Long-Term Outcome of Laparoscopic Sleeve Gastrectomy in Morbidly Obese Japanese Patients

The impact of the bougie size and the extent of antral resection on weight-loss and postoperative complications following sleeve gastrectomy: results from the Scandinavian Obesity Surgery Registry

BACKGROUND

The optimal sleeve diameter and distance from the pylorus to the edge of the resection line in laparoscopic sleeve gastrectomy (LSG) remain controversial.

OBJECTIVES

To evaluate the influence of bougie size and antral resection distance from the pylorus on postoperative complications and weight-loss results in LSG.

SETTING

Nationwide registry-based study.

METHODS

This study included all LSGs performed in Sweden between 2012 and 2019. Data were obtained from the Scandinavian Obesity Surgery Registry. Reference bougie size of 35-36 Fr and an antral resection distance of 5 cm from the pylorus were compared to narrower bougie size (30-32 Fr), shorter distances (1-4 cm), and extended distances (6-8 cm) from the pylorus in assessing postoperative complications and weight loss as the outcomes of LSG.

RESULTS

The study included 9,360 patients with postoperative follow-up rates of 96%, 79%, and 50% at 30 days, 1 year, and 2 years, respectively. Narrow bougie and short antral resection distance from the pylorus were significantly associated with increased postoperative weight loss. Bougie size was not associated with increased early or late complications. However, short antral resection distance was associated with high risk of overall early complications [odds ratio: 1.46 (1.17-1.82, P = .001)], although no impact on late complications at 1 and 2 years was observed.

CONCLUSIONS

Using a narrow bougie and initiating resection closer to the pylorus were associated with greater maximum weight loss. Although a closer resection to the pylorus was associated with an increased risk of early postoperative complications, no association was observed with the use of narrow bougie for LSG.

Verification of Safety and Efficacy of Sleeve Gastrectomy Based on National Registry by Japanese Society for Treatment of Obesity

In Japan, bariatric surgical treatment was started in 1982. The Japanese Society for Treatment of Obesity (JSTO) was established in 2007, and then, JSTO started the national registry of bariatric surgery cases and multidisciplinary educational program. A total of 44 facilities registered 4055 bariatric surgical cases until 2021. In this study, the purpose is to clarify the indication, the safety and the effectiveness of the sleeve gastrectomy using national registry database compiled by JSTO. Preoperative BMI ranged from 27.6 to 90.7 kg/m², and the mean value was 42.7. With regard to gender, men/women was 1/1.3. Age was 42.2 as mean. As preoperative comorbidities, DM ratio was 54.4% of the patients, hypertension 64.5%, dyslipidemia 65.1%, and sleep apnea syndrome 69.8%. As an operation method, laparoscopic method was conducted in 99.7% of the cases. The intraoperative incidence rate was 0.9%. Conversion rate to open method was 1.1%. Postoperative morbidity ratio was 5.6%, and mortality was 0%. Reoperations were performed in 1.5% of the cases. Postoperative hospital stay was 5 days in median value. Body weight loss was 27.6 kg in the mean value after follow-up days of 279 ± 245. As the effect on the preoperative metabolic comorbidities, DM has improved in 82.9% of the cases, hypertension 67.9% and dyslipidemia 66.6%. In conclusion, using JSTO database, we evaluated the indication, postoperative complications and weight loss effect of sleeve gastrectomy in Japan. Regarding the evaluation of the effect on preoperative comorbidities, future follow-up based on more detailed criteria was considered to be necessary.

Trocar number and placement for laparoscopic sleeve gastrectomy and comparison of single-incision and conventional laparoscopic sleeve gastrectomy: a systematic review and meta-analysis

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.

Feasibility of Laparoscopic Sleeve Gastrectomy for Patients with Obesity and Disorders of Intellectual Development: a Single Institutional Experience

BACKGROUND

Owing to their difficulty following clinical advice for procedural safety and ideal surgical outcomes, bariatric and metabolic surgery (BMS) for patients with disorders of intellectual development (DID) is concerning. Studies reporting the feasibility of BMS for this population remain scarce. This study aims to clarify the feasibility of laparoscopic sleeve gastrectomy (LSG) for patients with clinically severe obesity and DID.

METHODS

A retrospective analysis of a single institutional prospective database collected from 2010 to 2022 was performed. The Wechsler Adult Intelligence Scale (WAIS) was used to measure intellectual ability before LSG. A multidisciplinary team approach was implemented to give special support and care to patients with DID. Patients were categorized into groups according to their WAIS scores. LSG outcomes were statistically compared between the DID and average intellectual ability groups.

RESULTS

Using the WAIS to measure intellectual ability among patients who underwent LSG, we identified 14 patients with DID (IQ score: < 69, mean IQ: 63.4) and 71 with average intellectual ability (IQ score: 90-109, mean IQ: 98.9). Operative outcomes were comparable between the groups as follows: operation time (DID: 163 ± 41 min, average intelligence: 162 ± 30 min), hospital stay (DID: 4 [4-5] days, average intelligence: 5 [4-6] days), and total comorbidities (DID: 7.1%, average intelligence: 8.4%). No reoperations were performed, and no mortalities were observed.

CONCLUSIONS

With medical and social support and care, performing LSG on patients with clinically severe obesity and DID is safe, with good short-term results.

Metabolic and bariatric surgery in China: A summary of the Greater China Metabolic and Bariatric Surgery Database and comparison with other international registry databases

AIMS

To summarize the Greater China Metabolic and Bariatric Surgery Database (GC-MBD) and to compare patient characteristics and different procedures performed with data from published reports from other international bariatric surgery registries.

MATERIALS AND METHODS

Data were extracted from the GC-MBD registry in 2021. Baseline demographic characteristics, obesity-related comorbidities and operational information were analysed. Descriptive comparisons of these data were made with the published reports from four other international/national databases, including the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) registry, the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database of the United States, the National Bariatric Surgical Registry (NBSR) of the United Kingdom, and the Scandinavian Obesity Surgery Registry (SOReg).

RESULTS

Fifty-three centres in China registered 6807 cases in the GC-MBD. Compared with published data from the IFSO registry, MBSAQIP, NBSR and SOReg, patients in China undergoing surgery were younger and had a lower body mass index. The incidence of other obesity-related comorbidities, except for gastroesophageal reflux disease, was also higher than in Western countries. Furthermore, more patients underwent sleeve gastrectomy, less revisional bariatric surgery was reported in China, and jejunojejunal bypass with sleeve gastrectomy, uncommon in other countries, was China's second-leading bariatric procedure.

