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Al Sabah S, Haddad EA, Shuaibi S, Qadhi I, Al-Saidan L, Khayat A. Long-term Outcomes of Sleeve Gastrectomy in Adolescent Patients: The Effect of Weight Loss in Younger Years to Outcomes in Adulthood. BMC Surg 2023; 23:103. [PMID: 37118797 PMCID: PMC10148482 DOI: 10.1186/s12893-023-02006-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 04/12/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Childhood obesity is associated with a variety of complications that see their light throughout adulthood. Due to the serious side effects of these morbidities, early intervention is essential. Laparoscopic sleeve gastrectomy (SG) is a safe and effective procedure for the treatment of obesity, however, the long-term data on its use in adolescents is lacking in the literature. METHODS A retrospective analysis was conducted on all patients that underwent SG aged between 12 and 21 years old at a public hospital in Kuwait. Data on their weight and comorbidities was collected and analyzed. RESULTS 164 adolescent patients with a mean age of 19 underwent SG. 71% of the patients were female, while the mean weight at surgery was 128.6 kg, corresponding to a BMI of 47.8 Kg/m2. 32% of patients had a starting BMI more than 50, while 6.7% had a BMI over 60. The highest weight loss was achieved at 18 months post-op, corresponding to an EWL of 82.66%. On long-term follow-up, weight loss was maintained over the 13 years post-op. Obstructive sleep apnea resolved in 75% of the patients while hypertension persisted in the 2 patients who were diagnosed with it pre-op. 21 patients developed gastro-esophageal reflux disease 5.7 years post-op, while 20 patients were treated for gall bladder stones 4.4 years post-op. CONCLUSION It is of ample importance to tackle obesity during childhood before complications ensue later in life. Bariatric surgery, specifically SG, has been found to be an effective and safe weight loss tool, with sustained long-term weight maintenance and resolution of early comorbidities.
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Affiliation(s)
- Salman Al Sabah
- Department of Surgery, Kuwait University, Kuwait City, Kuwait.
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Mulita F, Lampropoulos C, Kehagias D, Verras GI, Tchabashvili L, Kaplanis C, Liolis E, Iliopoulos F, Perdikaris I, Kehagias I. Long-term nutritional deficiencies following sleeve gastrectomy: a 6-year single-centre retrospective study. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2021; 20:170-176. [PMID: 35069068 PMCID: PMC8764960 DOI: 10.5114/pm.2021.110954] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is associated with short-term nutritional deficiencies postoperatively. This study evaluates the long-term percentage of excess weight loss (% EWL), and nutritional deficiencies in a single-centre cohort undergoing SG as a primary procedure, with a 6-year follow-up. MATERIAL AND METHODS From January 2005 to December 2010 the records of 209 patients who underwent laparoscopic SG were retrieved from a computer database for analysis. Sixty out of the 209 paients completed follow-ups for 6 years. RESULTS Median % EWL at 1, 2, 3, 4, 5, and 6 years postoperatively was 80.9%, 79.1%, 73.8%, 71.8%, 71.5%, and 64.9%, respectively. Prior to surgery, 17.2% had anaemia. Deficiencies of iron, ferritin, folic acid, vitamin B12, magnesium, and phosphorus were 22%, 5.3%, 1.4%, 3.8%, 29.7%, and 5.3%, respectively. Six years post-surgery, deficiencies of haemoglobin, ferritin, and B12 worsened (36.7%, 43.3%, and 11.7%, p = 0.001, p < 0.001, p = 0.019, respectively), whereas there was no significant difference in deficiencies of iron, folic acid, magnesium, and phosphorus (25%, 1.7%, 20%, and 3%, p = 0.625, p = 0.896, p = 0.139, p = 0.539, respectively). There was elevated PTH before and 6 years after surgery (2.9% and 1.7%, p = 0.606). CONCLUSIONS This retrospective study shows that laparoscopic sleeve gastrectomy had a considerable effect on specific nutritional deficiencies in our patients at 6 years post-surgery. Knowledge of micronutrient deficiencies in these patients is beneficial for both prevention and management of nutritional complications associated with SG with the administration of oral nutritional supplementation according to the patient's needs.
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Affiliation(s)
- Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Greece
- Corresponding author: Francesk Mulita, Md, Department of Surgery, General University Hospital of Patras, Greece, e-mail:
| | | | | | | | | | | | - Elias Liolis
- Department of Internal Medicine, Division of Oncology, General University Hospital of Patras, Greece
| | - Fotios Iliopoulos
- Department of Surgery, General University Hospital of Patras, Greece
| | | | - Ioannis Kehagias
- Department of Surgery, General University Hospital of Patras, Greece
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Salman AA, Salman MA, Shawkat M, Hassan SA, Saad EH, Hussein AM, Refaie ORM, Tourky MS, Shaaban HED, Abd Allah N, El Domiaty HF, Elkassar H. Effect of laparoscopic sleeve gastrectomy on vasoactive mediators in obese hypertensive patients: A prospective study. Clin Endocrinol (Oxf) 2021; 94:193-203. [PMID: 33064869 DOI: 10.1111/cen.14352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The causal relationship between obesity and high blood pressure is established; however, the detailed pathways for such association are still under research. This work aims to assess the changes in neprilysin, vasoconstrictor and vasodilatory molecules in obese hypertensive patients undergoing laparoscopic sleeve gastrectomy (LSG). PATIENTS The present prospective study was done on 59 hypertensive obese patients in whom LGS was performed. Blood pressure, as well as blood samples for neprilysin, angiotensinogen, angiotensin II, renin, endothelin-1 "ET-1", aldosterone, atrial natriuretic peptide "ANP" and B-type natriuretic peptide "BNP", were assessed before and 15 months after surgery. Patients were divided into two groups according to the remission of hypertension (HTN). RESULTS After 15 months, remission of hypertension was seen in 42 patients (71%). The declines in the following measurements were significantly higher in patients with remission than those with persistent HTN: aldosterone (p = .029567), angiotensin II (p < .000001), angiotensinogen (p = .000021), neprilysin (p = .000601), renin (p = .000454) and endothelin-1(p = .000030). There was a significantly higher increment in ANP (p = .000002) and a non-significant increment in BNP (p = .081740). Angiotensin II 15 months after LSG and Δ ANP % were significant independent predictors of persistent HTN. CONCLUSION In the setting of LSG, aldosterone, angiotensinogen, angiotensin II, renin and neprilysin were significantly lower in patients with remission of HTN after 15 months than those with persistent HTN, and natriuretic peptides were significantly higher. A lower postoperative level of angiotensin II and a larger percentage increment of ANP are independently associated with hypertension remission after LSG.
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Affiliation(s)
| | | | - Mohamed Shawkat
- Internal Medicine Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Shady A Hassan
- Internal Medicine Department, Faculty of medicine, Cairo University, Cairo, Egypt
| | - Eman H Saad
- Internal Medicine Department, Faculty of medicine, Cairo University, Cairo, Egypt
| | | | - Osama R M Refaie
- General Surgery Department, Faculty of medicine, Cairo University, Cairo, Egypt
| | | | - Hossam El-Din Shaaban
- Gastroenterology & Hepatology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Nesrin Abd Allah
- Anatomy and Embryology Department, Faculty of Medicine, Menoufia University, Al Minufiyah, Egypt
| | - Heba Fathy El Domiaty
- Clinical Physiology Department, Faculty of Medicine, Menoufia University, Al Minufiyah, Egypt
| | - Hesham Elkassar
- Internal Medicine Department, Faculty of medicine, Cairo University, Cairo, Egypt
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Seyit H, Alis H. Five-year outcomes for laparoscopic sleeve gastrectomy from a single center in Turkey. Ann Saudi Med 2020; 40:310-315. [PMID: 32757987 PMCID: PMC7410219 DOI: 10.5144/0256-4947.2020.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are no long-term results for laparoscopic sleeve gastrectomy (LSG) from Turkey. OBJECTIVES Assess the outcomes of LSG at 5 years. DESIGN Retrospective. SETTING Training and research hospital. PATIENTS AND METHODS The study included patients with LSG performed from August 2012 to December 2013. The data was prospectively collected with the aim of providing 5-year outcomes. MAIN OUTCOME MEASURES Changes in percentage excessive weight loss (%EWI) and BMI. Changes in the pharmacological treatment status of patients with type 2 diabetes mellitus and hypertension. SAMPLE SIZE AND CHARACTERISTICS 120 patients (89 female) completed follow up; mean age 37 years (range, 19-63 years), mean preoperative BMI 48.3 kg/m2 (range 40-80.4 kg/m2). RESULTS After a mean 5.6-year follow-up, the mean (SD) postoperative weight loss was 43.5 (11.8) kg and the mean (SD) BMI loss was 16.1 (4.4). The mean %EWL value was 62.9% (range, 30-101%). Most patients (87.5%, n=105) achieved satisfactory %EWL values. The major complication rate was 6.6%. After surgery, 74.2% of patients taking medication for hypertension were able to stop treatment, while 12.9% reduced the dose, of patients that took medication for diabetes, all had a dosage reduction. CONCLUSIONS We showed that LSG is an acceptable bariatric procedure, but in the long-term there may be weight gain and frequent reflux symptoms. We think renewed weight gain can be partially prevented by close clinical follow-up. There is a need for long-term randomized controlled studies with long-term follow-up to clearly define the indications for LSG. LIMITATIONS Retrospective, incomplete clinical visits, GERD symptoms not objectively assessed. CONFLICT OF INTEREST None.
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Affiliation(s)
- Hakan Seyit
- From the Department of General Surgery, Bakirkoy Dr. SadiKonuk Training and Research Hospital, Istanbul, Turkey
| | - Halil Alis
- From the Department of General Surgery, Istanbul Aydin University Medical School, Istanbul, Turkey
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Thomopoulos T, Podetta M, Studer AS, Atlas H, Pescarus R, Denis R, Garneau PY. Efficiency of Laparoscopic One-Step Revision of Failed Adjusted Gastric Banding to Gastric Sleeve: a Retrospective Review of 101 Consecutive Patients. Obes Surg 2019; 29:3868-3873. [PMID: 31278655 DOI: 10.1007/s11695-019-04061-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Until recently, laparoscopic adjustable gastric banding (LAGB) was one of the most commonly performed bariatric surgeries worldwide. Today, its high rate of complications and failure rates up to 70% requires revisional surgery. The one-stage conversion from LAGB to laparoscopic sleeve gastrectomy (LSG) has been shown to be safe, although there are some concerns on efficacy and long-term weight loss. OBJECTIVES To demonstrate that one-step revision of LAGB to another restrictive procedure, such as LSG, might have efficient long-term outcomes. METHODS The charts from 133 revisional LSGs for failed or complicated LAGB were retrospectively reviewed for the period between January 2010 and August 2017. Thirty-two patients were excluded for loss to follow-up. Demographics, complications, and percentage of excess weight loss (%EWL) were determined. RESULTS One hundred one patients were included (85 women and 16 men), with a mean age of 48.5 years, and a mean body mass index of 47.1 kg/m2. During the follow-up, 15 patients (15%) underwent a second revisional surgery for weight loss failure (8 Roux-en-Y gastric bypass (RYGBP), 3 biliopancreatic diversion, 3 single anastomosis duodenal-ileal bypass, 1 revisional LSG). Ten patients (10%) had long-term complications (8 severe reflux and 2 stenosis) during this period and underwent a second revisional surgery (10 RYGBP). The remaining 76 had a mean follow-up of 4.3 years and a mean %EWL of 53.2%. CONCLUSION Single-stage conversion to LSG is a safe and appropriate solution for failed or complicated LAGB with good long-term weight loss.
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Affiliation(s)
- Theodoros Thomopoulos
- Division of Bariatric Surgery, Department of Surgery, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, H4J1C5, Canada.
| | - Michele Podetta
- Division of Bariatric Surgery, Department of Surgery, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, H4J1C5, Canada
| | - Anne-Sophie Studer
- Division of Bariatric Surgery, Department of Surgery, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, H4J1C5, Canada
| | - Henri Atlas
- Division of Bariatric Surgery, Department of Surgery, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, H4J1C5, Canada
| | - Radu Pescarus
- Division of Bariatric Surgery, Department of Surgery, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, H4J1C5, Canada
| | - Ronald Denis
- Division of Bariatric Surgery, Department of Surgery, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, H4J1C5, Canada
| | - Pierre Y Garneau
- Division of Bariatric Surgery, Department of Surgery, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, H4J1C5, Canada
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