Juan José Ruiz-Manzanera
- General Surgery Service, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain.
| | - David Ruiz de Angulo
- Bariatric Surgery Unit and Upper Gastrointestinal Surgical, General Surgery Service, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Vicente Munitiz
- General Surgery Service, Upper Gastrointestinal Surgical Unit, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - David Ferreras
- General Surgery Service, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Víctor López
- General Surgery Service, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Ana Conesa
- General Surgery Service, Upper Gastrointestinal Surgical Unit, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Ángeles Ortiz
- General Surgery Service, Upper Gastrointestinal Surgical Unit, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Luisa F Martínez de Haro
- General Surgery Service, Upper Gastrointestinal Surgical Unit, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Pablo Ramírez
- General Surgery Service, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain.,Instituto Murciano De Investigación Biosanitaria (IMIB), 30120, El Palmar, Murcia, Spain
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6
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Safety and effectiveness of reduced-port laparoscopic sleeve gastrectomy in Asian morbidly obese patients. Sci Rep 2021; 11:23511. [PMID: 34873253 PMCID: PMC8648717 DOI: 10.1038/s41598-021-02999-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/24/2021] [Indexed: 12/04/2022] Open
Abstract
Laparoscopic sleeve gastrectomy is the most frequently performed surgical intervention in patients with morbid obesity. Single-port sleeve gastrectomy (SPSG) and reduced-port sleeve gastrectomy (RPSG) are increasingly reported in the literature. This study compared the short-term outcomes of SPSG, RPSG, and conventional laparoscopic sleeve gastrectomy (CLSG). This is a single-center retrospective study of 238 morbidly obese patients, of whom 148 (62.2%) patients completed follow-up one year after surgery. Propensity score matching was performed on factors influencing the choice of approach, and fifty patients from the SPSG + RPSG and CLSG groups were successfully matched. The groups were comparable in postoperative weight loss, morbidity, pain, and resolution of obesity-related comorbidities. The percentage of excess weight loss after one year was 90.0% in the SPSG + RPSG group and 75.2% in the CLSG group (P < 0.001). Complication rates showed no significant difference. The CLSG group was superior in dyslipidemia remission (17 [37.0%] vs. 28 [63.6%], P = 0.018) in the total cohort; however, this difference disappeared after matching. Our results suggest that single-port and reduced-port approaches could be alternative choices for selected patients. As our study was limited by its retrospective nature and potential selection bias, further studies are necessary to set standardized guidelines for SPSG.
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Vitiello A, Berardi G, Velotti N, Schiavone V, Musella M. Learning curve and global benchmark values of laparoscopic sleeve gastrectomy: results of first 100 cases of a newly trained surgeon in an Italian center of excellence. Updates Surg 2021; 73:1891-1898. [PMID: 34189700 PMCID: PMC8500908 DOI: 10.1007/s13304-021-01121-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/20/2021] [Indexed: 12/12/2022]
Abstract
To evaluate whether the learning curve for sleeve gastrectomy could be completed after 50 cases. First 100 patients undergoing LSG under a newly trained laparoscopic surgeon were included in this study and divided into two groups of 50 consecutive patients each. Perioperative outcomes were compared to recently introduced global benchmarks. Short-term weight loss was calculated as Total Weight Loss Percent (%TWL) and complications were classified in accordance with the Clavien–Dindo classification. CUSUM analysis was performed for operative time and hospital stay. Mean preoperative age and BMI were 41.8 ± 10.3 years and 42.9 ± 5.4 kg/m2, respectively. Demographics and rate of patients with previous surgery were comparable preoperatively in the two groups. Mean operative time was 92.1 ± 19.3 min and hospital stay was 3.4 ± 0.6 days as per our standard protocol of discharge. Uneventful postoperative course was recorded in 93% of patients and only one case of staple line leak was registered in the first 50 cases (group 1). No statistical difference in BMI and %TWL was found between the two groups at any time of follow-up. Comparison between two groups showed a significant reduction in hospital stay and operative time after the first 50 LSGs (p < 0.05). LSG can be performed by newly trained surgeons proctored by senior tutors. At least 50 cases are needed to meet global benchmark cut-offs and few more cases may be required to reach the plateau of the learning curve.
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Affiliation(s)
- Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy.
| | - Giovanna Berardi
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Nunzio Velotti
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Vincenzo Schiavone
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Mario Musella
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
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8
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Jaruvongvanich V, Wongjarupong N, Vantanasiri K, Samakkarnthai P, Ungprasert P. Midterm Outcome of Laparoscopic Sleeve Gastrectomy in Asians: a Systematic Review and Meta-analysis. Obes Surg 2021; 30:1459-1467. [PMID: 31865553 DOI: 10.1007/s11695-019-04332-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a commonly performed bariatric surgery. Studies have suggested that LSG can provide effective and sustainable weight loss although most of them were conducted in Western populations. Our aim was to characterize the midterm outcome of LSG in Asians with obesity. METHODS MEDLINE and EMBASE were searched through August 2019 for studies that reported % total body weight loss (TBWL) and/or % excess weight loss (EWL) at 3 and/or 5 years among adult Asians with obesity who underwent LSG. Data on complications and surgical revision rate were also extracted. The pooled effect size and 95% confidence interval (CI) were calculated using a random effects model. RESULTS A total of 19 studies involving 6235 patients were included. The pooled mean %EWLs were 72.6% (95% CI 67.2-78.0, I2 = 97%); 67.1% (95% CI 61.7-72.6, I2 = 95%); and 59.1% (95% CI 48.8-69.4, I2 = 94%) at 1, 3, and 5 years, respectively. The pooled mean %TBWLs were 32.1%, 29.0%, and 25.5% at 1, 3, and 5 years, respectively. The pooled rates of revision due to gastroesophageal reflux disease and weight regain were 1.9% and 2.5%, respectively. CONCLUSIONS Our meta-analysis suggests that LSG is an effective procedure for weight reduction that offers durable response for up to 5 years among Asians with obesity. The longer-term data is needed.
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Affiliation(s)
| | - Nicha Wongjarupong
- Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA.
| | | | - Parinya Samakkarnthai
- Division of Endocrinology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Patompong Ungprasert
- Division of Clinical Epidemiology, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Wehrtmann FS, de la Garza JR, Kowalewski KF, Schmidt MW, Müller K, Tapking C, Probst P, Diener MK, Fischer L, Müller-Stich BP, Nickel F. Learning Curves of Laparoscopic Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in Bariatric Surgery: a Systematic Review and Introduction of a Standardization. Obes Surg 2021; 30:640-656. [PMID: 31664653 DOI: 10.1007/s11695-019-04230-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The most commonly performed bariatric procedures are laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (LSG). Impact of learning curves on operative outcome has been well shown, but the necessary learning curves have not been clearly defined. This study provides a systematic review of the literature and proposes a standardization of phases of learning curves for RYGB and LSG. METHODS A systematic literature search was performed using PubMed, Web of Science, and CENTRAL databases. All studies specifying a number or range of approaches to characterize the learning curve for RYGB and LSG were selected. RESULTS A total of 28 publications related to learning curves for 27,770 performed bariatric surgeries were included. Parameters used to determine the learning curve were operative time, complications, conversions, length of stay, and blood loss. Learning curve range was 30-500 (RYGB) and 30-200 operations (LSG) according to different definitions and respective phases of learning curves. Learning phases described the number of procedures necessary to achieve predefined skill levels, such as competency, proficiency, and mastery. CONCLUSIONS Definitions of learning curves for bariatric surgery are heterogeneous. Introduction of the three skill phases competency, proficiency, and mastery is proposed to provide a standardized definition using multiple outcome variables to enable better comparison in the future. These levels are reached after 30-70, 70-150, and up to 500 RYGB, and after 30-50, 60-100, and 100-200 LSG. Training curricula, previous laparoscopic experience, and high procedure volume are hallmarks for successful outcomes during the learning curve.
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Affiliation(s)
- F S Wehrtmann
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - J R de la Garza
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - K F Kowalewski
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - M W Schmidt
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - K Müller
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - C Tapking
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - P Probst
- The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - M K Diener
- The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - L Fischer
- Department of Surgery, Hospital Mittelbaden, Balger Strasse 50, 76532, Baden-Baden, Germany
| | - B P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - F Nickel
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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10
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Uccelli M, Targa S, Cesana GC, Oldani A, Ciccarese F, Giorgi R, De Carli SM, Olmi S. Use of fibrin glue in bariatric surgery: analysis of complications after laparoscopic sleeve gastrectomy on 450 consecutive patients. Updates Surg 2020; 73:305-311. [PMID: 32785854 DOI: 10.1007/s13304-020-00865-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/07/2020] [Indexed: 02/07/2023]
Abstract
Laparoscopic Sleeve Gastrectomy (LSG) is one of the most performed surgical procedures in bariatric surgery. Staple line leak and bleeding are by far the two most feared complications after LSG. In this study, we retrospectively compared the efficacy of Fibrin Glue in preventing staple line leak and bleeding. From September 2019 to January 2020, 450 obese patients underwent elective LSG and were placed into groups with Fibrin Glue reinforcement (Group A) or without Fibrin Glue reinforcement (Group B). Primary endpoints were postoperative staple line leak and bleeding; while, secondary endpoints were reintervention rate, total operative time and mortality. Mean Body Mass Index (BMI) was 45.4 ± 7.9 kg/m2 (range: 35.1-81.8). Mean age was 43.3 ± 11.8 years (range: 18-65). No intraoperative complications or conversion to laparotomy were reported. Mean operative time was comparable between the groups (48 ± 18 min in Group A vs 48 ± 14 min in Group B; p > 0.05). No decrease in overall postoperative complications was found in Group A (5.1% vs 7.0%; p > 0.05), but after stratification according to Clavien-Dindo classification, we found a higher rate of Grade II (0.0% vs 1.6%; p < 0.05) and Grade IIIb (0.0% vs 1%; p < 0.05) complications in group B. Our study showed that Fibrin Glue as a reinforcement method during LSG is a reliable tool, without affecting the operative time of surgery and mortality. A significant reduction in complications (Clavien-Dindo grade II and grade IIIb) was observed in patients undergoing LSG with Fibrin Glue.