CONCLUSIONS

By establishing comprehensive national registries such as the GC-MBD, real-world information can be gathered on clinical practice and patient outcomes. Insights into variations in clinical practice can be identified by comparing reports from different countries, which can help in making and evaluating healthcare policies on the best clinical practices at a national level.

Personality traits and preoperative lifestyle improvement are predictors of early weight loss after sleeve gastrectomy

PURPOSE

This study investigated the associations of personality traits and preoperative lifestyle improvements with early weight loss after sleeve gastrectomy.

METHODS

This was a single-center, retrospective study of 57 patients who underwent preoperative lifestyle intervention with a multidisciplinary team approach based on cognitive behavioral therapy before sleeve gastrectomy. All patients underwent preoperative psychological testing with the Neuroticism-Extraversion-Openness Five-Factor Inventory (NEO-FFI) and the Tokyo University Egogram New Version II (TEG II). We investigated the associations of psychological testing results and lifestyle improvements with percent total weight loss (%TWL) one year after surgery.

RESULTS

The median %TWL at 1 year was 38.2% for patients with an improved lifestyle and 26.9% for those without improvement (P = 0.0008). Although TEG II factors were not associated with %TWL at 1 year, higher NEO-FFI extraversion (E) scores were significantly associated with a better %TWL at 1 year. The median %TWL at 1 year was 35.2% for patients with higher E scores and 25.4% for those with lower E scores (P = 0.0247). Lifestyle improvement and the NEO-FFI E score significantly influenced %TWL at 1 year based on a logistic regression analysis.

CONCLUSION

The NEO-FFI E score and preoperative lifestyle improvement may be predictors of early weight loss after sleeve gastrectomy.

Gastroesophageal Reflux Disease as an Indication of Revisional Bariatric Surgery-Indication and Results-a Systematic Review and Metanalysis

This systematic review evaluates the indications and results of revisional bariatric surgery (RBS) in gastroesophageal reflux disease (GERD). A systematic literature search and meta-analysis was performed for articles published by April 1, 2021. After examining 722 papers involving 17,437 patients, 48 studies were included (n = 915 patients). RBS for GERD was mostly reported after sleeve gastrectomy (n = 796, 87%) and one anastomosis gastric bypass (n = 62, 6.8%) and was performed due to intractable GERD (71.6%), GERD and weight issues (16%), and biliary reflux (6.2%). Mean follow-up of the studies was 31.5 (3-84) months. Pooled estimation of a meta-analysis of studies reported 7% of GERD following primary surgery needing RBS, in which 99% of the patients experienced remission.

Management of Staple Line Leaks after Laparoscopic Sleeve Gastrectomy

Background and Objectives:

Laparoscopic sleeve gastrectomy has become one of the most popular bariatric surgeries in the United States with a low rate of morbidity and effective weight loss. However, staple line leak remains a feared complication requiring a lengthy and difficult treatment course until resolution. This study outlines the various treatment methods used within a high-volume bariatric practice for successful leak resolution without necessitating a conversion procedure.

Methods:

A retrospective review was conducted on all patients with staple line leak after laparoscopic sleeve gastrectomy in a three-surgeon bariatric practice from January 1, 2010 to December 31, 2019.

Results:

A total of 10 staple line leaks were identified with a leak rate of 0.9%. Patients presented on average 29.3 days postoperatively and were all diagnosed on computed tomography. Three patients were initially managed operatively with washout and drainage procedure. Six patients were managed endoscopically initially with either stent or over-the-scope clip placement. Most patients required multiple interventions with an average of 2.4 interventions per patient. Average time to leak resolution was 48.2 days (15–95 days).

Conclusion:

Management of staple line leaks after laparoscopic sleeve gastrectomy requires a multimodal approach usually requiring multiple interventions before leak resolution. We demonstrate effective utilization of varying interventions that lead to effective leak resolution and avoid conversion operations.

Laparoscopic sleeve gastrectomy for morbid obesity improves gut microbiota balance, increases colonic mucosal-associated invariant T cells and decreases circulating regulatory T cells

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) for morbid obesity may improve gut microbiota balance and decrease chronic inflammation. This study examines the changes in gut microbiota and immune environment, including mucosal-associated invariant T cells (MAIT cells) and regulatory T cells (Treg cells) caused by LSG.

METHODS

Ten morbidly obese patients underwent LSG at our institution between December 2018 and March 2020. Flow cytometry for Th1/Th2/Th17 cells, Treg cells and MAIT cells in peripheral blood and colonic mucosa and 16S rRNA analysis of gut microbiota were performed preoperatively and then 12 months postoperatively.

RESULTS

Twelve months after LSG, the median percent total weight loss was 30.3% and the median percent excess weight loss was 66.9%. According to laboratory data, adiponectin increased, leptin decreased, and chronic inflammation improved after LSG. In the gut microbiota, Bacteroidetes and Fusobacteria increased after LSG, and indices of alpha diversity increased after LSG. In colonic mucosa, the frequency of MAIT cells increased after LSG. In peripheral blood, the frequency of Th1 cells and effector Treg cells decreased after LSG.

CONCLUSIONS

After LSG for morbid obesity, improvement in chronic inflammation in obesity is suggested by change in the constituent bacterial species, increase in the diversity of gut microbiota, increase in MAIT cells in the colonic mucosa, and decrease in effector Treg cells in the peripheral blood.

Long-Term Weight Loss Outcome of Laparoscopic Sleeve Gastrectomy Predicted by the Percentage of Excess Weight Loss at 6 Months in Chinese Patients with Body Mass Index ≥ 32.5 Kg/m2

PURPOSE

To evaluate the predictive effect of the initial weight loss on the long-term weight loss in Chinese patients with a body mass index (BMI) ≥ 32.5 kg/m² who underwent LSG.

PATIENTS AND METHODS

The follow-up was completed via phone or WeChat for outpatients and at the hospital for inpatients. We evaluated the BMI, percentage of excess weight loss (%EWL), and type 2 diabetes mellitus, hypertension, and hyperlipidemia statuses. Linear and logistic regression analyses were performed on the relationship between the initial and long-term weight loss. The optimal cut-off value was determined by receiver operating characteristic (ROC) curve analysis.

