Evaluation of laparoscopic sleeve gastrectomy on weight loss and co-morbidity

Prevalence of Rhabdomyolysis Following Bariatric Surgery and its Associated Risk Factors: a Meta-Analysis

PURPOSE

This study aimed to evaluate the prevalence of rhabdomyolysis (RML) following bariatric surgery and potential associated factors.

MATERIALS AND METHODS

We systematically searched PubMed, Embase, and CENTRAL for relevant trials from database inception through August 2022. Articles were eligible for inclusion if they reported the prevalence of RML after bariatric surgery and provided at least one of the following outcome indicators: preoperative mean BMI/mean operative time for the included population.

RESULTS

Sixteen studies with a total of 1540 patients were analyzed. The mean preoperative age distribution of the included patients was centered between 32.9 and 47.0 years, and the mean preoperative BMI ranged from 42.3 to 60.0 kg/m². The operative time varied between 126.7 and 403.3 min. The overall pooled crude prevalence of post-bariatric surgery RML was 19.4%. Subgroup analyses showed the pooled prevalence of RML was 8.1% for operative duration > 120 and ≤ 180 min, 32.8% for > 180 and ≤ 240 min, and 47.4% for > 240 min. Meta-regression revealed that operation time was an independent risk factor for developing RML. Besides, BMI > 50 kg/m² and open Roux-en-Y gastric bypass (RYGB) indicated a higher risk of RML.

CONCLUSION

Post-bariatric surgery RML prevalence occurred more frequently with the extension of the operation time. For bariatric subjects with surgery time > 180 min, open RYGB, or BMI > 50 kg/m², CKP could be routinely measured early to verify the presence of RML and to actively prevent its fatal complications.

Fistula Recurrence: A Clinical Reality after Successful Endoscopic Closure of Laparoscopic Sleeve Gastrectomy Fistulas

Background and Aims

Laparoscopic sleeve gastrectomy (LSG)-related fistulas are important and potentially fatal complications. We aimed at determining the incidence, predictive factors, and management of recurrence of post-LSG fistulas.

Methods

This is a retrospective cohort study of 12 consecutive patients with LSG fistulas managed endoscopically between 2008 and 2013. We analyzed factors associated with recurrence of post-LSG fistulas and the efficacy of a primarily endoscopic approach to manage fistula recurrence.

Results

The average age at fistula detection after LSG was 43.3 ± 10.9 years, and 10 (83%) patients were female. The median interval between surgery and initial fistula detection was 14 (4-145) days. Fistulas were located at the gastric cardia in 9/12 patients. A median of 4 (1-10) endoscopies were performed per patient until all fistulas were successfully closed. The median follow-up was 30.5 (15-72) months. Fistula recurrence was detected in 3 (25%) female patients with an average age of 31.7 ± 7.9 years after a median of 119 (50-205) days of the initial fistula closure. Fistulas in all 3 patients recurred at the gastric cardia and were successfully managed endoscopically. There was a second recurrence in 1 patient after 6 months, and she was re-operated with anastomosis of a jejunal loop at the site of the fistula orifice at the gastric cardia. We did not find any factors at initial fistula detection that were significantly associated with fistula recurrence. There were no deaths related to initial fistula after LSG and fistula recurrence.

Conclusions

A primarily endoscopic approach is an effective and safe method for the management of fistulas after LSG. Fistula recurrence occurred in 25% of patients and was managed endoscopically.

Key Messages

Although we could not define predictive factors of post-LSG fistula recurrence, it is a clinical reality and can be managed endoscopically.

[Outcomes, controversies and gastric volume after laparoscopic sleeve gastrectomy in the treatment of obesity]

BACKGROUND

Laparoscopic sleeve gastrectomy is a surgical procedure for the treatment of morbid obesity. However, there are still controversies regarding its efficiency in terms of weight reduction and incidence of complications. In this prospective study, the experience is presented of a referral centre for the treatment of morbid obesity with laparoscopic sleeve gastrectomy.

MATERIAL AND METHODS

A prospective study on 73 patients subjected to laparoscopic sleeve gastrectomy from February 2009 to September 2013. Patients were followed-up for a period of 12 months, evaluating the development of complications, reduction of gastric volume, and the weight loss associated with the surgery, as well as their impact on the improvement of comorbidities present at beginning of the study.