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Affiliation(s)
- Matteo Uccelli
- General and Oncologic Surgery Department-Centre of Bariatric Surgery, San Marco Hospital - Gruppo San Donato, Corso Europa, 7, 24040, Zingonia, BG, Italy
| | - Simone Targa
- General and Oncologic Surgery Department-Centre of Bariatric Surgery, San Marco Hospital - Gruppo San Donato, Corso Europa, 7, 24040, Zingonia, BG, Italy.
| | - Giovanni Carlo Cesana
- General and Oncologic Surgery Department-Centre of Bariatric Surgery, San Marco Hospital - Gruppo San Donato, Corso Europa, 7, 24040, Zingonia, BG, Italy
| | - Alberto Oldani
- General and Oncologic Surgery Department-Centre of Bariatric Surgery, San Marco Hospital - Gruppo San Donato, Corso Europa, 7, 24040, Zingonia, BG, Italy
| | - Francesca Ciccarese
- General and Oncologic Surgery Department-Centre of Bariatric Surgery, San Marco Hospital - Gruppo San Donato, Corso Europa, 7, 24040, Zingonia, BG, Italy
| | - Riccardo Giorgi
- General and Oncologic Surgery Department-Centre of Bariatric Surgery, San Marco Hospital - Gruppo San Donato, Corso Europa, 7, 24040, Zingonia, BG, Italy
| | - Stefano Maria De Carli
- General and Oncologic Surgery Department-Centre of Bariatric Surgery, San Marco Hospital - Gruppo San Donato, Corso Europa, 7, 24040, Zingonia, BG, Italy
| | - Stefano Olmi
- General and Oncologic Surgery Department-Centre of Bariatric Surgery, San Marco Hospital - Gruppo San Donato, Corso Europa, 7, 24040, Zingonia, BG, Italy
- University of Milan and Vita-Salute University San Raffaele, Milan, Italy
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11
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Brunaldi VO, Galvao Neto M, Zundel N, Abu Dayyeh BK. Isolated sleeve gastrectomy stricture: a systematic review on reporting, workup, and treatment. Surg Obes Relat Dis 2020; 16:955-966. [DOI: 10.1016/j.soard.2020.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/24/2020] [Accepted: 03/06/2020] [Indexed: 12/11/2022]
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Analysis of the learning process for laparoscopic sleeve gastrectomy: CUSUM-curve of 110 consecutive patients with 1-year follow-up. J Visc Surg 2020; 158:198-203. [PMID: 32446913 DOI: 10.1016/j.jviscsurg.2020.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) is the most popular bariatric procedure worldwide. A tremendous recent increase in the number of LSGs has not been driven by an accurate learning process, especially in low volume bariatric centers. The cumulative-sum (CUSUM) method is an effective analysis of the learning process, taking intraoperative and postoperative variables into account. This study was aimed at establishing a CUSUM learning curve for LSG in order to define the number of procedures needed to achieve sufficient surgical skill. METHODS All LSGs performed by a single general surgeon between September 2014 and November 2017 were considered. We hypothesized that the key t variables related to the LSG learning process (LP) are: operative time (OT), intraoperative complications or difficulties, need for expert assistance, length of hospital stay (LOS), and 3-month postoperative morbidity. All of these parameters are binary variables analyzed with the risk-adjusted CUSUM method. Two groups, learning group (LG) and experienced group (EG), were identified and compared by univariate analysis. Multivariate analysis was performed to identify the variables most closely associated with operative time and surgical success. One-year weight loss outcomes were likewise analyzed. RESULTS One hundred and ten (110) consecutive LSGs were considered. CUSUM-LSG showed that the mean number of consecutive interventions necessary to reach proficiency in LSG was 58. In multivariate analysis, surgical success was negatively correlated with longer operative time and need for expert assistance. Body mass index was not correlated with surgical success. CONCLUSION Fifty-eight LSG procedures were required to achieve surgical skill. Operative time and the need for expert assistance were variables most closely associated with surgical success. ACGME COMPETENCY Practice-based learning and improvement.
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Boyle M, Carruthers N, Mahawar KK. Five-Year Outcomes with Stand-alone Primary Sleeve Gastrectomy. Obes Surg 2020; 29:1607-1613. [PMID: 30719651 DOI: 10.1007/s11695-019-03756-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Sleeve gastrectomy is now the commonest bariatric procedure worldwide, making it important to determine 5-year weight loss and micronutrient deficiency outcomes following primary, stand-alone sleeve gastrectomy (SG) with adequate follow-up. The purpose of this study was to evaluate weight loss, co-morbidity resolution, and haematological outcomes at 5 years with primary, stand-alone SG in our unit. MATERIALS AND METHODS Baseline data were obtained from our prospectively maintained database and patients were invited for a 5-year follow-up. For those who could not attend, further information was obtained by telephoning them and contacting their general practitioners. RESULTS A total of 92 patients (66 females) underwent primary SG at our centre in 2011. The median age was 46.0 years. The median weight and the body mass index (BMI) were 133.0 kg and 47.0 kg/m2 respectively. After 5 years, 7 (7.6%) patients had died due to unrelated causes and 11 (12.0%) had been converted to Roux-en-Y gastric bypass (RYGB). Of the remaining 74, we were able to obtain follow-up data on 64 (86.5%). Despite all efforts, 10 (13.5%) patients were lost to follow-up. The median total weight loss was 21.9% and median excess weight loss (EWL) was 48.0%. Patients developed a range of micronutrient deficiencies over the follow-up period. CONCLUSION This study shows acceptable results with SG at 5 years in our unit, but a large number of patients experienced GORD and some patients needed additional micronutrient supplementation over and above our unit recommendation of a single multivitamin/mineral A-Z tablet daily.
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Affiliation(s)
- Maureen Boyle
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
| | | | - Kamal K Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK. .,University of Sunderland, Sunderland, UK.
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Mohan BP, Asokkumar R, Khan SR, Kotagiri R, Sridharan GK, Chandan S, Ravikumar NPG, Ponnada S, Jayaraj M, Adler DG. Outcomes of endoscopic sleeve gastroplasty; how does it compare to laparoscopic sleeve gastrectomy? A systematic review and meta-analysis. Endosc Int Open 2020; 8:E558-E565. [PMID: 32258380 PMCID: PMC7089787 DOI: 10.1055/a-1120-8350] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/23/2020] [Indexed: 02/06/2023] Open
Abstract
Abstract
Background and study aims Endoscopic sleeve gastroplasty (ESG) is a novel moderately invasive technique in endo-bariatrics as compared to laparoscopic sleeve gastrectomy (LSG). Data is limited as to its efficacy and safety.
Methods We searched multiple databases from inception through August 2019 to identify studies that reported on ESG in the treatment of obesity. Our goals were to calculate the pooled rates of total weight loss (%TWL), excess weight loss (%EWL), and body mass index (BMI) at 1 month, 6 months, and 12 months with ESG. We included studies that reported on LSG, in a similar time frame as ESG, and compared the 12-month outcomes.
Results From eight studies on ESG (1815 patients), the pooled rates of %TWL at 1 month, 6 months, and 12 months were 8.7 (7.2–10.2), 15.3 (14.1–16.6) and 17.1 (15.1–19.1), respectively. The pooled rates of %EWL at 1 month, 6 months, and 12 months were 31.7 (29.3–34.1), 59.4 (57–61.8) and 63 (51.3–74.6), respectively. The pooled rates of BMI at 1 m, 6 m, and 12 m were 32.6 (31–34.3), 30.4 (29–31.8) and 30 (27.7–32.3, I2 = 97), respectively. At 12 months, the pooled %TWL, %EWL and BMI with LSG (7 studies, 2179 patients) were 30.5 (27.4–33.5), 69.3 (60.1–78.4) and 29.3 (27.1–31.4) respectively. On comparison analysis, %TWL with LSG was superior to ESG (P = 0.001). %EWL and BMI were comparable. All adverse events, bleeding and gastro-esophageal reflux disease were significantly lower with ESG when compared to LSG.
Conclusion ESG demonstrates acceptable weight loss parameters and seems to have a better safety profile when compared to LSG.
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Affiliation(s)
- Babu P. Mohan
- Internal Medicine, University of Arizona, Banner University Medical Center, Tucson, Arizona, United States
| | - Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Shahab R. Khan
- Section of Gastroenterology, Rush University Medical Center, Chicago, Illinois, United States
| | - Rajesh Kotagiri
- Internal Medicine, University of Arizona, Banner University Medical Center, Tucson, Arizona, United States
| | | | - Saurabh Chandan
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Naveen PG. Ravikumar
- Internal Medicine, University at Buffalo, Buffalo General Hospital, Buffalo, New York, United States
| | - Suresh Ponnada
- Internal Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, United States
| | - Mahendran Jayaraj
- Department of Gastroenterology and Hepatology, University of Nevada, Las Vegas, Nevada, United States
| | - Douglas G. Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
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Asokkumar R, Babu MP, Bautista I, Lopez-Nava G. The Use of the OverStitch for Bariatric Weight Loss in Europe. Gastrointest Endosc Clin N Am 2020; 30:129-145. [PMID: 31739959 DOI: 10.1016/j.giec.2019.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Technological advances have permitted minimally invasive treatment of many gastrointestinal diseases. With the advent of endoscopic full-thickness suturing, it has become possible to replicate some of the surgical procedures. Endoluminal bariatric procedures to remodel and reduce the gastric volume similar to surgery is evolving as a treatment option for obesity. Some of these methods also have been extended to treat weight regain after gastric bypass surgery. There is a steep learning curve to gaining proficiency with different endoscopic gastric remodeling or gastroplasty techniques. This article describes a simplified technique of endoscopic sleeve gastroplasty using the OverStitch suturing device.