RESULTS

We enrolled 307 patients, with a median preoperative BMI of 39.68 (35.68, 45.47) kg/m². %EWL ≥ 50% was regarded as successful weight loss, and 76.55% of the patients lost their weight successfully. (Reviewer #1, comment #4) %EWL at 6 months and 5 years were positively correlated (P < 0.001). Further, the following linear equation could express the relationship: (%EWL_{5 years} = 29.193 + 0.526 × %EWL_{6 months}). %EWL ≥ 58.57% at 6 months was the best predictor of successful weight loss at 5 years after LSG (Reviewer #1, comment #5) (sensitivity, 73.62%; specificity, 73.61%; AUC value, 0.780). Internal verification of the prediction model revealed satisfactory results in terms of discrimination and calibration.

CONCLUSION

In Chinese patients with BMI ≥ 32.5 kg/m² who underwent LSG, %EWL at 6 months and 5 years were correlated. %EWL ≥ 58.57% at 6 months was a predictor of successful long-term weight loss.

General Public Awareness about the Indications and Complications of Sleeve Gastrectomy in Qassim Region, Saudi Arabia

BACKGROUND: Sleeve gastrectomy has become prevalent worldwide regardless of the patient’s awareness about the indications and complications. That would affect their judgment and decision. AIM: This study aimed to assess the level of awareness about indications and complications of sleeve gastrectomy in the general public at Al-Qassim, Saudi Arabia in 2021. MATERIALS AND METHODS: This is a quantitative cross-sectional study conducted among the general public living in the Qassim region, Saudi Arabia. Using a convenience sampling technique to select the participants as a representative sample for the general population. The target population will include all Saudis, who live in Al-Qassim and aged above 18 years, and will exclude who does not live in al-Qassim, age under 18 years, non-Saudi, who does not complete the questionnaire and who refuse to participate. The data were collected using a validated self-administered questionnaire. Questionnaires include; demographic characteristics, general awareness about sleeve gastrectomy, and awareness toward the indication and complication of sleeve gastrectomy. All statistical analyses were performed using Statistical Packages for Software Sciences version 26. RESULTS: A total of 1091 respondents took part. The mean age of the respondents was 37.5 (SD 12.9) years old with females dominating the males (87.8% vs. 12.2%). Awareness about the indications and complications of sleeve gastrectomy constitutes 49% and 82.4%, respectively. In univariate analyses, those who have heard about body mass index (BMI) had greater knowledge of the indications and complications of sleeve gastrectomy. In a multivariate regression model, gender female was the independent significant predictor of sleeve gastrectomy complications whereas those who heard of BMI was the independent significant predictor of the knowledge toward the indications and complications of sleeve gastrectomy. CONCLUSION: The general public demonstrated a lack of knowledge regarding the indications of sleeve gastrectomy but their knowledge about complications was better. Better knowledge about BMI comes with a better awareness of the indications and complications of sleeve gastrectomy.

Metabolic surgery in treatment of obese Japanese patients with type 2 diabetes: a joint consensus statement from the Japanese Society for Treatment of Obesity, the Japan Diabetes Society, and the Japan Society for the Study of Obesity

Bariatric surgery has been shown to have a variety of metabolically beneficial effects for patients with type 2 diabetes (T2D), and is now also called metabolic surgery. At the 2nd Diabetes Surgery Summit held in 2015 in London, the indication for bariatric and metabolic surgery was included in the “algorithm for patients with type T2D”. With this background, the Japanese Society for Treatment of Obesity (JSTO), the Japan Diabetes Society (JDS) and the Japan Society for the Study of Obesity (JASSO) have formed a joint committee to develop a consensus statement regarding bariatric and metabolic surgery for the treatment of Japanese patients with T2D. Eventually, the consensus statement was announced at the joint meeting of the 38th Annual Meeting of JSTO and the 41st Annual Meeting of JASSO convened in Toyama on March 21, 2021. In preparing the consensus statement, we used Japanese data as much as possible as scientific evidence to consider the indication criteria, and set two types of recommendation grades, “recommendation” and “consideration”, for items for which recommendations are possible. We hope that this statement will be helpful in providing evidence-based high-quality care through bariatric and metabolic surgery for the treatment of obese Japanese patients with T2D.

Weight Loss Outcomes and Lifestyle Patterns Following Sleeve Gastrectomy: an 8-Year Retrospective Study of 212 Patients

PURPOSE

Sleeve gastrectomy (SG) is an effective treatment for extreme obesity; however, long-term weight loss outcomes remain largely understudied. We aimed to examine the long-term weight changes following SG and patient characteristics and lifestyle patterns related to weight loss outcomes.

MATERIALS AND METHODS

Data from medical records of patients operated in a tertiary university medical center between 2008 and 2014 were reviewed, along with information derived from a telephone questionnaire. Information included the following: current medical status, medications, side effects, behavior, lifestyle habits, and weight changes.

RESULTS

A total of 212 patients (69.3% females) were included, with a median follow-up duration of 8 years post-SG. Mean age and baseline body mass index (BMI) of participants were 39.7 ± 12.0 years and 42.2 ± 4.9 kg/m², respectively. Mean BMI, percentage excess weight loss, and percentage total body weight loss were 33.1 ± 6.1, 55.5 ± 27.5%, and 21.7 ± 10.7%, respectively. Higher baseline BMI was found to be the strongest independent predictor for insufficient weight loss (OR = 0.90, P = 0.001, 95% CI 0.85, 0.96). Sweetened beverage intake, usage of psychiatric medications, higher initial BMI, and lower age were significant predictors for increased weight gain from nadir weight (P < 0.0001, P = 0.005, P = 0.035, and P < 0.0001, respectively).

CONCLUSIONS

SG patients were found to maintain a notable long-term weight loss. Nevertheless, weight regain and insufficient weight loss were prevalent in the long-term post-operative period, and were related to certain lifestyle patterns. Clinical practice should emphasize the relationship between post-operative weight loss outcomes and specific behaviors. Efforts should be made to educate patients on the need for lifelong follow-up and support.