RESULTS

There was a statistically a significantly reduction between the preoperative body mass index (BMI) and the BMI at 12 months after laparoscopic sleeve gastrectomy (p < 0.001), despite there being an increase in the gastric volume during follow-up, measured at one month and 12 months after surgery (p < 0.001). Five patients (6.85%) had complications, with none of them serious and with no deaths in the whole series.

CONCLUSIONS

Laparoscopic sleeve gastrectomy is a safe and effective technique for the treatment of morbid obesity. Its use is associated with a significant reduction in the presence of comorbidities associated with obesity. Multicentre studies with a longer period of monitoring are required to confirm the efficacy and safety of this surgical technique.

A systematic review of staple-line reinforcement in laparoscopic sleeve gastrectomy

BACKGROUND AND OBJECTIVES

Laparoscopic sleeve gastrectomy is gaining popularity as a bariatric procedure, with outcomes similar to gastric band and gastric bypass. Staple-line disruption is a significant source of morbidity and death. We aim to evaluate the effect of staple-line reinforcement on the gastric leak rate, morbidity, and mortality rate.

METHODS

A systematic review was performed using title key words "sleeve gastrectomy," and articles were reviewed for description of operative technique and postoperative outcomes including staple-line leak. Rates of leak, bleeding, surgical-site infection, reintervention, readmission, and mortality were analyzed. We calculated pooled event rates and 95% confidence intervals using fixed-effects modeling to determine differences between the reinforcement group (group A) and non-reinforcement group (group B).

RESULTS

We identified 390 articles, and 30 met the inclusion criteria. Group A had 3293 patients, and group B had 1588 patients. After heterogeneity calculations, 9 variables met the criteria to be analyzed. The leak rate was 3.9% (95% confidence interval, 2.9%-5.5%) in group A and 3.2% (95% confidence interval, 2.8%-4.1%) in group B. The mortality rate was 0.8% (95% confidence interval, 0.4%-1.5%) in group A and 0.7% (95% confidence interval, 0.4%-1.1%) in group B. Our results also showed no statistical difference for any of our other 7 outcome variables.

CONCLUSION

Our study shows a lack of statistical difference in leak rate, overall morbidity, or mortality rate in laparoscopic sleeve gastrectomy with or without staple-line reinforcement. Because of study limitations, we propose that prospective trials are needed to determine the effect of staple-line reinforcement on leak rates.

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

OBJECTIVE

The study compared laparoscopic sleeve gastrectomy (LSG) staple-line leak rates of 4 prevalent surgical options: no reinforcement, oversewing, nonabsorbable bovine pericardial strips (BPS), and absorbable polymer membrane (APM).

BACKGROUND

LSG is a multipurpose bariatric/metabolic procedure with effectiveness proven through the intermediate term. Staple-line leak is a severe complication of LSG for which no definitive method of prevention has been identified.

METHODS

The systematic review study design was employed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement screening guidelines. Inclusion criteria centered on variables potentially relevant to LSG leak: leak rate, age, gender, calibrating bougie size, distance between pylorus and gastric transection line, overall complication rate, and mortality. Analysis of variance models were used to explore differences in select demographic and surgical technique variables characterizing each reinforcement group. An omnibus χ(2) test followed by independent Fisher's exact tests were used to compare leak rates.

RESULTS

There were 659 articles identified; 41 duplicates removed. Of 618 remaining articles, 324 did not meet inclusion criteria. Of the 294 remaining articles, 206 were eliminated (kin studies, those not reporting staple-line or leak incidence, those reporting discontinued products). There were 88 papers included in the analysis. Statistically significant differences were found between groups across demographic and surgical variables studied (p<0.001). There were 191 leaks in 8,920 patients; overall leak rate 2.1%. Leak rates ranged from 1.09% (APM) to 3.3% (BPS); APM leak rate was significantly lower than other groups (p< 0.05).

CONCLUSION

Systematic review of 88 included studies representing 8,920 patients found that the leak rate in LSG was significantly lower using APM staple-line reinforcement than oversewing, BPS reinforcement, or no reinforcement.