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Affiliation(s)
- Ravishankar Asokkumar
- Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Calle de Oña, 10, Madrid 28050, Spain; Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore.
| | - Mohan Pappu Babu
- Department of Internal Medicine, University of Arizona, Banner University Medical Center, 1625 North Campbell Avenue, Tucson, AZ 85719, USA
| | - Inmaculada Bautista
- Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Calle de Oña, 10, Madrid 28050, Spain
| | - Gontrand Lopez-Nava
- Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Calle de Oña, 10, Madrid 28050, Spain
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Major P, Wysocki M, Dworak J, Pędziwiatr M, Pisarska M, Wierdak M, Zub-Pokrowiecka A, Natkaniec M, Małczak P, Nowakowski M, Budzyński A. Analysis of Laparoscopic Sleeve Gastrectomy Learning Curve and Its Influence on Procedure Safety and Perioperative Complications. Obes Surg 2019; 28:1672-1680. [PMID: 29275495 PMCID: PMC5973999 DOI: 10.1007/s11695-017-3075-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Laparoscopic sleeve gastrectomy (LSG) has become an attractive bariatric procedure with promising treatment effects yet amount of data regarding institutional learning process is limited. MATERIALS AND METHODS Retrospective study included patients submitted to LSG at academic teaching hospital. Patients were divided into groups every 100 consecutive patients. LSG introduction was structured along with Enhanced Recovery after Surgery (ERAS) treatment protocol. Primary endpoint was determining the LSG learning curve's stabilization point, using operative time, intraoperative difficulties, intraoperative adverse events (IAE), and number of stapler firings. Secondary endpoints: influence on perioperative complications and reoperations. Five hundred patients were included (330 females, median age of 40 (33-49) years). RESULTS Operative time in G1-G2 differed significantly from G3-G5. Stabilization point was the 200th procedure using operative time. Intraoperative difficulties of G1 differed significantly from G2-G5, with stabilization after the 100th procedure. IAE and number of stapler firings could not be used as predictor. Based on perioperative morbidity, the learning curve was stabilized at the 100th procedure. The morbidity rates in the groups were G1, 13%; G2, 4%; G3, 5%; G4, 5%; and G5, 2%. The reoperation rate in G1 was 3%; G2, 2%; G3, 2%; G4, 1%; and G5, 0%. CONCLUSION The institutional learning process stabilization point for LSG in a newly established bariatric center is between the 100th and 200th operation. Initially, the morbidity rate is high, which should concern surgeons who are willing to perform bariatric surgery.
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Affiliation(s)
- Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Jadwiga Dworak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Magdalena Pisarska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Mateusz Wierdak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
| | - Anna Zub-Pokrowiecka
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
| | - Michał Natkaniec
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Nowakowski
- Department of Medical Education, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
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Abstract
OBJECTIVE This study aimed to evaluate the cost-effectiveness of bariatric surgery (BS) compared to non-surgical treatment (NST) in Korean people with morbid obesity according to comorbidities and body mass index (BMI) severity. METHODS The target cohort was people with morbid obesity, defined as BMI of ≥ 35 kg/m2, or obese people with BMI of 30-34.9 kg/m2 having obesity-related comorbidities. A decision-tree model for 1-year obesity treatment and Markov model for the rest of life were used. In the decision-tree model, the comorbidity remission rate and BMI change after 1-year treatment were decided based on a prospective clinical trial. In the Markov model, the transition probabilities were calculated considering the BMI level and age. The starting age of 20 years, a cycle length of 1 year, a time horizon of 80 years, and a 5% discount rate were applied for the base case from the healthcare system perspective. RESULTS In the base case, BS improved quality-adjusted life years (QALYs) and was the cost-effective option in total cohort (incremental cost-effectiveness ratio of BS vs. NST was 674 USD/QALY). It was shown to be cost-effective in all subgroup analyses based on BMI level. In particular, BS was a dominant alternative for the subgroup with basal BMI of 35.0-37.4 kg/m2. Various sensitivity analyses showed the robustness of results indicating the cost-effectiveness of BS. CONCLUSION BS at BMI of > 30 kg/m2 was more effective than NST for a reduction in BMI and remission of obesity-related comorbidities and was cost-effective in Korea.
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Bhandari M, Reddy M, Kosta S, Mathur W, Fobi M. Laparoscopic sleeve gastrectomy versus laparoscopic gastric bypass: A retrospective cohort study. Int J Surg 2019; 67:47-53. [PMID: 31121327 DOI: 10.1016/j.ijsu.2019.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND There are many reports on short-term outcomes following sleeve gastrectomy, which demonstrate that it has comparable efficacy to gastric bypass. However, there are very few long-term comparative reports. This study compared the outcomes from laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LGB) in a cohort of patients who had surgery in 2011 with a six-year follow up. MATERIALS AND METHODS Data on patients who had either LSG or LGB at a single centre in Mohak Bariatric and Robotic Surgery Centre, Indore, M.P. India in 2011 were identified from a database of routinely collected data. This retrospective cohort was analysed for weight loss, resolution of comorbidities and nutritional status over six years. Patients who had revision operations or for whom six-year follow-up data were not available were excluded from the analysis. RESULTS 154 patients had LGB and 152 had LSG. The six-year follow up rate was 61.7% (n = 95) and 64.5% (n = 98) respectively for LGB and LSG. Percentage of excess bodyweight loss (%EWL) peaked at approximately 70% after two years in the LSG group and after three years in the LGB group. However, after six years %EWL was 61% for LGB and 50% for LSG (p = 0.001). Resolution of type-2 diabetes was more common in the LGB group compared to the LSG group (79% vs 62%, p = 0.126). Resolution of hypertension and dyslipidaemia was similar in both groups at approximately half of patients in each group for each condition. Nutrient deficiencies were found in both groups but were generally more pronounced in the LGB group. CONCLUSION LGB is a better operation for weight loss, weight loss maintenance, and resolution of type-2 diabetes than LSG. This is at the expense of an increased incidence of nutrient deficiencies. LSG appears to have greater treatment failure by six years follow up and this should be further investigated.
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Affiliation(s)
- Mohit Bhandari
- Mohak Bariatric and Robotic Surgery Center, Mohak Hi-tech Specialty Hospital, Indore, M.P., India.
| | - Manoj Reddy
- Mohak Bariatric and Robotic Surgery Center, Mohak Hi-tech Specialty Hospital, Indore, M.P., India.
| | - Susmit Kosta
- Mohak Bariatric and Robotic Surgery Center, Mohak Hi-tech Specialty Hospital, Indore, M.P., India.
| | - Winni Mathur
- Mohak Bariatric and Robotic Surgery Center, Mohak Hi-tech Specialty Hospital, Indore, M.P., India.
| | - Mathias Fobi
- Mohak Bariatric and Robotic Surgery Center, Mohak Hi-tech Specialty Hospital, Indore, M.P., India.