Promising effects of 33 to 36 Fr. bougie calibration for laparoscopic sleeve gastrectomy: a systematic review and network meta-analysis

The standard size of bougie for laparoscopic sleeve gastrectomy (LSG) is not yet established. Therefore, a systematic review and network meta-analysis were conducted to assess the weight loss effects and associated complications of LSG for patients with morbid obesity, based on different bougie sizes. A total of 15 studies were reviewed in this systemic review and network meta-analysis (2,848 participants), including RCTs and retrospective studies in PubMed, and Embase until September 1, 2020. The effectiveness of different bougie calibration sizes was assessed based on excess weight loss (EWL), total complications, and staple line leak. Within this network meta-analysis, S-sized (≤ 32 Fr.) and M-sized (33–36 Fr.) bougies had similar effects and were associated with the highest EWL improvement among all different bougie sizes (S-sized: standardized mean difference [SMD], 10.52; 95% confidence interval [CI] − 5.59 to  − 26.63, surface under the cumulative ranking curve [SUCRA], 0.78; and M-sized: SMD, 10.16; 95% CI − 3.04–23.37; SUCRA, 0.75). M-sized bougie was associated with the lowest incidence of total complications (M-sized: odds ratio, 0.43; 95% CI, 0.16–1.11; SUCRA, 0.92). Based on our network meta-analysis, using M-sized bougie (33–36 Fr.) is an optimal choice to balance the effectiveness and perioperative safety of LSG in the clinical practice.

Impact of the Hepatic Branch of the Vagus Nerve Transection in Laparoscopic Sleeve Gastrectomy for Patients with Obesity and Type 2 Diabetes Mellitus

BACKGROUND

An increase in gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy (LSG) has been reported, and concomitant hiatal hernia repair (HHR) during LSG is expected to reduce the incidence of post-LSG GERD. In HHR, the hepatic branch of the vagus nerve is anatomically transected. Recent experimental animal models suggest that vagotomy may affect glycemic control and weight loss through a neuroendocrine response.

OBJECTIVES

To examine whether LSG with/without hepatic branch vagotomy (HV) has a clinical impact on glycemic control in patients with obesity and type 2 diabetes mellitus (T2DM). Furthermore, the impact on weight loss and post-LSG GERD were evaluated.

METHODS

A total of 204 Japanese patients with obesity and T2DM, who underwent LSG and completed 1-year follow-up, were retrospectively analyzed. Operative outcomes, weight loss, glycemic, and GERD-related parameters were compared between the LSG/HHR/HV group (n = 89) and the LSG group (n = 115).

RESULTS

There was no significant difference in the background factors in terms of anthropometric and T2DM-related parameters between the groups. The median operation times in the LSG/HHR/HV and LSG groups were 133 and 124 minutes, respectively (p = 0.236). At 1 year, the diabetes remission rate, HbA1c, fasting glucose, and C-peptide levels were all comparable between the groups. The weight loss effect was also comparable. The patients in the LSG/HHR/HV group achieved significant improvement and prevention of GERD and hiatus hernia (p < 0.001).

CONCLUSION

HV does not appear to have a clinical impact on glycemic control and weight loss. Concomitant HHR with LSG serves to reduce post-LSG GERD.

One anastomosis gastric bypass vs. Roux-en-Y gastric bypass, remedy for insufficient weight loss and weight regain after failed restrictive bariatric surgery

Background

Failure occurs in up to 60% of the patients that were treated with primary restrictive bariatric operations such as Laparoscopic Adjustable Gastric Banding (LAGB), or restrictive/metabolic operations like Laparoscopic Sleeve Gastrectomy (LSG). Insufficient weight loss and weight regain are the most commonly reported reasons of failure. The aim of this retrospective multicenter study was to compare One Anastomosis Gastric Bypass (OAGB) to Roux-en-Y Gastric Bypass (RYGB) as a revisional procedure in terms of weight loss, procedure time, complication rate and morbidity.

Methods

491 patients operated on between 2012 and 2017 for failed restrictive surgery were included in this study (OAGB (n=185) or RYGB (n=306)). Failure was defined as total weight loss (TWL) less than 25%, excess weight loss (EWL) less than 50% and/or a remaining body mass index (BMI) larger than 40 kg/m2 at two years of follow up. Primary outcome measures were %TWL and % excess BMI loss (EBMIL) at 12, 24 and 36 months of follow-up. Secondary outcomes were procedure time, reduction of comorbidity, early and late complication rate, and mortality.

Results

%TWL was significantly larger in the OAGB group at 12 months (mean 24.1±9.8 vs. 21.9±9.7, p = 0.023) and 24 months (mean 23.9±11.7 vs. 20.5±11.2, p = 0.023) of follow-up. %EBMIL was significantly larger in the OAGB group at 12 months (mean 69.0±44.6 vs. 60.0±30.1, p = 0.014) and 24 months (mean 68.6±51.6 vs. 56.4±35.4, p = 0.025) of follow-up. Intra-abdominal complications (leakage, bleeding, intra-abdominal abscess and perforation) occurred less frequently after revisional OAGB (1.1% vs. 4.9%, p = 0.025). Surgical intervention for biliary reflux (5.4% vs. 0.3%, p < 0.001) was more prevalent in the OAGB group. Surgical intervention for internal herniation (0.0% vs. 4.9%, p = 0.002) was more prevalent in the RYGB group.

Conclusions

This study suggests that OAGB is superior to RYGB as a remedy for insufficient weight loss and weight regain after failed restrictive surgery with more weight loss and a lower early complication rate. To substantiate these findings, further research from prospective randomized controlled trials is needed.

Midterm Outcome of Laparoscopic Sleeve Gastrectomy in Asians: a Systematic Review and Meta-analysis

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.

Early Weight Loss after Laparoscopic Sleeve Gastrectomy Predicts Sustained Weight Maintenance Among Chinese Individuals with a BMI < 35 kg/m2

OBJECTIVES

This study assessed the efficacy and safety of laparoscopic sleeve gastrectomy (LSG) in Chinese individuals with a body mass index (BMI) under 35 kg/m² and to explore the association between early weight loss and sustained weight maintenance.

METHODS

Patients whose BMI < 35 kg/m² were recruited. Changes in BMI, total weight loss (%TWL), and excess weight loss (%EWL) were evaluated, with successful weight loss being a %EWL of > 50% and a %TWL of > 25%. Binary logistic regression was employed to assess relationships between %EWL and %TWL and to calculate a joint predictor. The association between early weight loss and sustained weight maintenance was assessed as a function of %EWL, %TWL, and this joint predictor, with receiver operating characteristic (ROC) curves being used for optimal cutoff threshold identification.

RESULTS

In total, 143 individuals with average preoperative weight and BMI values of 88 (82, 95) kg and 31.99 (29.41, 33.15) kg/m², respectively, were enrolled in present study. At 5 years, 48.00% of patients achieved successful weight loss. Both 3-month %EWL and %TWL were significantly related to sustained weight loss at 5 years (P < 0.05). ROC curves were used to identify %TWL of 19.54% at 3 months as the most reliable predictor of weight loss at a 5-year follow-up (sensitivity: 61.11%, specificity: 76.92%).