An observational longitudinal study of the impact of sleeve gastrectomy on glycemic control in type 2 diabetes mellitus

BACKGROUND

Laparoscopic sleeve gastrectomy is increasingly being acknowledged as an effective independent bariatric procedure for obese persons with type 2 diabetes. Data on laparoscopic sleeve gastrectomy from India on this group of patients are limited. This study presents 12-month follow-up data of laparoscopic sleeve gastrectomy on obese Indian patients with type 2 diabetes.

SUBJECTS AND METHODS

In total, 43 obese patients with type 2 diabetes who received sleeve gastrectomy surgery in the Department of Bariatric Surgery, Medanta the Medicity, Gurgaon, India, were evaluated prospectively for a period of 1 year.

RESULTS

Seven patients missed follow-up visits, and one patient died, leaving 35 patients who were analyzed. The mean glycated hemoglobin (HbA1c) levels at baseline and 12 months after surgery were 7.94±1.9% and 5.80±0.7%, respectively (P<0.001). Of these, 77.14% reached the primary end point of HbA1c level ≤6% without medication. HbA1c level at target (i.e., <7%) occurred in 91.4%. The mean body weight decreased from 122.08±23.32 kg to 83.43±15.12 kg at 12 months (P<0.001). The percentage of weight loss and percentage of excess weight loss at 12 months were 31.14±7.8% and 61.52±15%, respectively. Antidiabetes medication use decreased from 88.57% to 11.4%.

CONCLUSIONS

Laparoscopic sleeve surgery is a safe and effective treatment option among the obese Indian type 2 diabetes population with significant remission rates. Follow-up studies are necessary to assess the long-term durability of these results.

The impact of sleeve gastrectomy on hyperlipidemia: a systematic review

BACKGROUND

Weight loss and reduction in comorbidities can be achieved by longitudinal sleeve gastrectomy (LSG). Existing evidence suggests that LSG resolves or improves hyperlipidemia in morbidly obese patients. The aim of this study was to systematically review the effect of LSG on hyperlipidemia.

METHODS

A systematic literature search was conducted from English-language studies published from 2000 to 2012 for the following databases: MEDLINE, EMBASE, CINAHL, PubMed, Clinical evidence, Scopus, Dara, Web of Sciences, TRIP, Health Technology Database, Cochrane library, and PsycINFO.

RESULTS

A total of 4,211 articles were identified in the initial search, and 4,185 articles were excluded based on the exclusion criteria. Twenty-six studies met the inclusion criteria for this systematic review, involving 3,591 patients. The mean preoperative body mass index (BMI) was 48 ± 7.0 kg/m(2) (range 37.2-65.3). The mean postoperative BMI was 35 ± 5.9 kg/m(2) (range 26.3-49). The mean percentage of excess weight loss (EWL) was 63.1% (range 37.7-84.5), with a mean followup of 19.1 months (range 6-60). The mean levels of pre and post operative cholesterol were 194.4 ± 12.3 mg/dL (range 178-213) and 181 ± 16.3 mg/dL (range 158-200), respectively.

CONCLUSION

Most patients with hyperlipidemia showed improvement or resolution of lipid profiles after LSG. Based on this systematic review, LSG has a significant effect on hyperlipidemia in the form of resolution or improvement in the majority of patients.

The impact of sleeve gastrectomy on hypertension: a systematic review

Laparoscopic sleeve gastrectomy (LSG) is a relatively new bariatric surgical procedure associated with an acceptable weight loss and a relatively low morbidity. There is existing evidence suggesting bariatric surgery resolves or improves hypertension. The purpose of this study is to systematically review the effect of LSG on hypertension. An electronic search method was primarily used for identification of the studies. We performed a comprehensive search of all electronic databases (MEDLINE, PubMed, Embase, Scopus, Dare, Clinical Evidence, BIOSIS, Previews, TRIP, Web of Science, Health Technology Database, Conference abstracts, clinical trials, and the Cochrane Library database) using broad search terms. All human studies from August 2000 to September 2011 were included. After an initial screening, a total of 326 studies were identified. After assessment of these studies based on our exclusion criteria, 222 studies were considered for the abstract review. A total of 33 studies were identified after a careful screening, involving a total of 3,997 patients. The mean pre-operative body mass index (BMI) was 49.1 ± 7.5 kg/m(2) (range 37-68). The average follow-up time was 16.9 ± 9.8 months (range 12-48). The mean post-operative BMI was 36 ± 7.0 kg/m(2) (range 25.6-54). LSG resulted in resolution of hypertension in 58% of patients. On average, 75% of patients experienced resolution or improvement of their hypertension. Based on our systematic review, LSG has a significant effect on hypertension, inducing resolution or improvement in the majority of cases. Therefore, LSG remains a viable surgical option in obese patients with hypertension.

