A Meta-analysis of 2-Year Effect After Surgery: Laparoscopic Roux-en-Y Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy for Morbid Obesity and Diabetes Mellitus

Literature search was performed for bariatric surgery from inception to September 2013, in which the effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) on body mass index (BMI), percentage of excess weight loss (EWL%), and diabetes mellitus (DM) were compared 2 years post-surgery. A total of 9,756 cases of bariatric surgery from 16 studies were analyzed. Patients receiving LRYGB had significantly lower BMI and higher EWL% compared with those receiving LSG (BMI mean difference (MD)?=??1.38, 95 % confidence interval (CI)?=??1.72 to ?1.03; EWL% MD?=?5.06, 95 % CI?=?0.24 to 9.89). Improvement rate of DM was of no difference between the two types of bariatric surgeries (RR?=?1.05, 95 % CI?=?0.90 to 1.23). LRYGB had better long-term effect on body weight, while both LRYGB and LSG showed similar effects on DM.     

Laparoscopic Conversion of Gastric Bypass Complication to Sleeve Gastrectomy: Technique and Early Results

Background

Laparoscopic gastric bypass is a commonly performed bariatric surgery for the treatment of morbid obesity. Revision surgery for patients who have gastric bypass complications is a challenge for bariatric surgeon. Our aim is to present the early results of the conversions of gastric bypass complications to sleeve gastrectomies.

Methods

From January 2001 to April 2015, 49 of 2382 gastric bypasses underwent revisional surgery to convert gastric bypasses to sleeve gastrectomies. The demographic data, surgical parameters, and outcomes were studied.

Results

The mean age of the study group was 35.0 years (range 20 to 55), and the average body mass index (BMI) prior to the reoperation was 25.3 kg/m². Seven patients had previous laparoscopic Roux-en-Y gastric bypasses (LRYGBs), and 42 had laparoscopic single anastomosis (mini-) gastric bypasses (LSAGBs). The main reasons for the revisions were malnutrition (58 %), weight regain (10 %), intolerance (18 %), and others (14 %). The revisional surgeries had longer operative times, greater blood loss, and longer flatus passage times than the primary gastric bypass surgeries. Four patients (8.1 %) developed major complications during revisional surgery, including three (6.1 %) cases of leakage and one (2.0 %) case of internal bleeding. No mortality was noted. After conversion to sleeve gastrectomy, the body weights of the patients remained stable, and all patients improved in terms of malnutrition, including anemia, hypoalbuminemia, and secondary hyperparathyroidism.

Conclusions

Conversion to sleeve gastrectomy is an effective and safe option for patients with gastric bypass complications. The conversions to sleeve gastrectomy resulted in significant improvements in malnutrition and maintained weight loss at the early follow-ups.

     

The Results of a Surgical Complication Protection Program (BLIS, Inc.) for Private Pay Bariatric Patients in the U.S.: 2006–2011

Background

Bariatric surgery is the most effective treatment for morbid obesity and associated medical co morbidities. There is currently minimal surgical treatment penetration of this widespread disease. BLIS has been able to improve the access to bariatric surgery for cash-pay patients by alleviating concern about the costs of post-surgical complications. Recently, there has become an ability to attract payor groups by offering a “bundled” payment which includes BLIS complication protection.

Methods

A total of 5,364 self-pay patients underwent laparoscopic adjustable gastric banding, laparoscopic vertical sleeve gastrectomy, or laparoscopic Roux-en-Y gastric bypass with BLIS complication insurance.

Results

Of the overall 5,364 patients, the 30-day mortality rate was 0.04 % and 1-year mortality rate was 0.06 %. The frequency of complications was 5.4 % in the gastric banding group, 6.5 % in the sleeve gastrectomy group, and 9.7 % in the gastric bypass group.

Conclusions

The results for mortality and complications in the BLIS data set compares very well with other large data sets in bariatric surgery. BLIS complication insurance improves the access to bariatric surgery in patients who self-pay.     

Laparoscopic revisional surgery after Roux-en-Y gastric bypass and sleeve gastrectomy

BackgroundFailure of primary bariatric surgery is frequently due to weight recidivism, intractable gastric reflux, gastrojejunal strictures, fistulas, and malnutrition. Of these patients, 10–60% will undergo reoperative bariatric surgery, depending on the primary procedure performed. Open reoperative approaches for revision to Roux-en-Y gastric bypass (RYGB) have traditionally been advocated secondary to the perceived difficulty and safety with laparoscopic techniques. Few studies have addressed revisions after RYGB. The aim of the present study was to provide our experience regarding the safety, efficacy, and weight loss results of laparoscopic revisional surgery after previous RYGB and sleeve gastrectomy procedures.MethodsA retrospective analysis of patients who underwent laparoscopic revisional bariatric surgery for complications after previous RYGB and sleeve gastrectomy from November 2005 to May 2007 was performed. Technical revisions included isolation and transection of gastrogastric fistulas with partial gastrectomy, sleeve gastrectomy conversion to RYGB, and revision of RYGB. The data collected included the pre- and postoperative body mass index, operative time, blood loss, length of hospital stay, and intraoperative and postoperative complications.ResultsA total of 26 patients underwent laparoscopic revisional surgery. The primary operations had consisted of RYGB and sleeve gastrectomy. The complications from primary operations included gastrogastric fistulas, refractory gastroesophageal reflux disease, weight recidivism, and gastric outlet obstruction. The mean prerevision body mass index was 42 ± 10 kg/m². The average follow-up was 240 days (range 11–476). The average body mass index during follow-up was 37 ± 8 kg/m². Laparoscopic revision was successful in all but 1 patient, who required conversion to laparotomy for staple line leak. The average operating room time and estimated blood loss was 131 ± 66 minutes and 70 mL, respectively. The average hospital stay was 6 days. Three patients required surgical exploration for hemorrhage, staple line leak, and an incarcerated hernia. The overall complication rate was 23%, with a major complication rate of 11.5%. No patients died.ConclusionLaparoscopic revisional bariatric surgery after previous RYGB and sleeve gastrectomy is technically challenging but compared well in safety and efficacy with the results from open revisional procedures. Intraoperative endoscopy is a key component in performing these procedures.     

Pulmonary Function Testing and Complications of Laparoscopic Bariatric Surgery

Background

Obesity is associated with respiratory symptoms and impaired pulmonary function, which could increase the risk of complications after bariatric surgery. The purpose of this study is to assess the relationship between pulmonary function parameters before, and the risk of complications after, laparoscopic bariatric surgery.

Methods

This prospective study included patients (age 18–60, BMI >35 kg/m²), who were eligible for bariatric surgery. Spirometry was performed in all patients. Complications up to 30 days after bariatric surgery were recorded.

Results

Four hundred eighty-five patients were included (304 laparoscopic sleeve gastrectomy, 181 laparoscopic gastric bypass). There were 53 complications (8 pulmonary, 27 surgical, 14 infectious, 4 other) in 50 patients (10 %). There were 35 re-admissions (7.2 %), and 17 re-laparoscopies (3.5 %). Subjects with and without complications did not differ significantly with respect to demographics, weight, BMI, abdominal circumference or fat percentage. Subjects with complications had a significantly lower mean FEV₁ (mean 86.9 % predicted) and FVC (95.6 % predicted) compared to patients without complications (95.9 % predicted, p?=?0.005, and 100.1 % predicted, p?=?0.045, respectively). After adjustment for age, gender, BMI, and smoking, abnormal spirometry value remained the single predictive covariable of postoperative complications: FEV₁/FVC <70 % adjusted OR 3.1 (95%CI 1.4–6.8, p?=?0.006) and ΔFEV₁ ≥12 % adjusted OR 2.9 (95 %CI 1.3–6.6, p?=?0.010).

Conclusions

The risk of pulmonary complications after laparoscopic bariatric surgery is low. However, subjects with abnormal spirometry test results have a threefold risk of complications after laparoscopic bariatric surgery. Preoperative pulmonary function testing might be useful to predict the risk of complications of laparoscopic bariatric surgery.     

Preceptorship and Proctorship as an Effective Way to Learn Laparoscopic Sleeve Gastrectomy

Background

Laparoscopic sleeve gastrectomy has rapidly gained popularity as a procedure for morbidly obese patients. The goal of this project is to evaluate a training program for the laparoscopic sleeve gastrectomy (LSG), given to a group of surgeons by a specialized consultant in bariatric surgery.

Methods

The training process is divided in two parts. First, bringing the trainee surgeons to a specialized bariatric center to observe and take part in bariatric procedures with an experienced bariatric surgeon (preceptorship). Second, the consulting surgeon offers on-site training to all surgeons within their own hospital (proctorship). The support personnel (bariatric nurse, OR nurse, nutritionist) accompany the surgeon and are included in the training process. Finally, preoperative, intraoperative and postoperative data are compiled and analyzed.

Results

This study included 31 patients operated for LSG by the two newly trained surgeons after proctorship. Median age was 43 and mean BMI was 45.9. No leak, stricture, or mortality was found after the surgery. Mean surgical time was 94 min, and mean hospital length of stay was 3.9 days. Minor complications were seen during the follow-up at 1 to 3–6 months with excessive weight loss (EWL) of 62 % at 6 month.

Conclusions

This study showed the effectiveness of training provided through preceptorship/proctorship with a specialized consulting surgeon. The low complication rate and the weight loss achieved in only 6 months demonstrate the safety and efficacy of this learning method.     

Laparoscopic Sleeve Gastrectomy for Late Adolescent Population

Background

Morbid obesity prevalence is rapidly increasing among adolescents worldwide. Evidence is mounting that bariatric surgery is the only reliable method for substantial and sustainable weight loss; however, the debate continues with regard to the optimal surgical procedure for adolescents and to the age limit when bariatric surgery should be proposed.

Methods

A retrospective multicenter review included all late adolescent patients (<20 years old) who underwent sleeve gastrectomy from 2005 to 2012 in three French bariatric centers: Montpellier University Hospital, Casamance Private Hospital, and Noumea Regional Hospital. Collected data included age, sex, body mass index (BMI), intraoperative complications, length of hospital stay, operative morbidity, the need for reoperation, and percentage of excess weight loss (% EWL) at 6 months, 1 year, and 2 years postoperatively.

Results

A total of 61 adolescent patients have undergone sleeve gastrectomy. Of these, 42 were women and 19 were men. The mean preoperative weight was 132.8 kg (range 90–217 kg) with a BMI of 46.7 (range 35.5–68.7). Seventeen patients (27.9 %) were superobese (BMI?>?50), and seven patients (11.5 %) were supersuperobese (BMI?>?60). All the procedures were performed by laparoscopy with no intraoperative complications. The mean hospital stay was 4.6 days. Four major complications were recorded: one staple line leak, two hematomas, and one case of pneumonia. No mortality was recorded. The % EWL at 6 months, 1 year, and 2 years postoperatively was 48.1 % (±17.9 %), 66.7 % (±19.5 %), and 78.4 % (±16.8 %), respectively, for a follow-up of 93.4, 81.9, and 52.4 %, respectively. There were 18 patients (29.5 %) with identified comorbid conditions: 10 cases of sleep apnea, 7 cases of hypertension, and 1 case of type 2 diabetes, with a resolution rate of 77.8 %.

Conclusions

Laparoscopic sleeve gastrectomy may be advantageous for this age group, since it involves neither foreign body placement nor lifelong malabsorption. Laparoscopic sleeve gastrectomy represents an attractive bariatric procedure for adolescent patients, more efficient than gastric banding and with less morbidity compared to gastric bypass.     

Resolution of Diabetes After Bariatric Surgery Among Predominantly African-American Patients

Background

The aim of this study was to assess the relative efficacy in diabetes remission among predominantly African-American patients who have undergone one of the three different types of bariatric surgical procedures.

Methods

A total of 597 morbidly obese patients underwent one of the three bariatric surgical procedures at Harper University Hospital, Detroit, Michigan from 2008 to 2011. Of the three procedures, 203 (34 %) patients had laparoscopic sleeve gastrectomy, 264 (44.2 %) patients had laparoscopic gastric bypass, and 130 (21.8 %) had laparoscopic adjustable gastric banding. The prevalence of diabetes prior to surgery was 20.7, 17.4, and 24 %, respectively. There was no statistical difference in the prevalence of diabetes among the three surgical groups.

Results

Of the 119 patients with diabetes, 46 (38.7 %) were males and 73 (61.3 %) were females. The majority of patients were African-Americans (65 %). The average age of patients was 42.2?±?8.3 years for sleeve gastrectomy, 44.8?±?7.9 years for gastric banding, and 41.5?±?7.7 years for gastric bypass surgery. Of all the study patients with a preoperative diagnosis of type 2 diabetes, 86 patients (72.3 %) had resolution of diabetes 1 year after surgery. The resolution of diabetes was reported in 89.1, 66.7, and 54.8 % of patients who underwent laparoscopic gastric bypass, sleeve gastrectomy, and gastric banding, respectively.

Conclusions

This study, which was conducted among predominantly African-Americans, showed consistent results with other studies. Patients who underwent laparoscopic gastric bypass appeared to benefit the most in terms of achieving better remission of diabetes.     

Laparoscopic single-port sleeve gastrectomy for morbid obesity: preliminary series

BackgroundLaparoscopic sleeve gastrectomy has been recently proposed as a sole bariatric procedure because of the resulting considerable weight loss in morbidly obese patients. Traditionally, laparoscopic sleeve gastrectomy requires 5–6 skin incisions to allow for placement of multiple trocars. With the introduction of single-incision laparoscopic surgery, multiple abdominal procedures have been performed using a sole umbilical incision, with good cosmetic outcomes. The purpose of our study was to evaluate the feasibility and safety of laparoscopic single incision sleeve gastrectomy for morbid obesity.MethodsA total of 8 consecutive patients underwent laparoscopic single-incision sleeve gastrectomy at the Operative Unit of Bariatric Surgery of the University of Rome Tor Vergata from March 2009 to June 2009.ResultsOf the 8 patients, 5 were women and 3 were men, with a mean age of 44.4 years. The mean preoperative body mass index was 56.2 kg/m². The mean operative time was 128 minutes. The mean postoperative stay was 2.4 days. The mean postoperative body mass index was 49.3 kg/m² at a mean follow-up period of 3.6 months. The mean percentage of excess weight loss was 33% for the same period.ConclusionsLaparoscopic single-incision sleeve gastrectomy seems to be safe, technically feasible, and reproducible. A randomized trial comparing single-incision sleeve gastrectomy and conventional sleeve gastrectomy might be needed to evaluate the postoperative results in relation to the development of abdominal wall complications.     

Predictors of Increased Length of Hospital Stay Following Laparoscopic Sleeve Gastrectomy from the National Surgical Quality Improvement Program

Background

Laparoscopic sleeve gastrectomy is the most commonly performed bariatric procedure in the USA. Identifying preoperative risk factors for prolonged postoperative hospital stay will help appropriately select patients for fast-track protocols and avoid costly readmissions. To date, there has been no large national database analysis of risk factors for prolonged length of stay following laparoscopic sleeve gastrectomy.

Methods

Laparoscopic sleeve gastrectomy procedures reported to the American College of Surgeons National Surgical Quality Improvement Program between 2009 and 2012 were reviewed. Open procedures and revisional procedures were excluded. Baseline patient characteristics and preoperative lab values were reviewed. Univariate analysis was conducted to identify patient factors that predicted prolonged hospitalization (defined as ≥?3 days). Multivariate logistic regression was used to identify factor associated with prolonged length of stay.

Results

We identified 11,430 patients who underwent laparoscopic sleeve gastrectomy. The median length of stay was 2 days and 18.4% required hospitalization ≥?3 days. Multivariate analysis revealed that female sex, age greater than 65, body mass index greater than 50, chronic obstructive pulmonary disease, hypertension, renal insufficiency, anemia, and prolonged operative time were significantly associated with prolonged hospital stay.

Conclusions

Preoperative patient characteristics as well as operative details predict prolonged length of stay following laparoscopic sleeve gastrectomy. As the utilization of fast-track protocols in bariatric surgery programs expands, these data may be used to assist in the selection of patients who may be inappropriate for rapid discharge from the hospital after sleeve gastrectomy as well as guide medical optimization strategies preoperatively.

     

腹腔镜减重代谢袖状胃手术要点与适应证

腹腔镜袖状胃切除最开始是作为超级肥胖病人的前期手术出现,随后发现单独的腹腔镜袖状胃切除手术可以显著减轻体重和肥胖相关的并发症,并且具有手术难度低,术后并发症少等优点,因此近些年来应用的越来越多。虽然《中国肥胖与2型糖尿病外科治疗指南(2019)》对于腹腔镜袖状胃切除手术要点及适应证进行了进一步的规范,但由于中国开展减重代谢手术时间较短,手术不规范导致的减重效果不佳,严重并发症的情况依然存在。因此手术细节和相关技术要点的进一步优化,必将有利于手术的推广与开展。     

Initial Experience with Laparoscopic Sleeve Gastrectomy by a Novice Bariatric Team in an Established Bariatric Center—A Review of Literature and Initial Results

Background

Laparoscopic sleeve gastrectomy (LSG) is a highly successful approach to morbid obesity with low incidence of complications. The literature suggests a learning curve of 50–100 cases for attaining proficiency and reducing the complication rates for laparoscopic bariatric surgery. The aims of this paper were to review the literature of initial cases by bariatric surgeons worldwide and to report the experience of initial 50 cases of LSG by a novice bariatric team in a single center. The objective was to evaluate the outcomes for laparoscopic bariatric surgery in the first 50 patients by a novice team of bariatric surgeons in an already established bariatric surgery program with short-term follow-up.

Methods

All surgeries were done by a new bariatric team who underwent laparoscopic fellowship training under a bariatric team with an experience of over 600 bariatric procedures. Fifty consecutive patients from March 2010 to January 2012 were offered LSG and followed up for a minimum of 6 months. Weight loss and comorbidity resolution were tabulated and assessed.

Results

Mean preoperative and postoperative BMIs were 46.6 and 35.7 kg/m², respectively. There were no life threatening postoperative complications or mortality. The median percent excess weight loss was 50.3 % at the end of 6 months. Comorbidity resolution values were 96 % for obstructive sleep apnea, 89 % for diabetes mellitus, and 87 % for joint pains, among the most common comorbidities.

Conclusion

LSG is effective in achieving weight loss and in improving comorbidities with minimal complications even at the hands of novice bariatric surgeons with good laparoscopic skills and adequate bariatric training.     

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.     

术前饮食行为对减重手术效果的影响

目的: 探讨术前饮食行为对减重手术效果的影响,为预测减重手术效果提供参考。方法: 采用荷兰饮食行为问卷（Dutch Eating Behavior Questionnaire, DEBQ）及相关评分标准,对85例肥胖症行腹腔镜胃袖状切除的减重手术病人进行分组,分为限制性饮食组44例和非限制性饮食组41例,其中限制性饮食组再分为成功限制亚组27例与失败限制亚组17例。分别比较术前不同饮食行为组及亚组之间术后6、12个月的体重、体质量指数（body mass index, BMI）及多余体重减少率（excess weight loss, %EWL）改变。结果: 85例病人均成功接受减重手术。限制饮食组术后6、12个月体重和BMI显著高于非限制组,%EWL显著低于非限制组。限制饮食组中,成功限制亚组术后6、12个月体重和BMI显著高于失败限制亚组,%EWL显著低于失败限制亚组。结论: 术前饮食行为显著影响减重手术结果,可作为预测减重手术效果的参考。     

Gastric Leak After Laparoscopic Sleeve Gastrectomy: Early Covered Self-Expandable Stent Reduces Healing Time

Background

Laparoscopic sleeve gastrectomy has become a very frequent procedure in bariatric surgery due to its efficacy and simplicity compared to gastric bypass. Gastric staple line leak (1 to 7 % of cases) is a severe complication with a long nonstandardized treatment. The aim of this retrospective study was to examine the success and tolerance of covered stents in its management.

Methods

From January 2009 to December 2011, nine patients with gastric staple line leaks after sleeve gastrectomy were treated with covered stents in our department (seven referred from other institutions). The leaks were diagnosed by CT scan and visualized during the endoscopy. Among the studied variables were operative technique, post-operative fistula diagnosis delay, stent treatment delay, and stent tolerance. In our institution, Hanarostent® (length 17 cm, diameter 18 mm; M.I. Tech, Seoul, Korea) was used and inserted under direct endoscopic control.

Results

Stent treatment was successful in seven cases (78 %). Two other cases had total gastrectomy (405 and 185 days after leak diagnosis). Early stent removal (due to migration or poor tolerance) was necessary in three cases. The average stent treatment duration was of 6.4 weeks, and the average healing time was 141 days. The five patients with an early stent treatment (≤3 weeks after leak diagnosis) had an average healing time of 99 days versus 224 for the four others.

Conclusions

Covered self-expandable stent is an effective treatment of gastric leaks after sleeve gastrectomy. Early stent treatment seems to be associated with shorter healing time.     

Spiritual practices are associated with improved weight management following bariatric surgery

BackgroundResearch shows that spirituality and religiosity may positively impact various health outcomes, but little is known about their role in supporting weight management efforts, particularly in the context of bariatric surgery.ObjectiveThis study examined spiritual practices and health-related behaviors of bariatric surgery patients 1–2 years postoperatively.SettingLarge bariatric center in the Midwest of the United States.MethodsPatients (n = 152) completed questionnaires 1–2 years postoperatively examining weight, physical activity, eating behaviors, and spiritual practices and experiences related to bariatric surgery.ResultsParticipants were primarily married (59.2%), Caucasian (81.6%), and female (84.2%) who had undergone Roux-en-Y gastric bypass (64.5%) or sleeve gastrectomy (32.9%) 17.3 months previously. Most participants (71%) believed their spirituality did or could impact weight loss after surgery. Practices including connecting with nature, art and music, meditation, yoga, and attending spiritual or religious-based activities were positively correlated with weight loss, healthy eating, or exercise participation.ConclusionFindings provide preliminary evidence for the benefits of spirituality in bariatric patients making lifestyle changes after surgery.     

Symptomatic gallstones after sleeve gastrectomy

Background

Cholelithiasis is a common complication after bariatric surgery. Pure restrictive procedures such as sleeve gastrectomy and gastric banding theoretically should result in less gallstone formation because the food continues to follow the normal gastrointestinal transit, maintaining the enteric–endocrine reflex intact. To the authors’ knowledge, the literature has no studies that analyze the incidence of gallstone formation after sleeve gastrectomy. This study aimed to compare the rates of symptomatic gallstones between laparoscopic Roux-en-Y gastric bypass (RYGBP) and sleeve gastrectomy (SG).

Methods

A retrospective chart review of patients who underwent laparoscopic RYGBP and SG between 2004 and 2006 was performed. The patients with previous cholecystectomy, known gallstones with or without concomitant cholecystectomy, and previous weight-reduction operations were excluded from the analysis. The outcome measures were the numbers of patients who had experienced symptomatic and complicated gallstones. Using Cox regression analysis, comparisons was made between the patients with laparoscopic RYGBP (group A) and those with laparoscopic SG (group B).

Results

Groups A excluded 174 (26%) of 670 patients, and group B excluded 27 (34.2%) of 79 patients. The patients in group A had a significantly higher preoperative body mass index (BMI) than those in group B. Additionally, more group A than group B patients had a BMI exceeding 45 and more than a 25% loss of original weight. No significant difference in the development of symptomatic (8.7% vs. 3.8%; p = 0.296) or complicated (1.8% vs. 1.9%; p = 0.956) gallstones was noted between the two groups

Conclusions

There was no significant difference in symptomatic or complicated gallstone disease between the patients treated with laparoscopic SG and those treated with laparoscopic RYGBP. Routine prophylactic cholecystectomy should not be recommended for weight reduction during laparoscopic SG.     

Mid-term Results of Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass in Adolescent Patients

The prevalence and severity of obesity in children and adolescents has been increasing in recent years at an unprecedented rate. Morbidly obese children will almost certainly develop severe comorbidities as they progress to adulthood, and bariatric surgery may provide the only alternative for achieving a healthy weight. The aim of this study was to assess the long-term outcomes and safety of laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB) as new treatment modalities for morbidly obese adolescents. We conducted a retrospective review of a prospectively collected database of all adolescent patients who underwent LSG and RYGB under IRB protocol at the Bariatric and Metabolic Institute in Cleveland Clinic Florida between 2002 and 2011. Patients were also contacted by phone, adhering to HIPAA regulations, and were asked to answer a survey. Eighteen adolescents had a bariatric procedure performed at this institution. The mean age was 17.5 years, the average weight was 293.1 lbs, and the average BMI was 47.2 kg/m². The mean follow-up period consisted of 55.2 months. The postoperative weight at 55 months follow-up was 188.4 lbs and average BMI was 30.1 kg/m². Fifteen of the patients were available for follow-up. Thirteen out of 16 (81 %) comorbidities in patients available for follow-up were in remission following rapid weight loss. The long-term follow-up and perioperative morbidity shown in this study suggest that LSG and LRYGB appear to be safe and effective operations in morbidly obese adolescents.     

Health-Related Quality of Life after Bariatric Surgery and its Correlation with Glycaemic Status in Hong Kong Chinese Adults

Background

To evaluate health-related quality of life (HRQOL) following bariatric surgery and its correlation with different glycaemic status in Hong Kong Chinese adults.

Materials and Methods

In 2002–2008, obese Chinese adults were recruited for bariatric surgery, undergoing laparoscopic adjustable gastric banding or laparoscopic sleeve gastrectomy. Patients were invited to complete the Chinese Hong Kong Medical Outcomes Study Short-Form Health Survey (SF-36) at baseline and at 1-year post operation.

Results

Sixty patients (60 % female) completed baseline and 1-year follow-up HRQOL assessments. Mean age was 38 years and mean BMI was 41.6 kg/m². At baseline, 30.0 % of patients had diabetes and 31.7 % prediabetes. Mean absolute weight reduction 1 year after bariatric surgery was 19.8 kg. Statistically significant improvements in SF-36 scores were demonstrated in all physical domains and in three of the four psychological domains. Greater body weight reduction was associated with greater improvements in certain physical domains postoperatively. After adjusting for co-variables, abnormal glucose tolerance was associated with greater improvements in five of the eight HRQOL domains.

Conclusions

Bariatric surgery resulted in significant gains in HRQOL as well as significant reductions in body weight in obese Chinese adults. This study suggests that bariatric surgery offers greater HRQOL improvements in patients with prediabetes and diabetes compared with normoglycaemic individuals.