CONCLUSION

LSG had long-term safety and efficacy, and %TWL at 3 months can predict sustained 5-year weight loss in Chinese individuals with BMI < 35 kg/m².

The influence of patient's age on metabolic and bariatric results of laparoscopic sleeve gastrectomy in 2-year observation

BACKGROUND

The incidence of obesity has been constantly growing and bariatric procedures are considered to be the most effective treatment solution for morbidly obese patients. The results of laparoscopic sleeve gastrectomy (LSG) may differ depending on patient's age, gender, preoperative body mass index (BMI) and physical activity.

METHODS

The aim of this study was to evaluate age-related differences in the outcome of LSG in terms of weight loss parameters, lipid and carbohydrate profile. The retrospective analysis of 555 patients who had undergone LSG was performed to compare the metabolic outcomes of surgery in individuals < 45 and ≥ 45 years old. Evaluation of weight loss parameters along with selected laboratory data was performed to demonstrate the results of LSG in 2 years follow-up.

RESULTS

Overall, 238 males and 317 females (43%/57%) with median age of 43 years and median preoperative BMI of 46.41 (42.06-51.02) kg/m2 were analyzed. Patients in both groups presented significant weight loss at 24 months after the surgery with comparable percentage of total weight loss (40.95% in < 45 years old group and 40.44% in ≥ 45 years old group). The percentage of excess weight loss (78.52% vs. 74.53%) and percentage of excess BMI loss (91.95% vs. 88.01%) were higher in patients < 45 years old. However, the differences were not statistically significant (p = 0.662, p = 0.788 respectively). Patients under 45 years old experienced faster decrease in fasting glucose level that was observed after only 3 months (109 mg/dl to 95 mg/dl in < 45 years old group vs. 103.5 mg/dl to 99.5 mg/dl in ≥ 45 years old group, p < 0.001). Both groups presented improvement of lipid parameters during the observation. However, patients < 45 years old achieved lower values of LDL at 3 and 12 months follow-up (115 mg/dl vs. 126 mg/dl, p = 0.010; 114.8 mg/dl vs. 122 mg/dl, p = 0.002). Younger group of patients also showed superior improvement of triglycerides level.

CONCLUSIONS

LSG results in significant weight loss in all patients regardless age. In turn, superior and faster improvement in lipid and carbohydrate profile is achieved in patients under 45 years old.

Early Weight Loss Following Laparoscopic Sleeve Gastrectomy Is Predictive of Long-Term Weight Loss in Morbidly Obese Chinese

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) is a bariatric surgical approach often used to treat Chinese individuals suffering from morbid obesity.

OBJECTIVES

To verify the long-term safety and efficiency of LSG and to evaluate the predictive effect of initial weight loss on long-term weight maintenance after LSG in morbidly obese Chinese.

METHODS

Follow-up was conducted by telephone or in hospital. We measured the body mass index (BMI), percentage of total body weight loss (%TWL), and excess weight loss (%EWL), and assessed patients for the alleviation of co-morbidities. Relationships between initial weight loss and successful weight maintenance were assessed via linear regression analyses, while optimal cutoff values were determined based on receiver operative characteristic (ROC) curves.

RESULTS

We included 384 patients in this study. Before surgery, these patients had median weight and BMI values of 110 (91.00-130.75) kg and 38.49 (32.82-44.12) kg/m², respectively. Successful weight loss of > 50% EWL was accomplished in 91.21%, 82.69%, and 79.37% of patients at 1, 3, and 5 years after surgery. In addition, the %EWL at 6 months was significantly correlated with the %EWL up to 5 years (P < 0.001) in morbidly obese Chinese. Based on the ROC curve, the EWL of 56.54% at 6 months was the best predictor of successful weight loss at 5 years (sensitivity 72.38%, specificity 82.69%) in morbidly obese Chinese.

CONCLUSION

LSG has long-term safety and efficacy for morbidly obese Chinese patients. The %EWL at 6 months can be used to predict weight maintenance up to 5 years after LSG.

Five-Year Outcomes with Stand-alone Primary Sleeve Gastrectomy

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.

Patient awareness about the indications and complications of sleeve gastrectomy

OBJECTIVES

To assess patients' awareness of the indications and complications of sleeve gastrectomy in King Khalid University Hospital, Riyadh, Saudi Arabia.

METHODS

The cross-sectional study conducted from December 2017 to May 2018 in KKUH, Riyadh, Saudi Arabia included all patients aged 18 years and older. Data collection was conducted through self-administered questionnaires. Chi-square test was performed to determine the significant differences between variables. A P value of < 0.05 was considered statistically significant.

RESULT

Of 480 participants, 247 (51.5%) of them were male. The educational level of most was bachelor's degree (253; 52.7%). Most of the participants (326; 67.9%) are not aware about BMI. However, 80 (16.7%) participants knew the true answer to obese BMI. Of the total participants, 283 (59.0%) did not knew about sleeve gastrectomy indications; however, 311 (64.8%) of the participants had heard about the complications of sleeve gastrectomy. All these results are correlated with the educational level of the participants.

CONCLUSION

Our study shows a lack of awareness of sleeve gastrectomy indications and complications among study population. We need to increase public awareness about sleeve gastrectomy indications and complication by proper scientific health education in the community.

Background characteristics and postoperative outcomes of insufficient weight loss after laparoscopic sleeve gastrectomy in Japanese patients

AIM

Laparoscopic sleeve gastrectomy (LSG) is becoming popular in Japan, but insufficient weight loss is often observed in patients after LSG. We investigated the effect of LSG on obesity-related comorbidities and identified the background characteristics of Japanese patients with insufficient weight loss after LSG.

METHODS

In this multi-institutional retrospective study at 10 certified bariatric institutions, 322 Japanese patients who underwent LSG with a follow-up period of more than 2 years were analyzed. Anthropometry, obesity-related comorbidities and psychosocial background data were collected. Weight loss was expressed as 2-year percent total weight loss (%TWL).

RESULTS

Mean age, body weight, body mass index (BMI) and glycated hemoglobin were 46.9 years, 119.2 kg, 43.7 kg/m2 and 7.1%, respectively. Prevalence of mental disorders was 26.3%. Mean BMI declined to 30.3 kg/m2 at 2 years and %TWL was 29.9%. Improvements in the markers and prevalence of obesity-related comorbidities were observed. Remission rates of diabetes, dyslipidemia and hypertension were 75.6%, 59.7% and 41.8%, respectively. %TWL at the respective cut-off level of diabetes remission was 20.8%. Lower remission rates of diabetes in patients with %TWL <20%, and less calorie restriction and higher prevalence of mental disorders (46.9%) in patients with %TWL <15% were observed. Frequencies of %TWL <15% and <20% were 6.5% and 18.5%, respectively.

CONCLUSION

%TWL 20% was a candidate cut-off point of insufficient weight loss for diabetes remission after LSG, and mental disorders might be relevant to intractable obesity in Japanese patients.

Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review

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.

Long-term outcomes after laparoscopic sleeve gastrectomy in Kuwait

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) has been established as an effective means of weight loss. Multiple studies report LSG as a cost-effective procedure with few perioperative complications.

OBJECTIVES

Report long-term weight changes after LSG in a single center in Kuwait.

DESIGN

Retrospective analysis of data collected 5-8 years after surgery.

SETTING

A single medical center.

PATIENTS AND METHODS

All patients that had undergone LSG between December 2008 and December 2011.

MAIN OUTCOME MEASURES

Weight changes, short-term complications following surgery (within one month).

SAMPLE SIZE

187.

RESULTS

The mean age at the time of the surgery was 36.5 (10.3) years. Females composed 71.6% of this study population.Two patients (1.1%) presented with a leak within 30 days of the surgery. Twenty-one (11.2%) patients underwent revisional bariatric surgery after LSG. Mean (SD) BMI decreased from 47.1 (8.3) kg/m2 before surgery to 34.3 (7) kg/m2 5-8 years after surgery. Mean (SD) body weight decreased from 126.3 (25.3) kg to 91.6 (19.9) kg 5-8 years following LSG. The mean excess body weight loss was 58.8% (29.2%).

CONCLUSION

LSG is a bariatric procedure with low complications and mortality in relation to other forms of bariatric surgery. It is associated with a significant improvement in weight loss in the long term.

LIMITATIONS

Recall bias due to the nature of collecting the data, small sample size.

CONFLICT OF INTEREST

None.

Prevalence of Chronic Kidney Disease in Morbidly Obese Japanese and the Impact of Bariatric Surgery on Disease Progression

BACKGROUND

The prevalence of chronic kidney disease (CKD) among Japanese morbidly obese patients undergoing bariatric surgery and the impact of bariatric surgery on their renal function has not previously been investigated.

OBJECTIVES

The aims were to assess the prevalence of CKD patients who underwent bariatric surgery in our institution and to elucidate the impact of bariatric surgery on their kidney function as measured by the estimated glomerular filtration rate by Cystatin-C (eGFRcys).

SETTING

The setting of the study was in a single private hospital.

METHODS

Two hundred fifty-four consecutive Japanese patients who underwent bariatric surgery were retrospectively analyzed to elucidate the prevalence of CKD. The eGFRcys was calculated to assess the change in the kidney function for 1 year after surgery.

RESULTS

The preoperative prevalence of CKD was as follows: G1, 45.3%; G2, 47.2%; G3, 6.5%; and G4, 0.9%. The eGFRcys values before and after surgery were compared; the G1 and G2 patients showed significantly improved eGFRcys values after surgery (G1 101 [94-108] vs 114 [103-127]; G2 79 [74-84] vs 97 [87-104] ml/min/1.73 m²; p < 0.01) with significant weight loss (G1 38.1 ± 6.2 vs 26.5 ± 3.4; G2 38.5 ± 6.9 vs 26.7 ± 3.6 kg/m²; p < 0.01). Although the renal function of G3 patients was not improved after surgery (44 [42-47] vs 45 [43-63] ml/min/1.73 m²; p = 0.08), successful weight loss was achieved (36.1 ± 6.3 vs 26.6 ± 3.6 kg/m²; p < 0.01). In multivariate analysis, postoperative eGFRcys correlated negatively with proteinuria (p < 0.01), age (p < 0.01), and body mass index (p < 0.01) and positively with persistence of antihypertensive drugs.

CONCLUSION

Bariatric surgery resulted in the significant improvement in the eGFRcys values of Japanese patients with morbid obesity, particularly those with pre-CKD (eGFRcys ≥ 60 ml/min/1.73 m²), while the eGFRcys values of CKD patients (< 60 ml/min/1.73 m²) were not ameliorated by surgery.

Laparoscopic Sleeve Gastrectomy Then and Now: An Updated Systematic Review of the Progress and Short-term Outcomes Over the Last 5 Years

INTRODUCTION AND AIM

Laparoscopic sleeve gastrectomy (LSG) is considered one of the most popular bariatric surgeries of the present time. This review aimed to evaluate the progress and short-term outcomes of LSG over the last 5 years.

METHODS

The systematic review of electronic databases revealed 27 relevant articles, which were carefully assessed. The data extracted from the studies were analyzed and compared with data reported by a previous review published in 2010.

RESULTS

A total of 5218 patients were included in this review with a mean age of 41.1. The average preoperative body mass index (43.8±8) significantly dropped at 12 months to 30.7±3.9. The average percentage of excess weight loss at 1 year was 67.3. The mean rates of remission of diabetes mellitus, hypertension, and dyslipidemia were 81.9%, 66.5%, and 64.1%, respectively. The mean complication rate across the studies was 8.7% and the average mortality rate was 0.3%. A significant drop in postoperative body mass index, higher percentage of excess weight loss, and significantly lower overall complication rate were observed in comparison with the previous systematic review.

CONCLUSIONS

LSG continues to achieve satisfactory weight loss and improvement of obesity-related comorbidities with acceptably low morbidity and mortality rates.

Efficacy and Safety of the Over-the-Scope Clip (OTSC) System in the Management of Leak and Fistula After Laparoscopic Sleeve Gastrectomy: a Systematic Review

BACKGROUND

Endoscopic management of leaks/fistulas after laparoscopic sleeve gastrectomy (LSG) is gaining popularity in the bariatric surgery.

OBJECTIVES

This study aimed to review the efficacy and safety of over-the-scope-clip (OTSC) system in endoscopic closure of post-LSG leak/fistula.

METHODS

PubMed/Medline and major journals of the field were systematically reviewed for studies on endoscopic closure of post-LSG leaks/fistula by means of the OTSC system.

RESULTS

A total of ten eligible studies including 195 patients with post-LSG leaks/fistula were identified. The time between LSG and leak/fistula ranged from 1 day to 803 days. Most of the leaks/fistula were located at the proximal staple line, and they sized from 3 to 20 mm. Time between leak diagnosis and OTSC clipping ranged from 0 to 271 days. Thirty-three out of 53 patients (63.5%) required one clip for closure of the lesion. Regarding the OTSC-related complications, a leak occurred in five patients (9.3%) and OTSC migration, stenosis, and tear each in one patient (1.8%). Of the 73 patients with post-LSG leak treated with OTSC, 63 patients had an overall successful closure (86.3%).

CONCLUSION

OTSC system is a promising endoscopic approach for management of post-LSG leaks in appropriately selected patients. Unfortunately, most studies are series with a small sample size, short-term follow-up, and mixed data of concomitant procedures with OTSC. Further studies should distinguish the net efficacy of the OTSC system from other concomitant procedures in treatment of post-LSG leak.

Risk factors of perioperative morbimortality after laparoscopic sleeve gastrectomy: a club coelio multicenter study

OBJECTIVES

Postoperative complications after Laparoscopic sleeve gastrectomy (LSG) can dramatically compromise patient's outcome. The aim of this study is to analyze the per- and postoperative short-term outcomes after LSG and to assess predictive risk factors of complications.

METHODS

The study group consisted of 790 patients (610 women and 180 men) who underwent LSG In 2014. All interventions were performed by 18 experienced surgeons members of the Club Coelio. Data about preoperative work-up, surgical techniques, 30-days postoperative morbidity and mortality were collected. Endpoints were perioperative morbidity and mortality and assessment of potential risk factors for complications.

RESULTS

Mean age and body mass index were respectively 39 years and 41.5kg/m². Ninety-one patients (11.5%) had previous bariatric surgery. Morbidity rate was 4.7% (37/790) including 16 leaks (2.0%) and 9 bleedings (1.1%) and no deaths. Risk factors for leak were: previous adjustable banding (p = .0051), with no difference between removal of the banding and LSG in 1 or 2 steps, and type of endostapler (p = .0129).

CONCLUSIONS

Leakage after Sleeve was rare but still observed even in experienced hands. The leak rate is particularly high when LSG is performed after adjustable gastric banding removal.

Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass for Type 2 Diabetes Mellitus

BACKGROUND

Laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG-DJB), which has been positioned as a novel bariatric procedure, is the combination of vertical sleeve gastrectomy and proximal intestinal bypass and is theoretically expected to have strong anti-diabetic effect. Also, preserving the pylorus, a physiological valve, leads to less occurrence of dumping syndrome and anastomotic stenosis which are often problematic after laparoscopic Roux-en-Y gastric bypass (LRYGB), a gold standard. The purpose of this study was to investigate the clinical effects of LSG-DJB on obese patients with type 2 diabetes mellitus (T2DM).

METHODS

Consecutive 75 obese patients (female 44/male 31) associated with T2DM who underwent LSG-DJB and were followed up for at least 1 year were analyzed. The mean age was 45.5 ± 8.6 years, and the mean preoperative body weight (BW) and body mass index (BMI) were 108.4 ± 21.4 kg and 39.6 ± 7.3 kg/m(2), respectively. The mean hemoglobin A1c (HbA1c) at the first visit was 9.0 ± 1.9 %, and the duration of T2DM from diagnosis was 7.2 ± 6.2 years. Thirty-six out of the 75 patients (48 %) were treated with insulin preoperatively. All patients were evaluated and managed under a strict multidisciplinary team approach. The follow-up rate at 1 year was 89 %.

RESULTS

At 1 year, the mean BW and BMI significantly dropped to 74.6 ± 16.9 kg and 27.5 ± 5.7 kg/m(2), respectively. The mean percent of excess weight loss (%EWL) and percent of total body weight loss (%TWL) were 99.4 ± 42.4 and 31.6 ± 8.8 %, respectively. Consequently, 68.7 % of the patients achieved HbA1c less than 6 %, and 82.1 % of them achieved HbA1c less than 6.5 % without diabetes medications. Glycemic control of HbA1c less than 7 % was achieved in 91.0 % of the patients. The percentage of patients who satisfied the American Diabetes Association (ADA)-defined composite endpoints for cardiovascular disease (CVD) risk factor control increased from 0 % (at baseline) to 31 % (at 1 year). A meal tolerance test revealed significant reduction of glucose area under the curve (AUC) and increase of insulin AUC postoperatively.

CONCLUSIONS

LSG-DJB for obese patients with T2DM has strong anti-diabetic effect in the short-term; however, a larger number of patients with a longer follow-up period are needed for definitive conclusions.

Five-Year-Results of Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass for Weight Loss and Type 2 Diabetes Mellitus

BACKGROUND

Laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG-DJB) has been designated as a novel bariatric surgery procedure. This combination of sleeve gastrectomy and proximal intestinal bypass theoretically offers an effective and prolonged anti-diabetes effect. This is a follow-up of our institution's previous report on the short-term effects of LSG-DJB on type 2 diabetes mellitus (T2DM), which a 68.7 % remission (HbA1c <6 % without diabetes medication) rate 1 year after surgery. The aforementioned result was comparable to the reported remission rates of laparoscopic Roux-en-Y gastric bypass. However, the durability of remission remains unknown.

OBJECTIVE

The objective of this study is to investigate the medium-term (up to 5 years) effects of LSG-DJB on weight loss and T2DM.

METHODS

In this analysis, consecutive 120 patients (female to male ratio = 61:59, mean age = 44.8 years) with T2DM who underwent LSG-DJB from April 2007 to November 2013 and were followed up beyond 1 year were included. The preoperative mean body weight and BMI were 105.7 kg and 38.5 kg/m², respectively. The mean HbA1c and fasting blood glucose values were 8.9 % and 194 mg/dL, respectively. The mean duration of T2DM was 7.3 years. Fifty-five patients (46 %) were being treated with insulin prior to surgery.

RESULTS

The follow-up rate was 97.5 % at 1 year, 73.3 % at 3 years, and 50.0 % at 5 years. The mean body weight was 74.9 kg at 1 year, 76.8 kg at 3 years, and 72.8 kg at 5 years (p < 0.001, compared to the baseline). The mean percent of total body weight loss (%TWL) was 28.9, 28.6, and 30.7 % at 1, 3, and 5 years, respectively. Remission of T2DM was achieved at 63.6, 55.3, and 63.6 % at 1, 3, and 5 years, respectively. Among those who achieved diabetes remission at 1 year, 10.8 % of them experienced recurrence during the subsequent follow-up period.