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Gagner M, Kemmeter P. Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surg Endosc 2019; 34:396-407. [PMID: 30993513 PMCID: PMC6946737 DOI: 10.1007/s00464-019-06782-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/04/2019] [Indexed: 12/19/2022]
Abstract
Background Staple-line leaks following laparoscopic sleeve gastrectomy (LSG) remain a concerning complication. Staple-line buttressing is largely adopted as an acceptable reinforcement but data regarding leaks have been equivocal. This study compared staple-line leaks in five reinforcement options during LSG: no reinforcement (NO-SLR), oversewing (suture), nonabsorbable bovine pericardial strips (BPS), tissue sealant or fibrin glue (Seal), or absorbable polymer membrane (APM). Methods This systematic review study of articles published between 2012 and 2016 regarding LSG leak rates aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Variables of interest included leak rates, bleeding, and complications in addition to surgical and population parameters. An independent Fisher’s exact test was used to compare the number of patients with and without leaks for the different reinforcement options. Results Of the 1633 articles identified, 148 met inclusion criteria and represented 40,653 patients. Differences in age (older in APM; p = 0.001), starting body mass index (lower in Suture; p = 0.008), and distance from pylorus (closer in BPS; p = 0.04) were observed between groups, but mean bougie size was equivalent. The overall leak rate of 1.5% (607 leaks) ranged from 0.7% for APM (significantly lower than all groups; p ≤ 0.007 for next lowest leak rate) to 2.7% (BPS). Conclusions This systematic review of staple-line leaks following LSG demonstrated a significantly lower rate using APM staple-line reinforcement as compared to oversewing, use of sealants, BPS reinforcement, or no reinforcement. Variation in surgical technique may also contribute to leak rates. Electronic supplementary material The online version of this article (10.1007/s00464-019-06782-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michel Gagner
- Department of Surgery, Hopital du Sacré Coeur, 315 Place D’Youville, Suite 191, Montréal, QC H2Y 0A4 Canada
- Herbert Wertheim School of Medicine, Florida International University, Miami, FL USA
- Westmount Square Surgical Center, Westmount, QC Canada
| | - Paul Kemmeter
- Department of Surgery, Mercy Health Saint Mary’s, 2060 E Paris Ave SE #100, Grand Rapids, MI USA
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Sleeve gastrectomy and hypertension: a systematic review of long-term outcomes. Surg Endosc 2018; 33:3001-3007. [DOI: 10.1007/s00464-018-6566-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/26/2018] [Indexed: 10/28/2022]
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Carandina S, Montana L, Danan M, Zulian V, Nedelcu M, Barrat C. Laparoscopic Sleeve Gastrectomy Learning Curve: Clinical and Economical Impact. Obes Surg 2018; 29:143-148. [PMID: 30194588 DOI: 10.1007/s11695-018-3486-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Genser L, Barrat C. Résultats à long terme après chirurgie bariatrique et métabolique. Presse Med 2018; 47:471-479. [PMID: 29618410 DOI: 10.1016/j.lpm.2018.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 01/03/2018] [Indexed: 12/26/2022] Open
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Metabolic Effects of Sleeve Gastrectomy and Laparoscopic Greater Curvature Plication: an 18-Month Prospective, Observational, Open-Label Study. Obes Surg 2018; 27:3258-3266. [PMID: 28674838 DOI: 10.1007/s11695-017-2779-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Laparoscopic greater curvature plication (LGCP) is an innovative restrictive technique designed to reduce gastric volume by plication at the region of greater curvature. The long-term efficacy, safety, and the metabolic effects of this procedure are the subject of this study. METHODS One hundred twenty-seven patients were enrolled; 84 underwent laparoscopic sleeve gastrectomy (LSG) and 43, LGCP. LSG and LGCP were then compared during long-term follow-ups in terms of glycemic control, hormone and lipid secretion, and changes in body composition. Measured parameters included serum glucose, triglycerides, high- and low-density lipoprotein cholesterol, testosterone, estradiol, leptin, adiponectin, ghrelin, fatmass, and lean body mass. RESULTS Significant weight-loss and a reduced body composition resulted from either procedure vs. baseline (i.e., pre-surgery), with levels of fasting glucose and glycated hemoglobin also showing statistically significant reductions (at 3 and 18 months for either surgery). Intergroup comparisons for glycemic parameters yielded no statistically significant differences. However, a dramatic reduction in ghrelin was detected following LSG, falling from pre-surgery levels of 140.7 to 69.6 ng/L by 6 months (P < 0.001). Subsequently, ghrelin levels increased, reaching 107.8 ng/L by month 12. Conversely, after LGCP, a statistically significant increase in ghrelin was seen, rising from 130.0 ng/L before surgery to 169.0 ng/L by month 12, followed by a slow decline. CONCLUSIONS Good metabolic outcomes were obtained following LGCP, which might be mediated via altered glucose metabolism and GI hormones. Nevertheless, this method is less effective than LSG, possibly due to its preservation of the entire stomach, including secretory regions.
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Hasan MY, Lomanto D, Loh LL, So JBY, Shabbir A. Gallstone Disease After Laparoscopic Sleeve Gastrectomy in an Asian Population-What Proportion of Gallstones Actually Becomes Symptomatic? Obes Surg 2018; 27:2419-2423. [PMID: 28401383 DOI: 10.1007/s11695-017-2657-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite evidence on gallstone disease after laparoscopic sleeve gastrectomy (LSG), there is an existing lack of consensus on practice guidelines, i.e., surveillance and stone-lowering prophylaxis. Available evidence also has a racial bias as western reports predominate current data. Considering the growing popularity of LSG in Asia and the unique Asian anthropometrics, we have attempted to provide a regional perspective by reviewing our LSG database to investigate the epidemiology of this complication. METHODS One hundred two morbidly obese cases were retrospectively reviewed. Abdominal ultrasounds were conducted preoperatively and at 12-month post-op. No gallstone-lowering prophylaxis was used. Outcome measure was the incidence of new gallstone formation at 1 year and the rate of symptomatic stones during the follow-up period. RESULTS Mean age was 43 years (range 20-68) with average initial BMI of 41.68 kg/m2. Preoperative gallstones were present in 14 (13.7%) cases. At 12-month post-op, 24 (27.5%) patients with no previous gallstone disease developed new stones. Within the mean follow-up period of 28.4 months, only one case (0.9%) developed gallstone complication requiring a cholecystectomy. We found no statistical difference in demographics, BMI variables (initial BMI, ΔBMI at 6 months and 1 year), and comorbidities between patients with new gallstone and those without stones. CONCLUSION Our results match western data in that gallstone formation is common after LSG though incidence of complicated stones is small. This is despite not using gallstone-lowering prophylaxis. The low conversion rate also questions the relevance of surveillance screening, as most patients with new gallstones remain asymptomatic at least in the short-term follow-up.
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Affiliation(s)
- Muhammed Yaser Hasan
- Division of General Surgery (Upper Gastrointestinal Surgery), University Surgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore
| | - Davide Lomanto
- Division of General Surgery (Upper Gastrointestinal Surgery), University Surgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore
| | - Lee Leng Loh
- Division of General Surgery (Upper Gastrointestinal Surgery), University Surgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore
| | - Jimmy Bok Yan So
- Division of General Surgery (Upper Gastrointestinal Surgery), University Surgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore
| | - Asim Shabbir
- Division of General Surgery (Upper Gastrointestinal Surgery), University Surgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore.
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Comparative Effectiveness of Laparoscopic Sleeve Gastrectomy on Morbidly Obese, Super-Obese, and Super-Super Obese Patients for the Treatment of Morbid Obesity. Obes Surg 2017; 28:1484-1491. [DOI: 10.1007/s11695-017-3053-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Rare Entities of Histopathological Findings in 755 Sleeve Gastrectomy Cases: a Synopsis of Preoperative Endoscopy Findings and Histological Evaluation of the Specimen. Obes Surg 2017; 28:1289-1295. [DOI: 10.1007/s11695-017-3014-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Garg H, Aggarwal S, Misra MC, Priyadarshini P, Swami A, Kashyap L, Jaiswal R. Mid to long term outcomes of Laparoscopic Sleeve Gastrectomy in Indian population: 3-7 year results - A retrospective cohort study. Int J Surg 2017; 48:201-209. [PMID: 29122706 DOI: 10.1016/j.ijsu.2017.10.076] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Few studies have addressed the mid to long term impact of Laparoscopic Sleeve Gastrectomy (LSG) on weight loss and obesity associated co-morbidities, particularly in Indian population. The aim of this study is to assess the efficacy of LSG in morbid obesity over 3-7 years follow up. MATERIALS AND METHODS Data of all patients who underwent LSG between January 2008 and March 2015 and completed their at least 1 year follow up till March 2016 was retrospectively reviewed using a prospectively collected database. RESULTS 424 patients undergoing primary LSG were included. The mean age (±2SD) was 39.8 ± 22.5 years and the mean Body Mass Index (BMI) (±2SD) was 46.67 ± 15.8 kg/m2. 124 patients (29.2%) were super-obese (BMI >50 kg/m2). The percentage follow-up at 1 year, 3 years, 5 years and 7 years was 78.3%, 66.7%, 42.3% and 38.4% respectively. The mean percentage Excess weight Loss (%EWL) (±2SD) at 1year, 3years, 5years, and 7years was 71.8 (±50.5%), 64.95% (±41.8%), 61.7% (±46.2%) and 57.15% (±50.2%) respectively. The preoperative BMI significantly correlated with %EWL at 5 year (r2 = 0.107, p = 0.018). The overall complication rate was 5.8%. Early complications included staple line leak (1.2%), bleeding (1.2%), deep venous thrombosis (0.4%) and 30-day mortality (0.21%). Late complications included stricture formation (0.21%) and new onset Gastro-esophageal Reflux Disease (GERD) (2.8%).At 5 years, 83.3% of diabetic patients showed remission while rest showed improvement in glycemic control with decrease in dosage. 69.3% patients showed improvement in hypertension, 100% patients showed improvement in Obstructive Sleep Apnea Syndrome, 75% patients showed improvement in hypothyroidism after surgery. GERD resolved in 62.8% patients while worsened in 11.4% patients. CONCLUSIONS LSG has durable weight loss at 5 year with %EWL of 61% and significant resolution of obesity associated co-morbidities.
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Affiliation(s)
- Harshit Garg
- Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
| | - Sandeep Aggarwal
- Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
| | - Mahesh Chandra Misra
- Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
| | - Pratyusha Priyadarshini
- Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
| | - Ashish Swami
- Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
| | - Lokesh Kashyap
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
| | - Richa Jaiswal
- Department of Dietetics, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
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The Regulations and Mechanisms of Laparoscopic Sleeve Gastrectomy (LSG) for Obesity and Type 2 Diabetes: A Systematic Review. Surg Laparosc Endosc Percutan Tech 2017; 27:e122-e126. [PMID: 28945696 DOI: 10.1097/sle.0000000000000468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Obesity and diabetes mellitus are becoming 2 of the most leading risk factors that threaten public health worldwide. Obesity is a very strong but preventable risk factor for getting type 2 diabetes. Laparoscopic sleeve gastrectomy (LSG) has been a main approach to the surgical management of morbid obesity and type 2 diabetes but its role remains undefined. Here, we overviewed the clinical outcomes and regulatory mechanisms of LSG, aiming at providing thorough theoretical supports and effective technical guidance to the pathogenesis, prognosis, treatment and prevention of type 2 diabetes with obesity. Futher more, the prospectives and main drawbacks (such as considerable heterogeneity and unicity, little comparability and relevance) of LSG are also discussed.
