Laparoscopic Sleeve Gastrectomy as an Initial Bariatric Operation for High-Risk Patients: Initial Results in 10 Patients

Background: The outcomes and initial results of laparoscopic sleeve gastrectomy were evaluated. Methods: A prospective study of the initial 10 patients who underwent laparoscopic sleeve gastrectomy (LSG) was performed. Study endpoints included operative time, complication rates, hospital length of stay and percentage of excess weight loss (%EWL). Results: There were 5 women and 5 men, with mean age 43 years (range 31 to 52). Mean preoperative weight was 182 kg (range 125-247 kg), with mean preoperative BMI 64 (range 61-80). Indication for LSG was related to BMI in all patients. 1 patient had previous restrictive bariatric surgery. Mean operative time was 2 hours (range 1.5-2.5). No patient required conversion. There were no postoperative complications nor mortality. Median hospital stay was 7.2 days. Average %EWL and BMI at 1 year were 51% and 23 kg/m², respectively. Conclusion: LSG can be safely integrated into a bariatric surgical program with good results in terms of weight loss and quality of life. LSG can be a firststage procedure before gastric bypass or duodenal switch or a one-stage restrictive procedure if longterm results are good. LSG should be considered as a surgical option in the bariatric field.     

Safety and Short-Term Outcomes of Laparoscopic Sleeve Gastrectomy as a Revisional Approach for Failed Laparoscopic Adjustable Gastric Banding in the Treatment of Morbid Obesity

Laparoscopic sleeve gastrectomy (LSG) has been used as a first step of a two-stage approach in bariatric surgery for high-risk patients. Recently, LSG is being utilized as a primary and final procedure for morbid obesity with acceptable short-term results. The aim of this study is to investigate the effectiveness of LSG as a revisional procedure for patients with unsatisfactory outcomes after laparoscopic adjustable gastric band (LAGB). A retrospective review of a prospectively maintained database was performed. Data were reviewed for all patients undergoing revision from LAGB to LSG during the period May 2005 and May 2009. Data collected included demographics, indication for revision, operative time, length of stay, postoperative complications, and degree of weight reduction. Fifteen patients (three males and 12 females) had revisional surgery converting a LAGB to a LSG. The indication in four patients (26.66%) was weight regains and in five patients (33.33%) was poor weight loss; four patients (26.66%) had a band slippage and symptoms of gastroesophageal reflux, and one patient (6.66%) had poor weight loss, band slippage, and reflux. In one patient (6.66%), the indication was slippage and duodenal fistula. One-step revision procedure was done in 13 patients (86.66%), while two-step procedure was done in two patients (13.33%). Mean preoperative weight and BMI were 233.02 (181.4–300) lb and 38.66 (29.7–49.3) kg/m², respectively. Mean weight loss at 2, 6, 12, 18, and 24 months postoperatively was 20.7, 48.3, 57.2, 60.1, and 13.5 lb, respectively. Mean % excess BMI loss was 28.9%, 64.2%, 65.3%, 65.7%, and 22.25% at 2, 6, 12, 18, and 24 months, respectively. There was one major complication (staple line leak) and one postoperative acute gastric outlet obstruction. We had no mortality. Thirteen patients were followed up postoperatively. The number decreased as follow-up time progressed. LSG could provide short-term weight loss after previously failed LABG, but prone to more complications compared to an initial LSG without a prior bariatric procedure.     

三孔法在腹腔镜胃袖状切除术中的应用

目的: 初步探讨三孔法腹腔镜胃袖状切除术（three-port laparoscopic sleeve gastrectomy, TPLSG）的可行性、安全性及短期临床疗效。方法: 回顾性分析我院普外科2018年1月至7月接受腹腔镜胃袖状切除术（laparoscopic sleeve gastrectomy, LSG）的病人共39例,其中20例为TPLSG,19例常规五孔LSG。比较两种手术方式的手术时间、术中出血量、手术相关并发症发生率、术后疼痛程度、术后住院时间以及术后3个月多余体重减少率（excess weight loss, %EWL）。结果: TPLSG组术后疼痛程度和术后出院时间均少于常规五孔LSG组,差异有统计学意义（P<0.05）,两组的手术时间、术中出血量、手术相关并发症发生率、术后3个月%EWL的差异均无统计学意义（P>0.05）。结论: TPLSG是一种安全有效的手术方式,其临床效果安全有效,可加快病人康复,缩短住院时间。     

Results of teenaged bariatric patients performed in an adult program

BACKGROUND: Morbid obesity is a growing epidemic among adolescents. Bariatric surgery has proven to be the only long-term effective method in treating morbidly obese adults for over a decade. The laparoscopic approach has become a popular option. This study tested the hypothesis that laparoscopic Roux-en-Y gastric bypass is a feasible option in teenaged patients with good results through an adult bariatric program. METHODS: All patients under the age of 20 at the time of surgery were included in this study. Each patient had undergone a laparoscopic Roux-en-Y gastric bypass. Charts were reviewed for preoperative evaluation, operative time, complications, and length of hospital stay. Percentage of excess body weight lost (%EBWL) was calculated at the follow-up. RESULTS: Of the 202 patients who underwent a laparoscopic gastric bypass procedure at our institution, 5 (2%) were teenagers. The mean age was 18 years (range, 17-19). The mean height was 69 inches (range, 61-75). Average weight was 323 lbs (range, 227-394). The mean preoperative body mass index was 48 kg/m2 (range, 44-56). All patients had medical and psychological clearance prior to surgery. Mean operative time was 150 minutes (range, 130-172). There were no complications in this subset of patients. All 5 patients were discharged on postoperative day 2. Follow-up ranged from 17.8 to 44.8 months. The mean %EBWL was 77% (range, 58%-88%). CONCLUSIONS: The laparoscopic gastric bypass procedure is technically feasible in teenaged patients, with excellent results even when performed in an adult bariatric program. Long-term data will be needed to determine its role in the treatment of morbidly obese adolescents.     

Laparoscopic Roux-en-Y fistulojejunostomy as a salvage procedure in patients with chronic gastric leak after sleeve gastrectomy

BackgroundThe most common postoperative complication of laparoscopic sleeve gastrectomy (LSG) is staple-line leak. Even if its rate following LSG has been recently reduced, management of chronic leaks remains challenging.ObjectiveTo present a series of patients treated with laparoscopic Roux-en-Y fistulojejunostomy (LRYFJ) for chronic gastric leak (>12 wk) post-LSG.SettingUniversity hospitals; specialized bariatric surgery units.MethodsData were prospectively gathered and retrospectively analyzed. Parameters of interest were patient characteristics, perioperative data, and postoperative outcomes. Hemodynamically unstable patients and/or presentations of signs of severe sepsis were excluded. Surgical technique was standardized.ResultsFourteen patients underwent LRYFJ for chronic gastric leak (12 women, 2 men). The mean age was 49.2 years and the mean weight was 88.7 kg with a mean body mass index of 31.1 kg/m². All procedures were successfully performed by laparoscopy except 1 (7.1%) converted to open surgery. The mean operative time was 198 minutes, with a mean estimated blood loss of 135.7 mL and 2 patients necessitating transfusion (14.2%). Mortality was null. Five postoperative complications were noted (35.7%): 2 leaks of the fistulojejunostomy treated by antibiotherapy and endoscopic drainage; 1 perianastomotic hematoma treated by relaparoscopy and antibiotherapy; and 1 pleural effusion and 1 hematemesis both medically treated. The mean length of hospital stay was 14 days. The mean follow-up was 40 months, with all patients being in good health at last contact.ConclusionsLRYFJ seems to be a good salvage option in selected patients for the treatment of chronic gastric leaks after LSG. However, it is a challenging procedure and should be performed in experienced bariatric centers by expert bariatric surgeons.     

Staged Laparoscopic Sleeve Gastrectomy Followed by Roux-en-Y Gastric Bypass for Morbidly Obese Patients: A Risk Reduction Strategy

Background  In our centre laparoscopic Roux-en-Y gastric bypass (LRYGBP) is the most effective weight loss surgical procedure performed. However, LRYGBP may be associated with higher risk of peri- and postoperative complications in contrast to a purely restrictive procedure to justify this procedure on all comers. Laparoscopic sleeve gastrectomy (LSG) as a staged procedure may be an alternate risk reduction strategy. The aim of this study is to report on the short-term outcomes of LSG, the effect on operative risk reduction and resolution of comorbidities. Methods  A prospective review of 138 patients who underwent consecutive LSG from November 2004 to November 2006 was performed. Data were collected on all patients who attended the three to six monthly clinical follow-up and/or the patient questionnaire. Data collection included demographics, degree of weight reduction, postoperative complications, and changes in comorbidities. Results  Median BMI was 50.60 kg/m² (33–82). Of the patients, 46.38% had a BMI ≥50 kg/m². The overall median postoperative excess weight loss (EWL) was 43.26%, 31.08% at 6 months, 54.50% at 12 months, 51.47% at 18 months and 46.05% at 24 months. Of the patients, 39% had resolution of type 2 diabetes mellitus, 48% had resolution of dyslipidemia, 29% in hypertension, 52% in obstructive sleep apnea. Complication rate was 5.07% and four patients needed further surgical intervention. The mortality rate was zero. Conclusion  LSG does minimize postoperative complication rates significantly on high-risk patients and achieves effective short-term weight loss with resolutions in comorbidities. Additional studies are required to evaluate LSG as a stand-lone procedure.     

Laparoscopic sleeve gastrectomy versus intragastric balloon: a case-control study

Aim

To compare the efficacy of laparoscopic sleeve gastrectomy (LSG) and BioEnterics intragastric balloon (BIB^®) to lose weight and comorbidities after 12 months of follow-up before a more invasive bariatric procedure.

Methods

From January 2004 to December 2006, 40 patients underwent laparoscopic sleeve gastrectomy (LSG) as a first step in biliopancreatic diversion with duodenal switch. Controls (n = 80) were selected based on charts of patients who, during the same period, underwent BioEnterics intragastric balloon therapy. In both groups we considered: length of procedure, hospital stay, intraoperative or endoscopic complications, postoperative or postendoscopic complications, comorbidities at baseline, after 6 months (time of BIB removal), and after 12 months from baseline, and weight loss parameters [weight in kg, percentage excess weight less (%EWL), body mass index (BMI), and percentage excess BMI loss (%EBL)]. Results are expressed as mean ± standard deviation.

Results

Mortality, intra- and postoperative complications (in LSG group), and intra- and postendoscopic complications (in BIB group) were absent. Mean operative time in the LSG group was 120 ± 40 (range 60–200) min. Mean positioning time for BIB was 15 ± 5 (range 10–25) min. BMI at baseline was 54.1 ± 2.9 (range 45.1–55.9) kg/m² and 54.8 ± 2.5 (range 45.1–56.2) kg/m² in BIB and LSG groups, respectively. At 6-month follow-up, mean BMI was 46.2 ± 3.5 and 45.3 ± 5.5 kg/m² in the BIB and LSG patients, respectively [p = not significant (ns)]. After 12 months BIB patients regained BMI, even if strictly followed with a diet regimen, while LSG patients continued to lose weight. Significant differences between groups were absent for the comorbidities considered.

Conclusions

Laparoscopic sleeve gastrectomy and BioEnterics intragastric balloon are two valid options for producing weight loss as a first-step procedure. LSG has all the related risks of general anesthesia, laparoscopic surgery, and digestive anastomosis, whereas BIB presents a very low rate of minor complications, such as psychological intolerance. For all these reasons, at this time, BIB is considered a better option than LSG as a first-step procedure in the short term (12 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.     

Conversion of failed laparoscopic adjustable gastric banding: Sleeve gastrectomy or Roux-en-Y gastric bypass?

BackgroundIn the literature, late complications and treatment failures in laparoscopic adjustable gastric banding (LAGB) have been reported. When the patient presents with failure of LAGB, surgeons have the option to convert it to a different procedure. The aim of our study is to evaluate and compare the safety and efficacy of converting LAGB to laparoscopic sleeve gastrectomy (LSG) versus laparoscopic Roux-en-Y gastric bypass (LRYGB).MethodsBetween March 2008 and October 2012, a total of 54 patients underwent conversion of LAGB at our institution. Of these patients, 41 (75.9%) were converted to LRYGB, and 13 (24.1%) patients were converted to LSG. A retrospective review of a prospectively collected database was performed, noting the outcomes and complications of the procedure.ResultsMean body mass index at the time of conversion was 41.8±6.5 kg/m² in LRYGB and 39.0±6.6 kg/m² in LSG. Mean percentage of excess weight loss was 57.4%±17.0% and 62.4%±19.6% in LRYGB, and it was 47.7%±4.2% and 65.6%±34.5% in LSG at 12 months (P>.34) and 24 months (P>.79) after conversion. Of LRYGB patients, 7 (17.5%) were readmitted as a result of abdominal pain, dehydration, and nausea/vomiting, and 4 (10.0%) patients required reoperation. One LSG patient (8.3%) was readmitted for new-onset severe reflux and underwent hiatal hernia repair. She was converted to LRYGB 32 months after the LSG procedure. Readmission rate (P>.61) and reoperation rate (P>.63) did not show statistical difference between the 2 procedures.ConclusionConverting LAGB to LSG and LRYGB both seem feasible and resulted in substantial further weight loss.     

Complications after laparoscopic sleeve gastrectomy

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has recently become a feasible option in the management of morbid obesity. The objective of this study was to examine the morbidity and mortality arising from LSG as a primary procedure for weight loss. METHODS: We retrospectively reviewed the data of 164 patients who underwent LSG from 2004 to 2007. Patients underwent LSG as a primary procedure or as revisional bariatric surgery. The short-term morbidity and mortality were examined. RESULTS: One-stage LSG was performed in 148 patients. The major complication rate was 2.9% (4 of 149), including 1 leak (0.7%) and 1 case of hemorrhage (0.7%)-each requiring reoperation-1 case of postoperative abscess (0.7%), and 1 case of sleeve stricture that required endoscopic dilation (0.7%). One late complication of choledocholithiasis and bile duct stricture required a Whipple procedure. LSG was used as revisional surgery in 16 patients (9%); of these, 13 underwent LSG after complications related to laparoscopic adjustable gastric banding, 1 underwent LSG after aborted laparoscopic Roux-en-Y gastric bypass, and 2 underwent LSG after failed jejunoileal bypass. One of these patients developed a leak and an abscess (7.1%) requiring reoperation. One case was aborted, and 2 cases were converted to an open procedure secondary to dense adhesions. No patient died in either group. All but 3 cases were completed laparoscopically (98%). CONCLUSION: LSG is a relatively safe surgical option for weight loss as a primary procedure and as a primary step before a secondary nonbariatric procedure in high-risk patients.     

Mid-term Follow-up after Sleeve Gastrectomy as a Final Approach for Morbid Obesity

Background  In previous publications, we demonstrated the safety and short-term efficacy of laparoscopic sleeve gastrectomy (LSG) as a final step in the treatment of morbid obesity (MO). This study aimed to assess the mid-term efficacy of LSG. Methods  We performed a retrospective review of a prospectively collected database. Between November 2004 and January 2007, 130 consecutive patients underwent LSG as a final procedure to MO. Data including patient demographics, operative time, length of hospital stay, complications, preoperative body mass index (BMI), complications, and weight loss at 3, 6, 12, 18, and 24 months were recorded and analyzed. Results  The mean age was 45.6 (range: 12–79) years while the mean BMI was 43.2 (range: 30.2–75.4) kg/m². The mean operative time was 97 (range, 58–180) min and all operations were completed laparoscopically. The mean hospital stay was 3.2 (range, 1–19) days with zero mortality in this series. One patient (0.7%) had leakage at the stapler line, while four patients (2.8%) developed trocar site infection. Three patients (2.1%) complained of symptoms of gastroesophageal reflux disease (GERD), three patients (2.1 %) developed symptomatic gallstones, and trocar site hernia was present in one (0.7%) patient. The mean weight loss was 21, 31.2, 37.4, 39.5, and 41.7 kg at 3, 6, 12, 18, and 24 months, respectively, while the mean BMI decreased to 36.9, 32.8, 29.5, 28, and 27.1 at 3, 6, 12 18, and 24 months, respectively. Percent of excess weight loss (%EWL) was 33.1, 50.8, 62.2, 64.4, and 67.9 at 3, 6, 12, 18, and 24 months, respectively. Conclusions  LSG is a safe and effective surgical procedure for the morbidly obese up to 2 years. Excess body weight loss seems to be acceptable at 2 years postoperatively.     

Establishing a laparoscopic gastric bypass program

OBJECTIVE: To evaluate the outcomes for laparoscopic Roux-en-Y gastric bypass in a newly developed bariatric surgery program. METHODS: A prospective analysis of the initial 100 patients who underwent laparoscopic Roux-en-Y gastric bypass at a community based teaching hospital between December 2000 and October 2001 was performed. Study endpoints included operative time, early (less than 7 days) and late complication rates, hospital length of stay (LOS), time to initiation of oral diet, and percentage of excess body weight loss. RESULTS: There were 91 women and 9 men with a mean age of 39 years (range 21 to 57). Mean preoperative weight was 126.4 kg (range 92.3 kg to 214 kg), with a mean preoperative body mass index of 47.4 (range 37.3 to 75.7). Ninety (90%) patients had at least one significant medical comorbidity (median = 6 per patient). Mean operative time was 2.4 hours (range 1.0 to 6.5; 3.0 hours for the first 50 patients and 1.8 hours for the last 50 patients). Three patients required conversion to open gastric bypass, all due to equipment failure (two harmonic scalpel failures and one linear stapler malfunction). Seven patients had early complications, 3 with anastomotic hemorrhage requiring transfusion, 3 with intestinal leaks requiring reoperation, and 1 with transected nasogastric tube. Eleven patients had late complications: 5 patients with small bowel obstruction, all due to herniation through the transverse colon mesentery (these occurred early in the series, prompting a change in technique, with no subsequent occurrences), 3 with gastrojejunostomy strictures requiring endoscopic dilation, 2 superficial wound infections, and 1 port-site incisional hernia. No complications occurred in the last 40 patients. No deaths occurred. Median hospital stay was 2 days (range 1 to 37); 3 days in the first 50 cases and 1 day in the last 50 cases. The median number of days to the start of an oral diet was 1 day. Average excess body weight loss was 34% (median follow-up 4 months). CONCLUSIONS: Laparoscopic Roux-en-Y gastric bypass is a technically challenging procedure that can be safely integrated into a bariatric treatment program with good results. Improved outcomes, shorter operative times, and fewer complications are associated with increased surgical experience.     

腹腔镜胃肠部分切除术治疗重度肥胖症

目的 探讨腹腔镜下袖套式胃大部切除和部分小肠切除术治疗重度肥胖症的手术方法、安全性和近期疗效.方法 从2006年12月至2007年9月,为10例重度肥胖症患者进行了腹腔镜下袖套式胃大部切除和部分小肠切除术.手术包括3部分:(1)自大弯侧距幽门5～6 cm处起垂直向上至贲门左侧His角,用内镜下切割吻合器向上切除大弯侧胃,保留和形成宽约2～3 cm的小弯侧管状胃;(2)切除大网膜;(3)切除约1/3～2/5的小肠.结果 本组10例腹腔镜下袖套式胃大部切除和部分小肠切除术全部完成,无1例需中转开腹手术.手术中位时间3.1 h,无术后并发症,术后平均住院7 d.10例患者术前平均体质量指数为36.1 ks/m2,术后1个月、3个月和6个月平均体质量指数分别减少了4.1 ks/m2、5.6 ks/m2和7.3 ks/m2,平均体重分别减轻11.7 kg、17.5 kg和22.0 kg.结论 腹腔镜下袖套式胃大部切除和部分小肠切除术治疗重度肥胖症安全性高、近期疗效满意.     

A comparison study of laparoscopic versus open gastric bypass for morbid obesity

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (GBP) has been previously described, but a comparative study between laparoscopic and open GBP has not been reported. The purpose of this study was to compare surgical outcomes oflaparoscopic GBP with those of open GBP for treatment of morbid obesity. STUDY DESIGN: From August 1998 to September 1999, we prospectively collected outcome data on 35 patients with body-mass indices between 40 kg/m2 and 60 kg/m2 who underwent laparoscopic GBP. Demographics, operative data, perioperative complications, and weight losses were collected and compared with those obtained from a retrospective chart review of 35 patients with body-mass indices between 40 kg/m2 and 60 kg/m2 who underwent open GBP before August 1998. RESULTS: Age, gender, preoperative body-mass index, preoperative comorbidity, and earlier abdominal surgery were similar in both groups. All laparoscopic operations were completed without conversion to laparotomy. Mean operative time, operative blood loss, length of intensive care stay, and length of hospital stay were significantly less after laparoscopic GBP than after open GBP (p<0.05). There was no 30-day mortality in either group. At 1-year followup, analysis of the percentage of excess body weight loss showed no significant difference between the two groups (p<0.05). CONCLUSIONS: Laparoscopic Roux-en-Y gastric bypass is technically feasible and safe. Laparoscopic GBP confers the clinical benefits of laparoscopy and an initial weight loss similar to that of open GBP.     

Short-term Results of Laparoscopic Mini-Gastric Bypass

Background: The laparoscopic mini-gastric bypass (MGB) is a modification of Mason's loop gastric bypass, but with a long lesser curvature tube. With weight loss results similar to laparoscopic Roux-en-Y gastric bypass (LRYGBP), the MGB is a simpler operation with a low complication rate. Controversy exists concerning the efficacy and side-effects of this procedure. This report presents the technique of laparoscopic MGB and its results in 423 patients. Methods: From October 2001 to October 2004, 423 consecutive patients (87 males and 336 females) underwent laparoscopic MGB (LMGB) for morbid obesity. Mean age was 30.8 years, preoperative mean weight 120.3 kg and mean BMI 44.2 kg/m². Results: All procedures were completed laparoscopically. Mean operative time was 130.8 minutes, and mean hospital stay was 5.0 days. 18 minor early complications (4.3%) were encountered, and 7 major complications (1.7%) occurred. Marginal ulcers were noted in 34 patients (8.0%) during follow-up, and anemia was found in 41 patients (9.7%). Mean BMI decreased to 29.2 and 28.4 kg/m² at 1-year and 2-year follow-up, with mean excess weight loss 69.3% and 72.2%. The Gastrointestinal Quality of Life Index improved significantly 1 year after the operation. Conclusions: LMGB has a low complication and mortality rate. The learning curve is less steep than for LRYGBP, whereas the efficacy is similar.     

Laparoscopic Adjustable Gastric Banded Plication: a Case-Matched Comparative Study with Laparoscopic Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy (LSG) has been accepted as stand-alone restrictive bariatric procedure; laparoscopic adjustable gastric banded plication (LAGBP) is an innovative technique combining gastric banding and plication of the stomach. This study aims to compare LAGBP with LSG in terms of percent excess weight loss (%EWL), resolution of comorbidities, and complications. This study was conducted in a university hospital. We retrospectively analyzed data of 60 patients: 30 each receiving LSG and LAGBP between May 2009 to October 2010. Demographics, operative data, complications, % EWL, and resolution of comorbidities were analyzed and compared. All the patients were followed for at least 1 year. LSG and LAGBP were matched for age, sex, body mass index and comorbidity ratio. Mean operative time was significantly longer in LAGBP: 62.45?±?30.1 vs. 86.01?±?21.88 (p?=?0.001). Both groups had similar complication rates (6.67 %) and most of the patients achieved significant resolution of comorbidities. The mean %EWL was statistically significant for LSG till 18 months follow-up as compared to LAGBP, but there was no difference at 2 years (p?=?0.971). Mean frequency of band adjustment after LAGBP in 2 years was 1.50?±?1.51. There was no significant difference in comorbidity resolution in both groups. LAGBP is a dual restrictive bariatric procedure offering similar results with LSG at 2 years in terms of complications, % EWL, and comorbidity resolution with potential of continual weight loss due to band.     

Laparoscopic Roux-en-Y gastric bypass: minimally invasive bariatric surgery for the superobese in the community hospital setting

Roux-en-Y gastric bypass (RYGB) operation has become a popular choice for weight-reduction surgery. We report an outcome analysis of our early results with laparoscopic Roux-en-Y gastric bypass for superobese (BMI >50) patients. Between January 2000 and October 2001, we operated on 71 superobese patients. The mean body mass index (BMI) of patients at time of surgery was 57 kg/m2. The prospectively collected data included patient demographics, comorbidities, operative times, postoperative weight loss, and complications. Conversion to open gastric bypass was required in one patient. The overall complication rate was 10 per cent. Preoperative comorbidities were resolved or improved in 93 per cent of patients at 1-year postoperative. Average operative time and length of hospital stay were 196 minutes and 2.3 days, respectively. Mean percentage excess weight loss at 3, 6, 9, and 12 months was 27 per cent, 39 per cent, 49 per cent, and 55 per cent, respectively. Mean BMI decreased to 36 kg/m2 over a 12-month period. Laparoscopic Roux-en-Y gastric bypass surgery for superobese patients as performed in the community hospital setting can be both safe and effective with respect to overall postoperative course, early weight loss, and reduction of comorbidity.     

Laparoscopic gastric banding: a minimally invasive surgical treatment for morbid obesity: prospective study of 500 consecutive patients

OBJECTIVE: To evaluate early and late morbidity of laparoscopic adjustable gastric banding for morbid obesity and to assess the efficacy of this procedure by analyzing its results. SUMMARY BACKGROUND DATA: Laparoscopic adjustable gastric banding is considered the least invasive surgical option for morbid obesity. It is effective, with an average loss of 50% of excessive weight after 2 years of follow-up. It is potentially reversible and safe; major morbidity is low and there is no mortality. METHODS: Between April 1997 and June 2001, 500 patients underwent laparoscopic surgery for morbid obesity with application of an adjustable gastric band. There were 438 women and 62 men (sex ratio = 0.14) with a mean age of 40.4 years. Preoperative mean body weight was 120.7 kg and mean body mass index (BMI) was 44.3 kg. m. RESULTS: Mean operative time was 105 minutes, 84 minutes during the last 300 operations. Mean hospital stay was 4.5 days. There were no deaths. There were 12 conversions (2.4%), 2 during the last 300 operations. Fifty-two patients (10.4%) had complications requiring an abdominal reoperation. Forty-nine underwent a reoperation for minor complications: slippage (n = 43, incisional hernias (n = 3), and reconnection of the catheter (n = 3). Three patients underwent a reoperation for major complications: gastroesophageal perforation (n = 2) and gastric necrosis (n = 1). Seven patients had pulmonary complications and 36 patients experienced minor problems related to the access port. At 1-, 2-, and 3-year follow-up, mean BMI decreased from 44.3 kg. m to 34.2, 32.8, and 31.9, respectively, and mean excess weight loss reached 42.8%, 52%, and 54.8%. CONCLUSIONS: Laparoscopic adjustable gastric banding is a beneficial operation in terms of excessive weight loss, with an acceptably low complication rate. It can noticeably improve the quality of life in obese patients. Half of the excess body weight can be effortlessly lost within 2 years.     

Adjustable Gastric Banding in a Multicenter Study in Turkey

Background: Adjustable gastric banding (AGB) is a minimally-invasive approach which allows adjustment of gastric restriction. Methods: The AGB was evaluated retrospectively in a consecutive series at 3 centers. From October 1998 to October 2001, 70 patients (49 women), mean age 34.3 years (18-59) with morbid obesity (preoperative mean BMI 45.2 kg/m²) underwent AGB The open approach was employed in the first 35 patients. Laparoscopic placement was used in the second 35 patients. Complete follow-up has been obtained in all patients. Results: Mean postoperative follow-up has been 18 months (12-39). Mean operative time was 120 minutes in the open approach and 150 minutes in the laparoscopic AGB. Mean hospital stay was 5 days after the open approach and 1.7 days after the laparoscopic surgery. The excess weight loss after 18 months was 59%. Incidence of early postoperative complications was 27.1%, including nausea and vomiting in 8 patients (5 in open approach, 3 in laparoscopic placement), wound infection in 10 patients (all 10 in open approach), and Wernicke's encephalopathy in 1 patient (open approach). Incidence of late complications was 28.5%, and included band migration in 2 patients (both by laparoscopic placement), pouch dilatation in 10 patients (6 in open approach, 4 in laparoscopic placement), incisional hernias in 4 patients (all by open approach), and port infections in 4 patients (all 4 in open approach). Conclusion: AGB has been effective in achieving good weight loss to 3 years follow-up. The ability to adjust the degree of gastric restriction has enabled progressive weight loss.     

Minimally invasive management of paraesophageal herniation in the high-risk surgical patient.

BACKGROUND: Traditional management of symptomatic paraesophageal herniation involves hernia reduction, hiatal closure, and an antireflux procedure or gastropexy. Patients with significant comorbidities may not tolerate operative repair. A new technique, laparoscopic-assisted endoscopic reduction and fixation of the stomach, may provide a minimally invasive treatment alternative. METHODS: Eleven elderly patients with symptomatic paraesophageal herniation were managed with flexible endoscopy and double percutaneous endoscopic gastrostomy (PEG) tube insertion with or without laparoscopic assistance. RESULTS: All patients presented with a symptomatic paraesophageal hernia. Mean age was 78.3 years (range 72 to 84). Each was deemed at high risk for definitive repair due to preexisting coronary artery disease as well as at least two other serious comorbidities. Hernia reduction and intra-abdominal fixation of the stomach was achieved in each case using flexible endoscopy and double PEG insertion. Laparoscopic assistance for reduction and gastropexy was utilized in 9 cases. Mean operative time was 61 minutes (range 28 to 104). Average length of stay was 2.8 days (range 0 to 12). One minor and three major postoperative complications occurred. Over a mean follow-up of 4.1 months (range 2 to 7), all patients have resumed oral intake and achieved weight gain. CONCLUSIONS: Patients with symptomatic paraesophageal herniation require intervention to alleviate symptoms and avoid the complications of gastric incarceration. For the high-risk patient, endoscopic reduction and PEG with laparoscopic assistance appears to provide effective treatment.