CONCLUSION

Although recurrence of T2DM is observed in some patients over time, LSG-DJB is an effective procedure for achieving significant weight loss and improvement of glycemic control, and the effects seem to be durable up to 5 years.

Long-Term Outcomes of Bariatric and Metabolic Surgery in Japan: Results of a Multi-Institutional Survey

BACKGROUND

The number of bariatric procedures performed in Japan is increasing. There are isolated reports of bariatric surgery, but there have been no nationwide surveys including long-term data.

METHODS

We retrospectively reviewed data for patients who underwent bariatric and metabolic surgery throughout Japan and reviewed outcomes. Surveys were sent to ten institutions for number of procedures, preoperative patient weight and preoperative obesity-related comorbidities, and data at 1, 3, and 5 years postoperatively. Improvement of type 2 diabetes mellitus at 3 years after surgery was stratified by baseline ABCD score, based on age, body mass index, C-peptide level, and duration of diabetes.

RESULTS

Replies were received from nine of the ten institutions. From August 2005 to June 2015, 831 patients, including 366 males and 465 females, underwent bariatric procedures. The mean age was 41 years, and mean BMI was 42 kg/m². The most common procedure was laparoscopic sleeve gastrectomy (n = 501, 60 %) followed by laparoscopic sleeve gastrectomy with duodenojejunal bypass (n = 149, 18 %). Laparoscopic Roux-en-Y gastric bypass was performed in 100 patients (12 %), and laparoscopic adjustable gastric banding was performed in 81 (10 %). At 3 years postoperatively, the remission rate of obesity-related comorbidities was 78 % for diabetes, 60 % for hypertension, and 65 % for dyslipidemia. Patients with complete remission of diabetes at 3 years postoperatively had a higher ABCD score than those without (6.4 ± 1.6 vs 4.2 ± 2.0, P < 0.05).

CONCLUSIONS

Bariatric and metabolic surgery for Japanese morbidly obese patients is safe and effective. These results are comparable with the results of previous studies.

Mid to long term outcomes of Laparoscopic Sleeve Gastrectomy in Indian population: 3-7 year results - A retrospective cohort study

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.

Trends in utilization of bariatric surgery, 2010-2014: sleeve gastrectomy dominates

BACKGROUND

Bariatric surgery is the most effective treatment for morbid obesity. Furthermore, the proportion of various types of bariatric procedures has significantly changed over the last two decades. Sleeve gastrectomy (SG) has been increasingly chosen as a primary bariatric procedure in recent years.

OBJECTIVES

This study aimed to analyze the changing pattern of bariatric surgery utilization from 2010 to 2014.

SETTINGS

Using the American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2014.

METHOD

We identified patients aged≥18 years with a body mass index (BMI)≥35 kg/m² undergoing primary bariatric surgery. The trend of surgical procedures was analyzed from 2010 to 2014.

RESULTS

A total of 93,328 patients were included (age of 44.6±11.8 years and BMI of 46.2±7.9 kg/m²). Roux-en-Y gastric bypass (RYGB), adjustable gastric band, and SG comprised 58.4%, 28.8%, and 9.3% of the procedures in 2010 which changed to 37.6%, 3.1%, and 58.2% in 2014, respectively. Baseline BMI of SG patients decreased from 47.5 to 45.6 kg/m² (P< .001). The proportion of diabetic patients undergoing RYGB increased (30.4% to 33.2%, P<.001) but decreased among those having SG (26.6% to 22.8%, P = .001). The proportion of patients with hypertension having RYGB remained unchanged while decreased among SG patients (56.2% to 47.6%, P<.001). Female patients among the SG group increased from 73.2% to 77.7% (P< .001).

CONCLUSION

SG has been increasingly performed in the United States superseding adjustable gastric band and RYGB. The trend is in favor of females, lower BMI, and lower ratio of patients with diabetes and hypertension. More data are needed on outcomes of SG to assess its long-term effectiveness and credibility.

Fifth International Consensus Conference: current status of sleeve gastrectomy

BACKGROUND

For the purpose of building best practice guidelines, an international expert panel was surveyed in 2014 and compared with the 2011 Sleeve Gastrectomy Consensus and with survey data culled from a general surgeon audience.

OBJECTIVES

To measure advancement on aspects of laparoscopic sleeve gastrectomy and identify current best practices.

SETTING

International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) 2014, Fifth International Summit for Laparoscopic Sleeve Gastrectomy, Montréal, Canada.

METHODS

In August 2014, expert surgeons (based on having performed>1000 cases) completed an online anonymous survey. Identical survey questions were then administered to general surgeon attendees.

RESULTS

One hundred twenty bariatric surgeons completed the expert survey, along with 103 bariatric surgeons from IFSO 2014 general surgeon audience. The following indications were endorsed: as a stand-alone procedure (97.5%); in high-risk patients (92.4%); in kidney and liver transplant candidates (91.6%); in patients with metabolic syndrome (83.8%); body mass index 30-35 with associated co-morbidities (79.8%); in patients with inflammatory bowel disease (87.4%); and in the elderly (89.1%). Significant differences existed between the expert and general surgeons groups in endorsing several contraindications: Barrett's esophagus (80.0% versus 31.3% [P<.001]), gastroesophageal reflux disease (23.3% versus 52.5% [P<.001]), hiatal hernias (11.7% versus 54.0% [P<.001]), and body mass index>60 kg/m(2) (5.0% versus 28.0% [P<.001]). Average reported weight loss outcomes 5 years postoperative were significantly higher for the expert surgeons group (P = .005), as were reported stricture (P = .001) and leakage (P = .005) rates. The following significant differences exist between 2014 and 2011 expert surgeons: Patients with gastroesophageal reflux disease should have pH and manometry study pre-laparoscopic sleeve gastrectomy (32.8% versus 50.0%; P = .033); it is important to take down the vessels before resection (88.1% versus 81.8%; P = .025); it is acceptable to buttress (81.4% versus 77.3%; P<.001); the smaller the bougie size and tighter the sleeve, the higher the incidence of leaks (78.8% versus 65.2%; P = .006).

CONCLUSION

This study highlights areas of new and improved best practices on various aspects of laparoscopic sleeve gastrectomy performance among experts from 2011 and 2014 and among the current general surgeon population.