Background
Sleeve gastrectomy is a new restrictive bariatric procedure increasingly indicated
in the treatment of morbid obesity. The authors report their experience of laparoscopic
sleeve gastrectomy (LSG), evaluate the efficacy of this procedure on weight loss,
and analyze the short-term outcome.
Methods
The data of 135 consecutive patients undergoing LSG between July 2004 and October
2007 were analyzed prospectively. LSG was indicated only for weight reduction with
a body mass index (BMI) > 40 or > 35 kg/m2 associated with severe comorbidity. Study endpoints included mean BMI, comorbidity,
operative data, conversion to laparotomy, intraoperative complications, major and
minor complication rates, excess weight loss, follow-up, and duration of hospital
stay. Possible risk factors for postoperative gastric fistula (PGF) were investigated.
Results
This series comprised 113 females and 22 males with a mean age of 40 years (range,
18–65). Mean weight was 132 kg (range, 94–186), and mean preoperative BMI was 48.8
kg/m2 (range, 37–72). The mean operating time was 103 minutes (range, 30–550). No patients
required conversion to laparotomy, and 96% of patients did not require drainage. The
nasogastric tube was removed on postoperative day 1. The postoperative course was
uneventful in 94.9% of cases, and the median duration of hospital stay was 3.8 days.
The median follow-up was 12.7 months. The mean postoperative BMI decreased to 39.8
kg/m2 at 6 months (P < .001). Average excess body weight loss was 38.6% and 49.4% at 6 months and 1 year,
respectively. There was no mortality, and the major complication rate, corresponding
to gastric fistula (PGF) in every case, was 5.1% (n = 7). Management of PGF required reoperation, radiologic and endoscopic procedures,
and fibrin glue; the median hospital stay was 47 days. BMI > 60 kg/m2 appears to be a risk factor for PGF.
Conclusion
LSG is a reproducible and seems to be an effective treatment to achieve significant
weight loss after 12 months follow-up. LSG can be used as a standalone operation to
obtain weight reduction. Management of PGF remains a major issue.
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Article info
Publication history
Published online: October 02, 2008
Accepted:
July 7,
2008
Identification
Copyright
© 2009 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