Excessive weight loss after sleeve gastrectomy: a systematic review

BACKGROUND

The clinical significance of sleeve gastrectomy (SG) as a primary bariatric intervention is still under debate. This article aims to systematically analyze excessive weight loss (EWL) in patients after SG.

METHODS

A systematic literature search on SG from the period January 2003 to December 2010 was performed. Data described from systematic reviews dealing with gastric bypass procedures was used as comparator.

RESULTS

The final study included 123 papers describing 12,129 patients. Most of the papers describe EWL at 12 months (43.9% of all papers). For SG, the maximum EWL occurred 24 and 36 months postoperatively with a mean EWL of 64.3% (minimum 46.1%, maximum 75.0%) and 66.0% (minimum 60.0%, maximum 77.5%), respectively. At 12 months, the mean EWL in patients receiving SG was significantly lower when compared to patients who underwent gastric bypass (SG 56.1%, gastric bypass 68.3%; p < 0.01, two-sided Wilcoxon test). Although patients with gastric bypass still had higher EWL rates at 24 months compared to patients after SG, these differences were not significant (SG 61.3%, gastric bypass 69.6%; p = 0.09, two-sided Wilcoxon rank-sum test). Reoperations after SG are necessary in 6.8% (range 0.7-25%) of cases with patients receiving SG as a stand alone procedure and in 9.6-28.5% of cases with patients undergoing SG as a planned first stage procedure.

CONCLUSIONS

SG is an effective bariatric procedure with a lasting effect on EWL. Compared with gastric bypasses, there is no difference in EWL at the time point of 24 months.

Laparoscopic sleeve gastrectomy feasible for bariatric revision surgery

Bariatric revision surgery is associated with several complications that can be attributed to decreased quality of tissue and complexity of the surgery. A laparoscopic sleeve gastrectomy is a simple technique with potential advantages. Therefore, the results of this procedure were evaluated as a revisional option. Fifty-one patients underwent laparoscopic sleeve gastrectomy (LSG). Indications for the LSG were insufficient weight loss (34 patients, group 1) or vomiting (17 patients, group 2) following a laparoscopic adjustable gastric banding (LAGB) or vertical banded gastroplasty (VBG). Patient and procedure characteristics as well as outcome were collected prospectively. From October 2006 to June 2010, 51 patients with a failed prior bariatic procedure (VBG or LAGB) were converted to (L)SG. The conversion rate was zero. The median procedure time was 99 min (range 54–221) and hospital stay was 3 days (range 2–38). There was no mortality after 30 days. Complications included bleeding (six) and leakage of the staple line (seven). Mean follow-up was 13.8 (2–46) months. LSG as revision surgery for insufficient weight loss resulted in extra weight loss of 52.7%, and the overall extra weight loss was 49.3%. When LSG was performed because of vomiting, 82% was able to eat solid food at follow-up. Of the 65 pre-existent co-morbidities, 21 were resolved and 18 improved. LSG as a revision procedure is feasible. An additional weight loss and further resolution of co-morbidity seem achievable, however, at the cost of a high number of complications. Therefore, revision bariatric surgery should be limited to expert tertiary bariatric centers.

Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for morbid obesity: case-control study

BACKGROUND

Laparoscopic sleeve gastrectomy (SG) is gaining popularity as a procedure for the treatment of morbid obesity and type 2 diabetes mellitus. Either as a first-stage procedure for superobese patients or as a definitive procedure, SG is becoming the first-choice bariatric procedure in France. Preliminary results have suggested that the weight loss and resolution of co-morbidities with SG could be comparable to those with laparoscopic Roux-en-Y gastric bypass (RYGB). In a multicenter, retrospective study, we analyzed the weight loss, resolution of co-morbidities, and complications of both SG and RYGB using a case-control study design.

METHODS

A retrospective, case-control, comparative analysis was performed with 200 patients in each treatment arm who had undergone either SG or RYGB from January 2005 to March 2008. The patients in each group were matched for age, gender, and body mass index. The postoperative complications, the percentage of excess weight loss, and the resolution of co-morbidities in each group were compared at 6, 12, and 18 months postoperatively.

