MEDIUM-TERM FOLLOW-UP RESULTS WITH LAPAROSCOPIC SLEEVE GASTRECTOMY

Almino Cardoso Ramos, Eduardo Lemos de Souza Bastos, Manoela Galvão Ramos, Nestor Tadashi Suguitani Bertin, Thales Delmondes Galvão, Raphael Torres Figueiredo de Lucena, Josemberg Marins Campos, Almino Cardoso Ramos, Eduardo Lemos de Souza Bastos, Manoela Galvão Ramos, Nestor Tadashi Suguitani Bertin, Thales Delmondes Galvão, Raphael Torres Figueiredo de Lucena, Josemberg Marins Campos

Abstract

Background: The indications for sleeve gastrectomy in the surgical treatment of morbid obesity have increased worldwide. Despite this, several aspects related to results at medium and long term remain in constant research.

Aim: To present the experience of sleeve gastrectomy in a center of excellence in bariatric surgery by analyzing clinical outcomes, complications and follow-up in the medium term.

Methods: The study included 120 morbidly obese patients who underwent sleeve gastrectomy and who were followed for at least 24 months. Aspects related to surgical technique, surgical complications and clinical outcome were analyzed.

Results: Seventy-five patients were women (62.5%) and the average age was 36 years. The body mass index preoperatively ranged from 35.5 to 58 kg/m2(average of 40.2 kg/m2). The length of stay ranged from 1 to 4 days (mean 2.1 days). Comorbidities observed were hypertension (19%), type 2 diabetes mellitus (6.6%), dyslipidemia (7.5%), sleep apnea (16.6%), reflux esophagitis (10%) and orthopedic diseases (7.5%). The mean body mass index and total weight loss percentage with 3, 12, 18 and 24 months were 32.2 kg/m2-19,9%; 29.5 kg/m2-26,5%; 28.2 kg/m2-30,3% and 26.9 kg/m2-32,7%, respectively. Remission of diabetes and dyslipidemia occurred in all patients. In relation to hypertension, there was improvement or remission in 86%. There were only two complications (bronchial pneumonia and dehydration), with good response to clinical treatment. There was no evidence digestive fistula and mortality was zero. Eleven patients (9.1%) had regained weighing more than 5 kg.

Conclusion: The sleeve gastrectomy is surgical technique that has proven safe and effective in the surgical treatment of obesity and control of their comorbidities in postoperative follow-up for two years.

Conflict of interest statement

Conflicts of interest: none

Figures

FIGURE 1. - Average reduction in BMI…
FIGURE 1. - Average reduction in BMI and increased weight loss percentage over the 24 months of postoperative observation of 120 patients undergoing laparoscopic GV