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Koç O, Şahiner İT, Ekiz F. A New Method in Laparoscopic Sleeve Gastrectomy: Reverse Trendelenburg with Right Lateral Tilt Position Prior to Trocar Entry. Med Sci Monit 2017; 23:4513-4517. [PMID: 28928358 PMCID: PMC5618935 DOI: 10.12659/msm.906737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The primary aim of this study was to evaluate the effectiveness of patient positioning prior to trocar entry in laparoscopic sleeve gastrectomy. Material/Methods The records of 300 patients that had a laparoscopic sleeve gastrectomy surgery at Aydin State Hospital from January 2015 until January 2017 were analyzed retrospectively. First, 140 patients who had been placed in the surgical position after the entry of trocars (PAET) were included as the first group, and 160 patients who had been placed in the surgical position before entry of trocars (PBET) were included as the second group. A comprehensive analysis based on the comparison of age, gender, body mass index (BMI), duration of total anesthesia, and incompleteness rate of operations between the two groups was performed. Results The PAET group was composed of 111 females (79.3%) and 29 males (20.7%). The averages of age, BMI, and duration of anesthesia for this group were 36.84, 46.3 kg/m2, and 161.56 minutes, respectively. The PBET group was composed of 123 females (76.9%) and 37 males (23.1%). The averages of age, BMI, and duration of anesthesia of this second group were 38.8, 47.4 kg/m2, and 120.8 minutes, respectively. In the PAET group, the operations for four patients (2.9%) were never completed; in the PBET group, there was no uncompleted operations (p=0.046). Conclusions PBET is an effective method which both shortens the operation time and decreases the rate of uncompleted operations.
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Affiliation(s)
- Okay Koç
- Gastroenterology Surgery Service, Aydın State Hospital, Aydın, Turkey
| | - İbrahim Tayfun Şahiner
- Department of General Surgery, Erol Olçok Training and Research Hospital, Hitit University School of Medicine, Çorum, Turkey
| | - Feza Ekiz
- Department of General Surgery, İstanbul School of Medicine, İstanbul University, İstanbul, Turkey
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Kafalı ME, Şahin M, Ece İ, Acar F, Yılmaz H, Alptekin H, Ateş L. The effects of bariatric surgical procedures on the improvement of metabolic syndrome in morbidly obese patients: Comparison of laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass. Turk J Surg 2017; 33:142-146. [PMID: 28944323 DOI: 10.5152/turkjsurg.2017.3865] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/12/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate patients who underwent laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy in terms of weight loss, metabolic parameters, and postoperative complications. MATERIAL AND METHODS Data on patients who underwent laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy with a diagnosis of morbid obesity between January 2012 and June 2014 were retrospectively evaluated. Patients were compared in terms of age, sex, body mass index, duration of operation, American Society of Anesthesiologists score, perioperative complications, length of hospital stay, and long term follow-up results. RESULTS During the study period, 91 patients (45 laparoscopic Roux-en-Y gastric bypass and 46 laparoscopic sleeve gastrectomy) underwent bariatric surgery. There was no difference between the two groups in terms of preoperative patient characteristics. Both groups showed statistically significant weight loss and improvement in co-morbidities when compared with the preoperative period. Weight loss and improvement in metabolic parameters were similar in both groups. The duration of operation and hospital stay was longer in the laparoscopic Roux-en-Y gastric bypass group. Furthermore, the rate of total complications was significantly lower in the laparoscopic sleeve gastrectomy group. CONCLUSION Laparoscopic sleeve gastrectomy is a safe and effective method with a significantly lower complication rate and length of hospital stay than laparoscopic Roux-en-Y gastric bypass, with similar improvement rates in metabolic syndrome.
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Affiliation(s)
| | - Mustafa Şahin
- Department of General Surgery, Selçuk University School of Medicine, Konya, Turkey
| | - İlhan Ece
- Department of General Surgery, Selçuk University School of Medicine, Konya, Turkey
| | - Fahrettin Acar
- Department of General Surgery, Selçuk University School of Medicine, Konya, Turkey
| | - Hüseyin Yılmaz
- Department of General Surgery, Selçuk University School of Medicine, Konya, Turkey
| | - Hüsnü Alptekin
- Department of General Surgery, Selçuk University School of Medicine, Konya, Turkey
| | - Leyla Ateş
- Department of General Surgery, Selçuk University School of Medicine, Konya, Turkey
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Hayssam FM, El Hage Chehade HH, Zbibo RH, El khatib ZO, Mneimne M, Dakour Aridi H, Abtar HK. Early Complications Post Laparoscopic Sleeve Gastrectomy: A Single-Center Experience and Literature Review. Bariatr Surg Pract Patient Care 2017. [DOI: 10.1089/bari.2017.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | - Mustapha Mneimne
- Department of Surgery, Makassed General Hospital, Beirut, Lebanon
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Altieri MS, Yang J, Groves D, Obeid N, Park J, Talamini M, Pryor A. Sleeve Gastrectomy: the first 3 Years: evaluation of emergency department visits, readmissions, and reoperations for 14,080 patients in New York State. Surg Endosc 2017; 32:1209-1214. [DOI: 10.1007/s00464-017-5793-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 07/28/2017] [Indexed: 02/06/2023]
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A prospective 4-year study of insulin resistance and adipokines in morbidly obese diabetic and non-diabetic patients after gastric banding. Wideochir Inne Tech Maloinwazyjne 2017; 12:147-153. [PMID: 28694900 PMCID: PMC5502336 DOI: 10.5114/wiitm.2017.67207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/22/2017] [Indexed: 01/06/2023] Open
Abstract
Introduction There are insufficient data regarding the changes in adipokine levels after laparoscopic adjustable gastric banding (LAGB) in diabetic and non-diabetic patients and their effects on insulin resistance and type 2 diabetes remission. Aim To assess leptin, adiponectin, and insulin resistance changes after LAGB in diabetic and non-diabetic morbidly obese patients. Material and methods One hundred and three patients (37 with and 66 without type 2 diabetes) underwent LAGB from January 2009 to January 2010. Glycated hemoglobin, insulin, adipokine levels and insulin resistance were evaluated preoperatively, and 1 and 4 years after LAGB. Results The mean patient age was 45.9 ±11.7 years and mean preoperative body mass index was 47.5 ±7.3 kg/m2. A total of 80 of 103 patients (77.6%) completed the 4-year follow-up. After 4 years the mean excess weight loss was 38.8% and 39.5% in diabetic and non-diabetic patients respectively. Leptin levels decreased significantly in both groups at 1 year, but after 4 years this was noted only in non-diabetic patients. After 1 year adiponectin levels increased significantly only in non-diabetic patients (p = 0.003) and remained almost the same at 4 years. A significant decrease in insulin resistance was noted in both groups 1 year after LAGB and diabetes remission was observed in 23 (62.1%) patients. There was a negative correlation between preoperative insulin resistance and adiponectin levels throughout the follow-up period. Leptin levels positively correlated with BMI throughout the study period (baseline r = 0.45; p < 0.001; after 1 year r = 0.71; p < 0.001; after 4 years r = 0.68; p < 0.001). There was no significant correlation between leptin and adiponectin concentrations preoperatively or after 1 year; however, at 4 years it was significant (r = 0.27; p < 0.02). Conclusions The most significant metabolic changes occurred within 1 year after LAGB. The 4-year follow-up revealed stabilization in metabolic indices rather than significant improvement.
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The bariatric surgery and weight losing: a meta-analysis in the long- and very long-term effects of laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on weight loss in adults. Surg Endosc 2017; 31:4331-4345. [PMID: 28378086 DOI: 10.1007/s00464-017-5505-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/08/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Several studies have been investigated to find the long-term effect of bariatric surgery on weight loss; nevertheless, a meta-analysis can detailedly demonstrate the effect of bariatric surgery on weight in morbidly obese patients. This study aimed to assess the long- and very long-term effects of laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic sleeve gastrectomy (LSG) on weight loss in adults. METHODS An electronic search using PubMed, Scopus, and Google scholar databases was performed for all English-language articles up to May 15, 2016 with no publication date restriction. Outcome was long-term (≥5-10 years) and very long-term (≥10 years) weight reduction that reported as the mean %EWL and changes in BMI from baseline. RESULTS Eighty articles with 87 arms were included in this meta-analysis. The excess weight loss percentage (%EWL) was 47.94% and 47.43% after LAGB at ≥5 and ≥10 years, respectively. After LRYGB the %EWL was 62.58% at ≥5 years and 63.52% at ≥10 years. It was 53.25% at ≥5 years after LSG. Results of subgroup analyses have indicated that LRYGB leads to higher %EWL in America and Asia compared with Europe. Meta-regression analyses have shown that there is no significant association between %EWL and baseline age, BMI and length of follow-up after three procedures. However, there is a positive association between gender and %EWL after LRYGB (β = 1.24). No publication bias was found. CONCLUSIONS These findings suggest that LRYGB is an effective procedure in morbidly obese patients that leads to sustainable weight loss over the long- and very long-term periods in compared with LAGB and LSG.
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Juodeikis Ž, Brimas G. Long-term results after sleeve gastrectomy: A systematic review. Surg Obes Relat Dis 2016; 13:693-699. [PMID: 27876332 DOI: 10.1016/j.soard.2016.10.006] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 10/05/2016] [Accepted: 10/05/2016] [Indexed: 12/13/2022]
Abstract
Sleeve gastrectomy (SG) has become one of the most commonly used bariatric procedures worldwide. However, data regarding long-term results remain insufficient. The aim of this study was to review the long-term results after SG. We conducted a comprehensive literature search of Medline and the Cochrane Library for articles published until May 2016 on the long-term results (>5 yr) after SG. Studies representing outcomes of SG were included if they reported≥5-year results that contained at least one outcome of interest-weight loss, co-morbidities, long-term complications, or quality of life-and SG was performed as a primary procedure. Of the 297 initially identified articles, 277 studies met the exclusion criteria, and 20 met the inclusion criteria. SG was performed on 2713 patients and 1626 patients reached the≥5-year follow-up point. Among the patients, 71.3% were women and 28.7% were men. The mean preoperative body mass index was 46.9 kg/m2. The duration of follow-up ranged 5 to 11 years. The mean 5-year follow-up rate was 66% (range, 57%-100%). The mean percentage excess weight loss was 58.4%, 59.5%, 56.6%, 56.4%, and 62.5% at 5, 6, 7, 8, and 11 years, respectively. Five years after SG, the resolution or improvement of type 2 diabetes was observed in 77.8% of patients, and arterial hypertension, dyslipidemia, obstructive sleep apnea, gastroesophageal reflux disease, and degenerative joint diseases had improved or resolved in 68.0%, 65.9%, 75.8%, 30.6%, and 55.7% of patients, respectively. This systematic review suggests that SG can lead to substantial and lasting excess weight loss and significant improvement in obesity-related co-morbidities. However, the lack of randomized clinical trials, low follow-up rates, and poorly reported data regarding co-morbidities and quality of life in many of the studies indicate that these findings should be interpreted with caution.
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Affiliation(s)
- Žygimantas Juodeikis
- Department of Surgery, Republican Vilnius University Hospital, Vilnius, Lithuania.
| | - Gintautas Brimas
- Department of Surgery, Republican Vilnius University Hospital, Vilnius, Lithuania
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Chang PC, Tai CM, Hsin MC, Hung CM, Huang IYW, Huang CK. Surgical standardization to prevent gastric stenosis after laparoscopic sleeve gastrectomy: a case series. Surg Obes Relat Dis 2016; 13:385-390. [PMID: 27865815 DOI: 10.1016/j.soard.2016.09.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 09/08/2016] [Accepted: 09/09/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is accepted as a stand-alone bariatric procedure. A specific and potentially severe complication of LSG is gastric stenosis (GS). OBJECTIVE Reviewing the treatment and prevention of GS after LSG. SETTING University hospital, Taiwan. MATERIALS AND METHODS A retrospective analysis was conducted involving all of the LSG cases (n = 927) at our institution between February 2007 and December 2015. RESULTS Eight patients (0.8%) with GS were identified in our unit and 1 patient was transferred from another institution with symptomatic GS. The median intervals from initial LSG to the presence of symptoms, endoscopic dilation, and surgical revision were 14±30 days (range, 7-103 days), 21±35.6 days (range, 9-110 days), and 36±473.9 days (range, 11-1185 days), respectively. The majority of stenoses were located at the incisura angularis (8/9 [88.9%]). Among the 9 patients, only 1 responded satisfactorily to repetitive endoscopic dilation and the remaining 8 patients required revisional laparoscopic surgery, including conversion to Roux-en-Y gastric bypass (n = 6), stricturoplasty (n = 1), and Roux-en-Y gastric bypass after failed seromyotomy (n = 1). No patients experienced recurrent symptoms of GS after revisional surgery. In September 2013, we modified our surgical techniques for the subsequent 489 patients and GS did not occur after the change in surgical procedures. CONCLUSION A combined treatment modality, endoscopic intervention with and without surgical revision is essential for managing GSs. Based on our own experience, we emphasize the clinical significance of surgical standardization to prevent the occurrence of GS.
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Affiliation(s)
- Po-Chih Chang
- Bariatric and Metabolic International Surgery Center, E-Da hospital/I-Shou University, Kaohsiung City, Taiwan; Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan; Weight Management Center, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chi-Ming Tai
- Bariatric and Metabolic International Surgery Center, E-Da hospital/I-Shou University, Kaohsiung City, Taiwan; Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan
| | - Ming-Che Hsin
- Body Science and Metabolic Disorders International (BMI) Medical Center, China Medical University Hospital, Taichung City, Taiwan
| | - Chao-Ming Hung
- Division of General Surgery, Department of Surgery, E-Da Cancer Hospital/I-Shou University, Kaohsiung City, Taiwan
| | - Ivy Ya-Wei Huang
- Bariatric and Metabolic International Surgery Center, E-Da hospital/I-Shou University, Kaohsiung City, Taiwan; Weight Management Center, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chih-Kun Huang
- Body Science and Metabolic Disorders International (BMI) Medical Center, China Medical University Hospital, Taichung City, Taiwan.
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Coskun H, Yardimci E. Effects and results of fibrin sealant use in 1000 laparoscopic sleeve gastrectomy cases. Surg Endosc 2016; 31:2174-2179. [PMID: 27604365 DOI: 10.1007/s00464-016-5215-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 08/23/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Staple-line leakage and bleeding are worrisome and feared postoperative complications after laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients. The purpose of this study was to review clinical evidence following the use of fibrin sealant in standard LSG. METHODS Morbidly obese patients who underwent standard technique of LSG with using fibrin sealant were included in the study. Demographics variables [age, gender, body mass index (kg/m2), and comorbid conditions], the re-admission rate, and postoperative early complications, such as bleeding, staple-line leak, twist and stricture, were evaluated at the follow-up during the postoperative first month. RESULTS In total, 1000 patients [586 female (58.6 %)] with a mean age of 42.6 ± 13.6 years underwent LSG. Fibrin sealant was used in all operations. In total, 186 patients (18.6 %) had previous abdominal surgery. The mean operative time was 72 ± 19 min, and the mean hospital stay was 3.2 ± 1.1 days. Only 3 patients (.3 %) experienced bleeding. Staple-line leakage, twist and stricture were not observed. The re-admission rate was .5 %, and no mortalities were noted. CONCLUSION This retrospective study indicates that bariatric surgeons should consider implementing standardized surgical operative technique for reduced postoperative complications in LSG. Fibrin sealant is a reliable and useful tool to reinforce the staple line and may prevent potential twists of the sleeved stomach.
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Affiliation(s)
- Halil Coskun
- Department of General Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Yardimci
- Department of General Surgery, Bezmialem Vakif University, Istanbul, Turkey. .,Department of General Surgery, Arnavutkoy State Hospital, Eski Edirne Str, Arvanutkoy, 34275, Istanbul, Turkey.
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Seki Y, Kasama K, Hashimoto K. Long-Term Outcome of Laparoscopic Sleeve Gastrectomy in Morbidly Obese Japanese Patients. Obes Surg 2016; 26:138-45. [PMID: 25986429 DOI: 10.1007/s11695-015-1728-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recently, laparoscopic sleeve gastrectomy (LSG) as a standalone bariatric procedure has rapidly gained popularity worldwide mainly because of its technical simplicity and the relatively good short-term outcome. In Japan, according to a domestic survey, 71 % of the bariatric procedures performed were LSG. However, the number of studies reporting long-term results are still not enough; particularly, data for Asian patients are scarce. OBJECTIVE The objective of this study was to evaluate the long-term outcomes for LSG in morbidly obese Japanese regarding weight loss and safety. METHODS Between October 2005 and July 2013, 179 morbidly obese Japanese patients (Female 89/Male 90) underwent LSG as a standalone procedure. The mean age was 40.7 years (range, 20-72 years), and the mean preoperative body weight and body mass index (BMI) were 120.4 kg (range, 71.4-231.6 kg) and 43.3 kg/m(2) (range, 30.9-76.5 kg/m(2)), respectively. All patients were evaluated and managed under a strict multidisciplinary team approach. RESULTS The mean BMI declined to 30.0 ± 8.7 kg/m(2) at 1 year, 29.1 ± 8.6 kg/m(2) at 2 years, 28.8 ± 8.7 kg/m(2) at 3 years, 29.3 ± 9.2 kg/m(2) at 4 years, and 32.7 ± 13.6 kg/m(2) at 5 years or more (p < 0.001). The mean percent total body weight loss (%TWL) achieved was 32.4 ± 12.9 % at 1 year, 34.3 ± 12.9 % at 2 years, 34.4 ± 11.6 % at 3 years, 32.8 ± 10.9 % at 4 years, and 29.5 ± 11.8 % at 5 years or more. Super morbidly obese patients and patients whose gastric tube was created using a thicker (45 Fr.) bougie had a tendency to achieve less weight loss. Early and late complications occurred in 16 patients (8.9 %) and in seven patients (3.9 %), respectively. Revision surgeries were required in six patients (3.4 %). The reasons for revision surgery were insufficient weight loss in five patients and intractable gastroesophageal reflux disease (GERD) in one patient. CONCLUSION LSG for Japanese morbidly obese patients is safe, effective, and acceptably durable up to 5 years although some complications unique to the procedure such as leakage from the staple line and intractable GERD occur. For super morbidly obese patients, other surgical options may be required.
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Affiliation(s)
- Yosuke Seki
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Kenkichi Hashimoto
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
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Saleh M, Cheruvu MS, Moorthy K, Ahmed AR. Laparoscopic sleeve gastrectomy using a synthetic bioabsorbable staple line reinforcement material: Post-operative complications and 6 year outcomes. Ann Med Surg (Lond) 2016; 10:83-7. [PMID: 27594992 PMCID: PMC4995473 DOI: 10.1016/j.amsu.2016.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/07/2016] [Accepted: 08/08/2016] [Indexed: 01/07/2023] Open
Abstract
Background Gastric leak after laparoscopic sleeve gastrectomy (LSG) is a serious complication. Currently, the literature lacks long-term outcomes in LSG and leak rates after reinforcement of the staple line. The aims are two-fold: to present leak rates from using staple line reinforcement and six year outcomes of LSG in relation to resolution of obesity-related comorbidities and long-term weight loss. Materials and methods This is a single-institution, retrospectively reviewed study of 204 patient case files. Data from all patients undergoing LSG between December 2007 and May 2013 was collected. Results The total complication rate was 6.9% (14/204), with no recorded staple line leaks. The mean postoperative Body Mass Index (BMI) at 1 year, 2 years, 3 years, 4 years, 5 years, and 6 years was 39.3 ± 8, 38.7 ± 8, 40.4 ± 9, 40.5 ± 10, 43.0 ± 10, and 42.4 ± 7, respectively. The mean % excess weight loss at 1 year, 3 years, and 6 years was 48.4 ± 19, 51.7 ± 28, and 41.0 ± 21, respectively. There were no significant differences between follow-ups at year 1 and 3 (p > 0.05), and between year 3 and 6 (p > 0.05) for the mean % excess weight loss. The resolution rates for all patients were 74%, 61%, 79%, and 90% for hypertension, hypercholesterolemia, diabetes mellitus type 2 and obstructive sleep apnea, respectively. Conclusion The synthetic bioabsorbable reinforcement material shows no staple line leaks making it safe to use. LSG as a procedure had a high resolution of obesity-related comorbidities as well as sustainable long-term weight loss. Laparoscopic sleeve gastrectomy shows sustainable long-term weight loss. Laparoscopic sleeve gastrectomy shows excellent resolution of comorbidities. The use of a bioabsorbable staple line reinforcement material is safe.
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Affiliation(s)
- Mahdi Saleh
- School of Medicine, Imperial College, London, UK
| | | | - Krishna Moorthy
- Bariatric Surgery Department, Imperial College Healthcare NHS Trust, London, UK
| | - Ahmed R Ahmed
- Bariatric Surgery Department, Imperial College Healthcare NHS Trust, London, UK
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Koh JC, Loo WM, Goh KL, Sugano K, Chan WK, Chiu WYP, Choi MG, Gonlachanvit S, Lee WJ, Lee WJJ, Lee YY, Lesmana LA, Li YM, Liu CJ, Matsuura B, Nakajima A, Ng EKW, Sollano JD, Wong SKH, Wong VWS, Yang Y, Ho KY, Dan YY. Asian consensus on the relationship between obesity and gastrointestinal and liver diseases. J Gastroenterol Hepatol 2016; 31:1405-13. [PMID: 27010240 DOI: 10.1111/jgh.13385] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/10/2016] [Accepted: 03/15/2016] [Indexed: 12/13/2022]
Abstract
The incidence of obesity is increasing in Asia, with implications on gastrointestinal (GI) and liver diseases. The Gut and Obesity in Asia Workgroup comprises regional experts with the aim of studying relationship between obesity and the GI and liver diseases in Asia. Through literature review and the modified Delphi process, consensus statements examining the impact of obesity on esophageal, gastric, pancreatic, colorectal, and liver diseases, exploring relationship between gut microbiome and obesity, and assessing obesity therapies have been produced by the Gut and Obesity in Asia Workgroup. Sixteen experts participated with 9/15 statements having strong consensus (>80% agreement). The prevalence of obesity in Asia is increasing (100% percentage agreement in brackets), and this increased prevalence of obesity will result in a greater burden of obesity-related GI and liver diseases (93.8%). There was consensus that obesity increases the risk of gastric cancer (75%) and colorectal neoplasia (87.5%). Obesity was also associated with Barrett's esophagus and esophageal adenocarcinoma (66.7%) and pancreatic cancer (66.7%) in Asia. The prevalence of non-alcoholic fatty liver disease (NAFLD) in Asia is on the rise (100%), and the risk of NAFLD in Asia (100%) is increased by obesity. Obesity is a risk factor for the development of hepatocellular carcinoma (93.8%). Regarding therapy, it was agreed that bariatric surgery was an effective treatment modality for obesity (93.8%) but there was less agreement on its benefit for NAFLD (62.5%). These experts' consensus on obesity and GI diseases in Asia forms the basis for further research, and its translation into addressing this emerging issue.
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Affiliation(s)
| | - Wai Mun Loo
- Department of Medicine, National University of Singapore, Singapore
| | - Khean Lee Goh
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Wah Kheong Chan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wai Yan Philip Chiu
- Department of Surgery, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Myung-Gyu Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Sutep Gonlachanvit
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan
| | | | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Laurentius A Lesmana
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia
| | - You-Ming Li
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chun Jen Liu
- Department of Internal Medicine, Graduate Institute of Clinical Medicine, Hepatitis Research Center, National Taiwan University College of Medicine and National Taiwan University Hospital, Taiwan
| | - Bunzo Matsuura
- Department of Lifestyle-Related Medicine and Endocrinology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Japan
| | - Enders Kwok Wai Ng
- Department of Surgery, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Jose D Sollano
- Department of Medicine, University of Santo Tomas, Manila, Philippines
| | - Simon Kin Hung Wong
- Department of Surgery, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Vincent W S Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Yunsheng Yang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Khek Yu Ho
- Department of Medicine, National University of Singapore, Singapore
| | - Yock Young Dan
- Department of Medicine, National University of Singapore, Singapore
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Wang X, Chang XS, Gao L, Zheng CZ, Zhao X, Yin K, Fang GE. Effectiveness of laparoscopic sleeve gastrectomy for weight loss and obesity-associated co-morbidities: a 3-year outcome from Mainland Chinese patients. Surg Obes Relat Dis 2016; 12:1305-1311. [DOI: 10.1016/j.soard.2016.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 02/29/2016] [Accepted: 03/04/2016] [Indexed: 12/16/2022]
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Liu SYW, Wong SKH, Lam CCH, Yung MY, Kong APS, Ng EKW. Long-term Results on Weight Loss and Diabetes Remission after Laparoscopic Sleeve Gastrectomy for A Morbidly Obese Chinese Population. Obes Surg 2016; 25:1901-8. [PMID: 25761944 DOI: 10.1007/s11695-015-1628-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is an effective stand-alone bariatric procedure with favorable short-term results on weight reduction and comorbidity resolution. This study aims to evaluate the long-term results of LSG to see if weight reduction and diabetic improvement are sustainable. METHODS We conducted a prospective observational study on patients receiving LSG as an index stand-alone bariatric operation in our unit. RESULTS Between 2006 and 2014, there were 140 patients (91 females) aged 37.9 ± 10.5 years with a body mass index of 41.0 ± 7.0 kg/m(2). At 1-year (n = 123), 2-year (n = 99), 3-year (n = 77), 4-year (n = 52), and 5-year (n = 44) follow-ups, the mean percentages of excess weight loss (%EWL) were 70.5, 65.2, 60.2, 53.2, and 57.2%, respectively, while the corresponding proportions with failed weight loss (%EWL <30%) were 7.3, 9.1, 13.0, 25.0, and 22.7%. Weight regain (>25% rebound in %EWL) was evident with time as 0, 1.0, 11.6, 19.2, and 29.5% in the first 5-year follow-ups. In 65 patients with type 2 diabetes mellitus, remission (complete and partial) was achieved in 34.5% at 1-year, 52.7% at 3-year, and 70.6% at 5-year follow-ups. Proportions of patients having optimal glycemic control (HbA1c <7%) increased significantly from 26.2% preoperatively to 80.9% at the first year and maintained at 78.6% at the fifth year (P < 0.001). CONCLUSIONS LSG was effective in achieving substantial weight reduction and improved diabetic control for morbidly obese patients. Although weight regain was possible with time, majority of patients could maintain sustainable weight loss, diabetes remission, and glycemic improvement in the long run.
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Affiliation(s)
- Shirley Yuk-Wah Liu
- Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong,
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Sleeve Gastrectomy and Type 2 Diabetes Mellitus: a Systematic Review of Long-Term Outcomes. Obes Surg 2016; 26:1616-21. [DOI: 10.1007/s11695-016-2188-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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44
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Early outcomes of laparoscopic sleeve gastrectomy in a multiethnic Asian cohort. Surg Obes Relat Dis 2016; 12:330-7. [DOI: 10.1016/j.soard.2015.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/27/2015] [Accepted: 05/15/2015] [Indexed: 12/12/2022]
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Dogan K, Gadiot RPM, Aarts EO, Betzel B, van Laarhoven CJHM, Biter LU, Mannaerts GHH, Aufenacker TJ, Janssen IMC, Berends FJ. Effectiveness and Safety of Sleeve Gastrectomy, Gastric Bypass, and Adjustable Gastric Banding in Morbidly Obese Patients: a Multicenter, Retrospective, Matched Cohort Study. Obes Surg 2016; 25:1110-8. [PMID: 25408433 DOI: 10.1007/s11695-014-1503-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic adjustable gastric band (LAGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most performed procedures worldwide (92 %) nowadays. However, comparative clinical trials are scarce in literature. The objective of this study was to compare the effectiveness and safety of the three most performed bariatric procedures. METHODS A multicenter, retrospective, matched cohort study was conducted. Patients were eligible for analysis when a primary procedure was performed between 2007 and 2010 in one of the two specialized bariatric centers. Primary outcome was weight loss, expressed in the percentage excess weight loss (%EWL). Secondary outcome parameters are hospital stay, complication rate, and revisional surgery. RESULTS In total, 735 patients, 245 in each group, were included for analysis. The groups were comparable for age and gender after matching. Mean postoperative follow-up was 3.1 ± 1.2 years. LAGB patients showed less %EWL compared to LSG and LRYGB at all postoperative follow-up visits. LRYGB showed a %EWL of 71 ± 20 % compared to LSG (76 ± 23 %; p=0.008) after 1-year follow-up; thereafter, no significant difference was observed. After 3 years of follow-up, LAGB showed a higher complication rate compared to LSG and LRYGB (p<0.05). Revisional surgery after LAGB was needed in 21 %, while 9 % of the LSG underwent conversion to RYGB. CONCLUSIONS LRYGB is a safe and effective treatment in morbid obese patients with good long-term outcomes. LSG seems to be an appropriate alternative as a definitive procedure, in terms of weight reduction and complication rate. LAGB is inferior to both LRYGB and LSG.
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Affiliation(s)
- Kemal Dogan
- Department of Surgery, Rijnstate Hospital, Postal number 1190, PO box 9555, 6800 TA, Arnhem, The Netherlands,
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Casella G, Soricelli E, Giannotti D, Bernieri MG, Genco A, Basso N, Redler A. Learning curve for laparoscopic sleeve gastrectomy: role of training in a high-volume bariatric center. Surg Endosc 2015; 30:3741-8. [DOI: 10.1007/s00464-015-4670-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 10/14/2015] [Indexed: 02/07/2023]
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Rebibo L, Dhahri A, Maréchal V, Fumery M, Delcenserie R, Regimbeau JM. Gastric leaks after sleeve gastrectomy: no impact on weight loss, co-morbidities, and satisfaction rates. Surg Obes Relat Dis 2015; 12:502-510. [PMID: 26656670 DOI: 10.1016/j.soard.2015.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/03/2015] [Accepted: 07/27/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND No data are available concerning the results on weight loss, correction of co-morbidities, and satisfaction rates in patients with healed gastric leak (GL) after sleeve gastrectomy (SG). OBJECTIVE Evaluate weight loss, correction of co-morbidities, and satisfaction rate of patients with healed GL after SG. SETTING University hospital, France, public practice. METHODS Between March 2004 and October 2012, all patients managed for GL after SG with a minimum of 1 year follow-up were included. These patients (GL group) were matched in terms of preoperative data and type of surgical procedure (first- or second-line SG) on a 1:2 basis with 74 patients without GL (control group) selected from a population of 899 SGs. Primary endpoint was the weight change over a 1-year period after performing SG. Secondary endpoints were GL data, co-morbidities data, and satisfaction rates 1 year after SG. RESULTS The GL group consisted of 37 patients (27 first-line SG [73%]). The mean EWL in the GL group was 52.2% and 68.8% at 6 and 12 months, whereas the mean EWL in the control group was 58.9% and 72.2%, respectively (P = .12; P = .46). No significant difference was observed between the 2 groups in terms of correction of co-morbidities. At 12 months follow-up, mean BAROS score was 6.02 in the GL group and 7.14 in the control group (P = .08). No significant difference was observed between the 2 groups in terms of the SF-36 questionnaire. CONCLUSION Despite the morbidity associated with GL, the results on weight loss, correction of co-morbidities, and satisfaction rates were similar in patients with healed GL and in patients without GL.
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Affiliation(s)
- Lionel Rebibo
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - Abdennaceur Dhahri
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - Virginie Maréchal
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - Mathurin Fumery
- Department of Psychiatry, Amiens University Hospital, Amiens, France
| | | | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Department of Gastro-Enterology, Amiens University Hospital, Amiens, France; Jules Verne University of Picardie, Amiens, France; Clinical Research Center, Amiens University Hospital, Amiens, France.
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Abstract
The standard approach to laparoscopic sleeve gastrectomy (LSG) involves sleeve-forming through a vertical gastrectomy, producing a narrow, tubular stomach. Considerable laparoscopic skills are required to find a suitable size at which the pressure of the sleeve is not excessive and the restriction is sufficient for obtaining good weight-loss effect without increasing the risk of complications. There is no doubt that considerable technical details are required to create a “perfect sleeve.” We report our sleeve-forming technique for LSG involving both vertical gastrectomy and plication, which we have termed “laparoscopic plicated sleeve gastrectomy.” This technique was shown to be safe and efficacious for the treatment of severe obesity and can reduce technical difficulties in the creation of a “perfect sleeve.”
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Comparison of weight loss and body composition changes in morbidly obese Taiwanese patients with different bariatric surgeries: a 1-year follow-up study. Obes Surg 2015; 24:572-7. [PMID: 24222534 DOI: 10.1007/s11695-013-1115-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study investigated the impacts of two different bariatric surgeries on the body composition of morbidly obese patients in Taiwan. Also, the differences in body composition changes between genders were compared. METHODS In total, 198 patients who underwent bariatric surgery were included, with 130 receiving a sleeve gastrectomy (SG) and 68 receiving adjusted gastric banding (AGB). The weight and body composition were measured by bioelectrical impedance. Follow-up examinations were performed at subsequent visits after surgery and at 1 year. Only 81 SG and 40 AGB patients continued follow-up for the entire 12 months. RESULTS All patients experienced significant weight loss beginning from 3 months after surgery. Compared to patients with AGB, SG patients had a greater extent of body mass index (BMI) loss, whereas a greater muscle weight percentage increase was found compared to AGB patients. Female patients had a higher body fat mass and lower muscle weight percentage and BMI than did males. There were no differences in changes in BMI, or percentages of body fat and muscle mass between male and female patients for 12 months after surgery. However, the waist/hip ratio (WHR) decrement and percentage of excess weight loss (ExWL%) were significantly greater in female than male patients with both bariatric surgeries. CONCLUSIONS These findings suggest that although females had greater extents of WHR decrement and ExWL% than male patients with both surgical procedures, patients who received SG had higher BMI changes and body fat losses than SGB patients regardless of differences in the gender distribution.
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Fischer L, Wekerle AL, Bruckner T, Wegener I, Diener MK, Frankenberg MV, Gärtner D, Schön MR, Raggi MC, Tanay E, Brydniak R, Runkel N, Attenberger C, Son MS, Türler A, Weiner R, Büchler MW, Müller-Stich BP. BariSurg trial: Sleeve gastrectomy versus Roux-en-Y gastric bypass in obese patients with BMI 35-60 kg/m(2) - a multi-centre randomized patient and observer blind non-inferiority trial. BMC Surg 2015; 15:87. [PMID: 26187377 PMCID: PMC4506636 DOI: 10.1186/s12893-015-0072-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 07/08/2015] [Indexed: 02/08/2023] Open
Abstract
Background Roux-en-Ygastric bypass (RYGB) and sleeve gastrectomy (SG) rank among the most frequently applied bariatric procedures worldwide due to their positive risk/benefit correlation. A systematic review revealed a similar excess weight loss (EWL) 2 years postoperatively between SG and RYGB. However, there is a lack of randomized controlled multi-centre trials comparing SG and RYGB, not only concerning EWL, but also in terms of remission of obesity-related co-morbidities, gastroesophageal reflux disease (GERD) and quality of life (QoL) in the mid- and long-term. Methods The BariSurg trial was designed as a multi-centre, randomized controlled patient and observer blind trial. The trial protocol was approved by the corresponding ethics committees of the centres. To demonstrate EWL non-inferiority of SG compared to RYGB, power calculation was performed according to a non-inferiority study design. Morbidity, mortality, remission of obesity-related co-morbidities, GERD course and QoL are major secondary endpoints. 248 patients between 18 and 70 years, with a body mass index (BMI) between 35–60 kg/m2 and indication for bariatric surgery according to the most recent German S3-guidelines will be randomized. The primary and secondary endpoints will be assessed prior to surgery and afterwards at discharge and at the time points 3–6, 12, 24, 36, 48 and 60 months postoperatively. Discussion With its five year follow-up, the BariSurg-trial will provide further evidence based data concerning the impact of SG and RYGB on EWL, remission of obesity-related co-morbidities, the course of GERD and QoL. Trial registration The trial protocol has been registered in the German Clinical Trials Register DRKS00004766.
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Affiliation(s)
- Lars Fischer
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Anna-Laura Wekerle
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Inga Wegener
- Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus K Diener
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | | | - Daniel Gärtner
- Department of General and Visceral Surgery, Städtisches Krankenhaus Karlsruhe, Moltkestraße 90, 76133, Karlsruhe, Germany
| | - Michael R Schön
- Department of General and Visceral Surgery, Städtisches Krankenhaus Karlsruhe, Moltkestraße 90, 76133, Karlsruhe, Germany
| | - Matthias C Raggi
- Department of General and Visceral Surgery, Agaplesion Bethesda Krankenhaus Stuttgart, Hohenheimer Straße 21, 70184, Stuttgart, Germany
| | - Emre Tanay
- Department of General and Visceral Surgery, Agaplesion Bethesda Krankenhaus Stuttgart, Hohenheimer Straße 21, 70184, Stuttgart, Germany
| | - Rainer Brydniak
- Department of General and Visceral Surgery, Schwarzwald- Baar Klinikum, Klinikstraße 11, 78052, Villingen-Schwenningen, Germany
| | - Norbert Runkel
- Department of General and Visceral Surgery, Schwarzwald- Baar Klinikum, Klinikstraße 11, 78052, Villingen-Schwenningen, Germany
| | - Corinna Attenberger
- Department of Surgery, Caritas-Krankenhaus St. Josef, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Min-Seop Son
- Department of General and Visceral Surgery, Johanniter Krankenhaus, Johanniter GmbH, Johanniterstraße 3, 53113, Bonn, Germany
| | - Andreas Türler
- Department of General and Visceral Surgery, Johanniter Krankenhaus, Johanniter GmbH, Johanniterstraße 3, 53113, Bonn, Germany
| | - Rudolf Weiner
- Department of Bariatric Surgery and Metabolic Surgery, Sana Klinikum Offenbach GmbH, Starkenburgring 66, 63069, Offenbach, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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