RESULTS

The overall mortality rates were similar in both groups. However, the morbidity rate was significantly greater in the RYGB group (20.5%) as compared to the SG group (6.5%; P <.05). The overall remission of type 2 diabetes was significantly better in the RYGB group (P <.05). However, the percentage of excess weight loss at 6, 12, and 18 months as well as the resolution of nondiabetes co-morbidities were comparable in both groups.

CONCLUSION

In our study, as compared with SG, RYGB was associated with a greater short-term morbidity rate. RYGB could be associated with better diabetes control. However, additional studies are needed to evaluate the comparative efficacy of SG and RYGB for the treatment of morbid obesity and its co-morbidities.

Is sleeve gastrectomy as effective as gastric bypass for remission of type 2 diabetes in morbidly obese patients?

BACKGROUND

The benefits of Roux-en-Y gastric bypass (RYGB) for the control of type 2 diabetes mellitus (T2DM) in morbidly obese patients are well known, although the implicated mechanisms have not yet been elucidated. However, little is known about the remission of T2DM after sleeve gastrectomy (SG). The aim of our study was to compare the outcomes of T2DM after both procedures.

METHODS

We performed a retrospective analysis of diabetic morbidly obese patients who had undergone RYGB or SG. The variables analyzed included weight, fasting glycemia, and glycosylated hemoglobin.

RESULTS

A total of 90 patients were included (60 RYGB and 30 SG). The body mass index was 46.22 kg/m(2) for the RYGB group and 56.80 kg/m(2) for the SG group. The fasting glycemia was 10.63 mmol/L and 8.05 mmol/L and the glycated hemoglobin was 8.1% and 7.3% in the RYGB and SG groups, respectively. No significant differences were seen in the amount of weight loss after 2 years between the 2 techniques. Similarly, no significant differences were found in T2DM control after either 1 year (91.8% versus 82.3%) or 2 years (91.8% versus 88.9%). No significant differences were found in the duration of T2DM in either group nor in the percentage of patients treated with insulin and oral hypoglycemic drugs before and 2 years after surgery.

CONCLUSION

We did not find any significant differences in weight loss or T2DM resolution between the 2 techniques. Our results highlight that 1 of the mechanisms implicated in T2DM remission after bariatric surgery is weight loss. The role of other factors, such as incretins, that we have not studied cannot be ruled out and should be analyzed further.

Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review

BACKGROUND

Existing evidence has suggested that bariatric surgery produces sustainable weight loss and remission or cure of type 2 diabetes mellitus (DM). Laparoscopic sleeve gastrectomy (LSG) has garnered considerable interest as a low morbidity bariatric surgical procedure that leads to effective weight loss and control of co-morbid disease. The objective of the present study was to systematically review the effect of LSG on type 2 DM.

METHODS

An electronic data search of MEDLINE, PubMed, Embase, Scopus, Dare, Clinical Evidence, TRIP, Health Technology Database, Conference abstracts, clinical trials, and the Cochrane Library database was completed. The search terms used included LSG, vertical gastrectomy, bariatric surgery, metabolic surgery, and diabetes (DM), type 2 DM, or co-morbidities. All human studies, not limited to those in the English language, that had been reported from 2000 to April 2010 were included.

RESULTS

After an initial screen of 3621 titles, 289 abstracts were reviewed, and 28 studies met the inclusion criteria and the full report was assessed. One study was excluded after a careful assessment because the investigators had combined LSG with ileal interposition. A total of 27 studies and 673 patients were analyzed. The baseline mean body mass index for the 673 patients was 47.4 kg/m(2) (range 31.0-53.5). The mean percentage of excess weight loss was 47.3% (range 6.3-74.6%), with a mean follow-up of 13.1 months (range 3-36). DM had resolved in 66.2% of the patients, improved in 26.9%, and remained stable in 13.1%. The mean decrease in blood glucose and hemoglobin A1c after sleeve gastrectomy was -88.2 mg/dL and -1.7%, respectively.

CONCLUSION

Most patients with type 2 DM experienced resolution or improvement in DM markers after LSG. LSG might play an important role as a metabolic therapy for patients with type 2 DM.