References

    1. Aly A, Lim HK. The Use of Over the Scope Clip (OTSC) Device for Sleeve Gastrectomy Leak. J Gastrointest Surg. 2013;17:606–608.
    1. Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N. Bariatric Surgery Worldwide 2013. Obes Surg. 2015
    1. ASMBS Clinical Issues Committee Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2012;8(3):e21–e26.
    1. Atkins ER, Preen DB, Jarman C, Cohen LD. Improved obesity reduction and co-morbidity resolution in patients treated with 40-French bougie versus 50-French bougie four years after laparoscopic sleeve gastrectomy. Analysis of 294 patients. Obes Surg. 2012;22(1):97–104.
    1. Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26:1509–1515.
    1. Baltasar A, Serra C, Bengochea M, Bou R, Andreo L. Use of Roux limb as remedial surgery for sleeve gastrectomy fistulas. Surg Obes Relat Dis. 2008;4:759–763.
    1. Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5:469–475.
    1. Buchwald H, Buchwald JN. Evolution of operative procedures for the management of morbid obesity 1950-2000. Obes Surg. 2002;12(5):705–717.
    1. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–1737.
    1. Buchwald H, Williams SE. Bariatric Surgery Worldwide 2003. Obes Surg. 2004;14:1157–1164.
    1. Buchwald H, Oien DM. Metabolic/Bariatric Surgery Worldwide 2008. Obes Surg. 2009;19:1605–1611.
    1. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23:427–436.
    1. Chour M, Alami RS, Sleilaty F, Wakim R. The early use of Roux limb as surgical treatment for proximal post sleeve gastrectomy leaks. Surg Obes Relat Dis. 2014;10:106–111.
    1. Corona M, Zini C, Allegritti M, Boatta E, Lucatelli P, Cannavale A. Minimally invasive treatment of gastric leak after sleeve gastrectomy. Radiol Med. 2013;118:962–970.
    1. Csendes A, Braghetto I, León P, Burgos AM. Management of Leaks After Laparoscopic Sleeve Gastrectomy in Patients with Obesity. J Gastrointest Surg. 2010;14:1343–1348.
    1. Melissas J, Koukouraki S, Askoxylakis J, Stathaki M, Daskalakis M, Perisinakis K, Karkavitsas N. Sleeve gastrectomy: a restrictive procedure? Obes Surg. 2007;17(1):57–62.
    1. Mukherjee S, Devalia K, Rahman MG, Mannur KR. Sleeve gastrectomy as a bridge to a second bariatric procedure in super obese patients - a single institution experience. Surg Obes Relat Dis. 2012;8:140–144.
    1. Parikh M, Gagner M, Heacock L, Strain G, Dakin G, Pomp A. Laparoscopic sleeve gastrectomy: does bougie size affect mean %EWL? Short-term outcomes. Surg Obes Relat Dis. 2008;4(4):528–533.
    1. Parikh M, Issa R, McCrillis A, Saunders JK, Ude-Welcome A, Gagner M. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257(2):231–237.
    1. Ramos AC, Silva AC, Ramos MG, Canseco EG, Galvão-Neto Mdos P, Menezes Mde A, Galvão TD, Bastos EL. Simplified gastric bypass: 13 years of experience and 12,000 patients operated. Arq Bras Cir Dig. 2014;27 Suppl 1:2–8.
    1. Ramos AC, Ramos MG, Campos JM, Galvão MP, Neto, Bastos EL. Laparoscopic total gastrectomy as an alternative treatment to postsleeve chronic fistula. Surg Obes Relat Dis. 2015;11(3):552–556.
    1. Rebibo L, Bartoli E, Dhahri A, Cosse C, Robert B, Brazier F, Pequignot A, Hakim S, Yzet T, Delcenserie R, Dupont H, Regimbeau JM. Persistent gastric fistula after sleeve gastrectomy: an analysis of the time between discovery and reoperation. Surg Obes Relat Dis. 2015
    1. Regan JP, Inabnet WB, Gagner M, Pomp A. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-superobese patient. Obes Surg. 2003;13:861–864.
    1. Silva LB, Moon RC, Teixeira AF, Jawad MA, Ferraz ÁA, G M, Neto, Ramos AC, Campos JM. Gastrobronchial Fistula in Sleeve Gastrectomy and Roux-en-Y Gastric Bypass-A Systematic Review. Obes Surg. 2015
    1. Slim R, Smayra T, Noun R. Biliary endoprosthesis in the management of gastric leak after sleeve gastrectomy. Surg Obes Relat Dis. 2013;9:485–486.
    1. Spivak H, Rubin M, Sadot E, Pollak E, Feygin A, Goitein D. Laparoscopic sleeve gastrectomy using 42-French versus 32-French bougie: the first-year outcome. Obes Surg. 2014;24(7):1090–1093.
    1. Yuval JB, Mintz Y, Cohen MJ, Rivkind AL, Elazary R. The effects of bougie caliber on leaks and excess weight loss following laparoscopic sleeve gastrectomy. Is there an ideal bougie size? Obes Surg. 2013;23(10):1685–1691.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel