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1.
Introduction
Sleeve gastrectomy has become a popular stand-alone bariatric procedure with comparable weight loss and resolution of comorbidities to that of laparoscopic gastric bypass. The simplicity of the procedure and the decreased long-term risk profile make this surgery more appealing. Nonetheless, the ever present risk of a staple-line leak is still of great concern and needs further investigation.Methods
An electronic literature search of MEDLINE database plus manual reference checks of articles published on laparoscopic sleeve gastrectomy for morbid obesity and its complications was completed. Keywords used in the search were “sleeve gastrectomy” OR “gastric sleeve” AND “leak.” We analyzed 29 publications, including 4,888 patients. We analyzed the frequency of leak after sleeve gastrectomy and its associated risks of causation.Results
The risk of leak after sleeve gastrectomy in all comers was 2.4%. This risk was 2.9% in the super-obese [body mass index (BMI)?>?50?kg/m2] and 2.2% for BMI?50?kg/m2. Staple height and use of buttressing material did not affect leak rate. The use of a size 40-Fr or greater bougie was associated with a leak rate of 0.6% compared with those who used smaller sizes whose leak rate was 2.8%. Leaks were found at the proximal third of the stomach in 89% of cases. Most leaks were diagnosed after discharge. Endoscopic management is a viable option for leaks and was documented in 11% of cases as successful.Conclusions
Sleeve gastrectomy has become an important surgical option for the treatment of the ever growing morbidly obese population. The risk of leak is low at 2.4%. Attention to detail specifically at the esophagogastric junction cannot be stressed enough. Careful patient selection (BMI?50?kg/m2) and adopting the use of a 40-Fr or larger bougie may decrease the risk of leak. Vigilant follow-up during the first 30?days is critical to avoid catastrophe, because most leaks will happen after patient discharge. 相似文献2.
Melissas J Peppe A Askoxilakis J Dimitriadis E Grammatikakis J 《Obesity surgery》2012,22(7):1104-1109
Background
The continuing need for simple, safe, and effective procedures led us to design a new operation for treating morbid obesity.Methods
Thirty-two patients underwent our novel procedure, sleeve gastrectomy plus side-to-side jejunoileal anastomosis (SG plus), and were followed for 6 to 24?months. A matched cohort of 32 patients underwent sleeve gastrectomy over the same period and was used as the control group. Weight loss, comorbidity outcomes, and the duodenum to cecum transit time after a gastrografin swallow, performed at postoperative day 4, were compared.Results
There were no deaths and no major perioperative complications. Three patients developed long-term complications requiring surgical intervention (intestinal obstruction, nausea?Cvomiting, and hypoalbuminemia). In the SG plus group, a 77.8 % excess weight loss was achieved at 12?months postoperatively, which was significantly better (p?0.01) than the 67 % observed in the control group. The comorbidity outcomes, particularly diabetes resolution, were also significantly superior in the SG plus patients. The duodenum to cecum transit time of 11?min in the SG plus group was significantly shorter (p?0.01) than the 31?min observed in the control group.Conclusions
Sleeve gastrectomy plus side-to-side jejunoileal anastomosis appears to be a simple, considerably safe, and effective procedure for treating obesity and its metabolic comorbidities. 相似文献3.
Teufel M Rieber N Meile T Giel KE Sauer H Hünnemeyer K Enck P Zipfel S 《Obesity surgery》2012,22(8):1232-1237
Background
Individuals with severe obesity commonly report poor body image. Improvement in body image has been found after conservative weight reduction programs as well as after bariatric surgery (gastric bypass, biliopancreatic diversion, or gastric banding). However, no studies investigating body image after laparoscopic sleeve gastrectomy (LSG) are available.Methods
Of 70 consecutive patients who planned to undergo LSG at a comprehensive obesity center, 62 patients were included in the study and evaluated before surgery. Their mean body mass index (BMI) was 51.3?kg/m2 and the patients?? mean age before surgery was 43.8?years. One-year follow-up data were obtained for 51 patients (82.3?%). Body image was assessed using the body image questionnaire (BIQ-20), and depression was assessed using the Patient Health Questionnaire (PHQ-9).Results
Patients reported poor body image before surgery. One year after LSG, negative evaluations of the body and perceptions of body dynamics and vitality had markedly improved, without reaching healthy levels. No correlations between body image and weight-related parameters (BMI, percentage of excess weight loss) or mood after 1?year were found.Conclusions
Body image improves after LSG. This improvement might reflect changes to patients?? attitudes, beliefs, and thoughts rather than real weight lost. Further studies should investigate the factors that mediate improvement of body image after bariatric surgery. 相似文献4.
P. W. J. van Rutte J. F. Smulders J. P. de Zoete S. W. Nienhuijs 《Obesity surgery》2012,22(12):1903-1908
Background
Sleeve gastrectomy (SG) is an upcoming primary treatment modality for morbid obesity. The aim of this study was to report the indications for and the outcomes of revisional surgery after SG.Methods
Four hundred sixteen individuals underwent a SG between August 2006 and July 2010 with a minimum follow-up of 12?months. The patients that needed revision were identified from our prospective registry. Patients were subdivided in a first group undergoing revision as part of a two-step procedure, a second group with failure of a secondary SG, and a third group with failure of a primary SG.Results
Twenty-three patients (5.5?%) had an unplanned revision. Fourteen (3.4?%) had a two-step procedure because of super obesity. A significant additional weight loss was achieved after revision; no complications occurred in this group. Five patients with failure of a secondary SG had no significant additional weight loss after revision. Reflux disease was cured. Eighteen patients in the third group showed significant additional weight loss and remission of diabetes and hypertension. Both reflux disease and dysphagia did not heal in all affected patients after revision. The early complication rate in the whole cohort was 23.4?%; staple line leakage was 5.4?%, and bleeding was 8.1?%. Revision-related mortality was 0?%.Conclusion
In a large series of sleeve gastrectomies, the unplanned revision rate was 5.5?%. Revision of a sleeve gastrectomy is feasible in patients that do not achieve sufficient weight loss and in those patients developing complications after the initial sleeve gastrectomy. 相似文献5.
S. Perretta M. Vix B. Dallemagne J. Nassif G. Donatelli J. Marescaux 《Surgical endoscopy》2012,26(2):565
Purpose
Transvaginal surgery has been performed by gynecologists for decades with abundant literature supporting its efficacy and safety. Recently, several groups reported on the NOTES transvaginal (TV) approach for extrapelvic disease. Nevertheless, repeated TV access for NOTES has never been reported to date. Two cases of “repeated” TV access for NOTES cholecystectomy after TV hybrid sleeve gastrectomy are described. 相似文献6.
Background
Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are performed in patients with obesity and type 2 diabetes mellitus (T2DM). The aim of this study is to evaluate retrospectively the clinical efficacy of RYGB and SG in two groups of obese T2DM patients.Methods
From the hospital database, we extracted the clinical records of 31 obese T2DM patients, of whom 15 (7 F/8 M) had undergone laparoscopic SG (LSG) and 16 (7 F/9 M) laparoscopic RYGB (LRYGB) in the period 2005?C2008. The groups were comparable for age (range 33?C59?years) and BMI (range 38?C57?kg/m2). LRYGB alimentary limb was 150?cm, and biliopancreatic limb was 150?cm from the Treitz ligament. LSG vertical transection was calibrated on a 40-Fr orogastric bougie. Data were analysed at 6, 12 and 18?C24?months with reference to weight loss and remission of comorbidities.Results
The reduction in body weight was comparable in the two groups. At 18?C24?months the percent BMI reduction was 29?±?8 and 33?±?11?% in LSG and LRYGB, respectively. Percent excess weight loss was 53?±?16 and 52?±?19?% in LSG and LRYGB, respectively. Thirteen patients in LSG and 14 patients in LRYGB discontinued their hypoglycaemic medications. Five (55?%) patients in LSG and eight (89?%) in LRYGB discontinued antihypertensive drugs. Three out of five patients in LSG and one out of two patients in LRYGB withdrew lipid-lowering agents.Conclusions
LSG and LRYGB are equally effective in terms of weight loss and remission of obesity-related comorbidities. Controlled long-term comparisons are needed to establish the optimal procedure in relation to patients?? characteristics. 相似文献7.
P. W. J. van Rutte J. F. Smulders J. P. de Zoete S. W. Nienhuijs 《Surgical endoscopy》2013,27(6):2014-2019
Background
With global aging, obesity will increasingly affect the older population with higher risks of morbidity and mortality, yet full consensus has been obtained for the role of sleeve gastrectomy (SG) in the older obese.Objective
The aim of this study is to report the outcomes of SG in the older obese.Setting
Bariatric department, large teaching hospital, The Netherlands.Methods
Between August 2006 and December 2011, 135 patients aged 55 years or older underwent SG. Outcomes in terms of perioperative complications, weight loss, remission of comorbidities, and revision were extracted from our prospectively held database. A subanalysis was done comparing three age groups: 55–59 years, 60–64 years, and 65 years and older.Results
During mean follow-up of 14.6 months, short-term mortality was 0 %. The 30-day complication rate was 11.1 %, without significant differences between age groups. Late complications occurred in 4.4 %. In 14 patients, revisions were performed because of development of reflux disease or dysphagia. Significant reduction of comorbidities was found in all age groups, except for sleep apnea. Among the total cohort, excellent weight loss was achieved during follow-up.Conclusions
Laparoscopic sleeve gastrectomy (LSG) as a primary treatment modality for the older morbidly obese is an effective and relatively safe procedure in terms of weight loss and remission of comorbidities with an acceptable low complication rate. 相似文献8.
Kiyokazu Nakajima Toshirou Nishida Tsuyoshi Takahashi Yoshihito Souma Johji Hara Takuya Yamada Toshiyuki Yoshio Tateki Tsutsui Takeshi Yokoi Masaki Mori Yuichiro Doki 《Surgical endoscopy》2009,23(12):2650-2655
Background
Transvaginal endoscopic gastric surgery is one of the cutting edge procedures in the field of natural orifice translumenal endoscopic surgery (NOTES). Its feasibility has been shown sporadically in bariatric cases but not in oncologic conditions. The authors report their early experience with hybrid transvaginal NOTES gastrectomy for gastric submucosal tumors (SMTs).Methods
Two female patients with SMTs in the distal stomach participated in this institutional review board (IRB)-approved study. Surgical indication was determined according to the National Comprehensive Cancer Network (NCCN) sarcoma guidelines, and the study adhered to the following oncologic principles: no direct handling of the lesion, full-thickness resection, and reasonable surgical margins. The study protocol required a minimum of two laparoscopic ports to ensure procedural safety and aforementioned oncologic appropriateness. Under laparoscopic guidance, a transvaginal route was created and secured with a 50-cm flexible overtube. A gastrointestinal endoscope was introduced, and the perigastric dissection was performed using an insulation-tipped diathermy knife (IT knife) and needle knife. This process was assisted with two laparoscopic graspers. After perigastric mobilization, the transvaginal endoscope was replaced with a digital stapling device, and partial gastrectomy was accomplished. The resected specimen was isolated and delivered through the vagina, and the vaginal wound was closed under direct vision. Outcomes measurements included surgical results, pain scoring, and clinical outcomes.Results
Both operations were completed successfully in compliance with the aforementioned oncologic principles. The operating time was 365 and 170 min, respectively. The estimated blood loss was negligible. A minilaparotomy for specimen delivery was successfully avoided in both cases. A minimal vaginal incision was added for one patient at retrieval. Postoperatively, both patients reported no pain and recovered rapidly. The final diagnosis was hemorrhagic lipoma and gastrointestinal stromal tumor (GIST), respectively.Conclusion
Our initial experience with human transvaginal NOTES gastrectomy showed it to be feasible and safe for gastric SMTs. It is a complex but promising surgical alternative for female oncologic patients undergoing partial gastric resection. 相似文献9.
Georg R. Linke Stephanie Luz Joanna Janczak Andreas Zerz Bruno M. Schmied Ikbale Siercks René Warschkow Ulrich Beutner Ignazio Tarantino 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2013,398(1):139-145
Purpose
The primary objective of this prospective cohort study was to investigate sexual function, quality of life and patient satisfaction in sexually active women 1 year after transvaginal hybrid natural orifice transluminal endoscopic surgery (NOTES).Patients and methods
This prospective single-centre cohort study included sexually active female patients after transvaginal hybrid NOTES cholecystectomy or anterior resection. Sexual life impairment and quality of life were assessed by the Gastrointestinal Quality of Life Index (GIQLI) prior and 1 year after surgery. Patient satisfaction was assessed as well as the sexual function 1 year postoperatively using the validated German version of the Female Sexual Function Index (FSFI-D).Results
Between September 2008 and December 2009, 106 sexually active women after transvaginal hybrid NOTES cholecystectomy or anterior resection were identified. Sexual life significantly improved (GIQLI scores 3.2?±?1.0 preoperatively vs. 3.7?±?0.7 1 year postoperatively, P?<?0.001), and painful sexual intercourse (3.3?±?1.0 vs. 3.6?±?0.7, P?=?0.008) decreased post-surgery. The mean FSFI-D total score after transvaginal NOTES was 28.1?±?4.6, exceeding the cutoff for sexual dysfunction defined as 26. Four (4.5 %) out of 88 patients who answered this question were not satisfied with the transvaginal hybrid NOTES procedure.Conclusions
This prospective cohort study of female sexual function after transvaginal NOTES provides compelling evidence that the transvaginal access is safe and associated with high satisfaction rate. 相似文献10.
David Nocca Marius Nedelcu Anamaria Nedelcu Patrick Noel Phillipe Leger Mehdi Skalli Patrick Lefebvre Yannael Coisel Caroline Laurent Frederic Lemaitre Jean Michel Fabre 《Obesity surgery》2014,24(6):861-865
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. 相似文献11.
Mereb Araia Michael Wood Joshua Kroll Abdul Abou-Samra Berhane Seyoum 《Obesity surgery》2014,24(6):835-840
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. 相似文献12.
Santiago Horgan Ozanan R. Meireles Garth R. Jacobsen Bryan J. Sandler Alberto Ferreres Sonia Ramamoorthy Thomas Savides Toshio Katagiri Takayuki Dotai Michael Sedrak Saniea F. Majid Sheetal Nijhawan Mark A. Talamini 《Surgical endoscopy》2013,27(6):1872-1880
Background
Natural orifice transluminal endoscopic surgery (NOTES) has been the focus of several studies as a less invasive alternative to conventional laparoscopy to access and treat intracavitary organs. For the last 5 years, much has been accomplished with animal studies, yet the clinical utilization of this novel technique is still modest. After 2 years of experience in the laboratory, we started our clinical experience. We report our experience with clinical utilization of NOTES procedures from 2007 to 2010.Methods
Under UCSD institutional review board–approved trials, 104 patients were enrolled under seven different NOTES protocols from 2007 to 2010, where a NOTES procedure was offered as an alternative to conventional treatments. The treated pathologies were cholelithiasis, biliary dyskinesia, acute and chronic appendicitis, ventral hernias, morbid obesity, and achalasia. The access routes included transgastric (TG), transvaginal (TV), transesophageal (TE), and perirectal (PR).Results
Among the 104 patients enrolled, 103 underwent a surgical procedure starting with diagnostic laparoscopy, and 94 cases were deemed appropriate to proceed via a NOTES approach. There were 9 aborted NOTES procedures at the time of the initial peritoneoscopy before creating a NOTES access route. The reasons to not proceed with a NOTES procedure in the TV cholecystectomy group (n = 5) were a large amount of pelvic adhesions in 4 patients and a severe inflammation of the gallbladder in 1 patient. In the TG cholecystectomy group (n = 1), it was severe inflammation of the gallbladder. In the TG appendectomy group (n = 1), it was the presence of localized peritonitis. In the TE endoscopic myotomy group (n = 2), it was the presence of megaesophagus with an inability to clean the esophagus of food debris. The NOTES procedures performed were 48 TV cholecystectomies, 4 TV appendectomies, 8 TG cholecystectomies, 2 PR peritoneoscopies, 3 TG appendectomies, 3 TV ventral hernia repairs, 5 TE endoscopic myotomies, 3 TV sleeve gastrectomies, and 18 TG sleeve gastrectomies. The average body mass indexes for those in the sleeve gastrectomy group was 42.1 kg/m2 (TG route) and 40.6 kg/m2 (TV route). There were no intraoperative complication and no conversions to standard laparoscopy during these procedures. The average hospital stay was 1–2 days. One patient who underwent TV cholecystectomy required an emergency department visit for nausea and vomiting. To date, 3 patients who underwent TV cholecystectomy have become pregnant and delivered normally.Conclusions
NOTES is safe, feasible, and reproducible with previous training in the laboratory and a consistent team at a high-volume center. Prospective randomized studies of a large patient population are necessary to assess long-term results. 相似文献13.
Yong Zhang Hongzhi Zhao Zhanguo Cao Xiangyu Sun Chen Zhang Wang Cai Rong Liu Sanyuan Hu Mingfang Qin 《Obesity surgery》2014,24(10):1617-1624
Background
No randomized comparative trials have presented long-term outcomes for laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). The present study was designed to compare the efficacy and safety of these two procedures.Methods
From January 2007 to July 2008, 64 eligible patients were randomly assigned to LSG or LRYGB. During the 5-year follow-up, we compared morbidity rate, body mass index (BMI), percent of excess weight loss (%EWL), Moorehead-Ardelt (M-A) II quality of life, and resolution or improvement rate of obesity-related comorbidities between the groups.Results
Both groups were matched with respect to age, gender, and BMI. Slightly more major complications were observed in patients undergoing LRYGB (P?>?0.05). Weight loss was significantly better with LRYGB except during the first postoperative year. At 5 years, %EWL for LSG and LRYGB was 63.2?±?24.5 % and 76.2?±?21.7 % (P?=?0.02), respectively. No statistical difference was observed in quality of life between the groups at all intervals (P?>?0.05). At the last follow-up, most comorbidities in both groups were resolved or improved, with no difference between the groups (P?>?0.05).Conclusion
LRYGB and LSG are equally safe and effective in quality of life and improvement or resolution of comorbidities, and LRYGB possesses the superiority in terms of weight loss. Further studies are needed to evaluate micronutrient deficiencies of these procedures. 相似文献14.
Niu Zhang Anthony Maffei Thomas Cerabona Anil Pahuja Juan Omana Ashutosh Kaul 《Surgical endoscopy》2013,27(4):1273-1280
Background
Bariatric surgery is currently the most effective treatment for morbid obesity. It provides not only substantial weight loss, but also resolution of obesity-related comorbidities. Laparoscopic sleeve gastrectomy (LSG) has rapidly been gaining in popularity. However, there are limited data on the reduction of obesity-related comorbidities for LSG compared to laparoscopic Roux-en-Y gastric bypass (LRYGB). The aim of this study was to assess the effectiveness of laparoscopic LSG versus LRYGB for the treatment of obesity-related comorbidities.Methods
A total of 558 patients who underwent either LSG or LRYGB for morbid obesity at the Westchester Medical Center between April 2008 and September 2010 were included. Data were collected prospectively into a computerized database and reviewed for this study. Fisher’s exact test analyses compared 30-day, 6-month, and 1-year outcomes of obesity-related comorbidities.Results
A total of 558 patients were included in the analysis of obesity-related comorbidity resolution; 200 underwent LSG and 358 underwent LRYGB. After 1 year, 86.2 % of the LSG patients had one or more comorbidities in remission compared to 83.1 % LRYGB patients (P = 0.688). With the exception of GERD (?0.09 vs. 50 %; P < 0.001), similar comorbidity remission rates were observed between LSG and LRYGB for sleep apnea (91.2 vs. 82.8 %; P = 0.338), hyperlipidemia (63 vs. 55.8 %; P = 0.633), hypertension (38.8 vs. 52.9 %; P = 0.062), diabetes (58.6 vs. 65.5 %; P = 0.638), and musculoskeletal disease (66.7 vs. 79.4 %; P = 0.472).Conclusions
Laparoscopic sleeve gastrectomy markedly improves most obesity-related comorbidities. Compared to LRYGB, LSG may have equal in reducing sleep apnea, hyperlipidemia, hypertension, diabetes, and musculoskeletal disease. LRYGB appears to be more effective at GERD resolution than LSG. 相似文献15.
Carlos Zerrweck Elisa M. Sepúlveda Hernán G. Maydón Francisco Campos Antonio G. Spaventa Verónica Pratti Itzel Fernández 《Obesity surgery》2014,24(5):712-717
Background
Super obesity [body mass index (BMI)?>?50 kg/m2] can yield to higher morbidity/mortality in bariatric surgery, this could be related to patient's characteristics and/or surgeon's experience. In morbid obesity, both techniques proved to have a positive impact and sometimes comparable outcomes during the first 2 years. This has not been clearly analyzed in the super obese patient.Methods
Retrospective study comparing the records of 77 consecutive super obese patients (BMI: 50–59.9 kg/m2) submitted to either laparoscopic gastric bypass (LGBP, n?=?32) or laparoscopic sleeve gastrectomy (LSG, n?=?45) between 2010 and 2012 at a single institution. The primary objective was to analyze baseline demographics, comorbidities, operative outcomes, and early complications (<30 days). Secondarily, weight loss [BMI and % excess weight loss (%EWL)] was also described and compared during the first year.Results
Female sex comprised 72.7 % of all cases. Both groups had comparable BMI (52.7?±?2.1 kg/m2 for LGBP vs. 53.87?±?2.8 kg/m2 for LSG; p?=?0.087) and homogeneous baseline characteristics. Operative time was lower for the LSG group (113.1?±?35.3 vs. 186.9?±?39 min for LGBP; p?≤?0.001). Overall, early complications were observed in 16.8 % of patients (LGBP 9 % vs. LSG 22 %; p?=?0.217). There were four major complications (two in each group), with two reinterventions. Weight loss (%EWL) at 6, 9, and 12 months was significantly higher in the LGBP group (51.6?±?12.9 %, 56.5?±?13 %, 63.9?±?13.3 %, respectively) than in the LSG group (40?±?12.8 %, 45.1?±?15.5 %, 43.9?±?10.4 %, respectively).Conclusions
Just like in morbid obesity, LGBP and LSG are effective and safe procedures in super obese patients. LGBP had better weight loss at 1 year. 相似文献16.
Boza C Salinas J Salgado N Pérez G Raddatz A Funke R Pimentel F Ibáñez L 《Obesity surgery》2012,22(6):866-871
Background
Laparoscopic sleeve gastrectomy (LSG) is an emerging surgical technique with encouraging results. The objective of this study is to report surgical results after 1,000 consecutive LSG cases as a stand-alone procedure for morbid obesity during a 3-year follow-up.Methods
Data were obtained by review of our prospectively maintained database, patients?? clinical charts, and phone interview of all patients who underwent LSG in our institution from December 2005 to February 2010.Results
There were 773 (77.3%) women whose preoperative age and BMI was 36.9?±?11.5?years and 37.4?±?4.0?kg/m2, respectively. The most common co-morbid conditions were insulin resistance 55.1%, dyslipidemia 45.5%, arterial hypertension 23.1%, hypothyroidism 15.4% and non-alcoholic fatty liver disease 12%. Excess weight loss was as follows: 1?year 86.6%, 2?years 84.1%, and 3?years 84.5%. Early and late complications occurred in 34 (3.4%) and 20 (2.0%) patients, respectively. Reoperation was required in seven (0.7%) patients. There was no mortality during follow-up.Conclusions
LSG seems to be a safe and effective surgical technique for morbid obesity as a stand-alone procedure. 相似文献17.
Helmiö M Victorzon M Ovaska J Leivonen M Juuti A Jaser N Peromaa P Tolonen P Hurme S Salminen P 《Surgical endoscopy》2012,26(9):2521-2526
Background
The long-term efficacy of laparoscopic Roux-en-Y gastric bypass (RYGB) in the treatment of morbid obesity has been demonstrated. Laparoscopic sleeve gastrectomy (SG) as a single procedure has shown promising short-term results, but the long-term efficacy of SG has not yet been demonstrated. The aim of this study was to determine the preliminary 30-day morbidity and mortality of RYGB and SG in a prospective multicenter randomized setting.Methods
A total of 240 morbidly obese (BMI?=?35–66?kg/m2) patients evaluated by a multidisciplinary team were randomized to undergo either RYGB or SG. There were 117 patients in the RYGB group and 121 in the SG group; two patients had to be excluded after randomization. Both study groups were comparable regarding age, gender, BMI, and comorbidities.Results
There was no 30-day mortality. The median operating time was significantly shorter in the SG group (66?min vs. 94?min, p?0.001). All complications were recorded thoroughly. There were 7 (5.8 %) major complications following SG and 11 (9.4 %) after RYGB (p?=?0.292). Nine (7.4 %) SG patients and 20 (17.1 %) RYGB patients had minor complications (p?=?0.023). The overall morbidity was 13.2 % after SG and 26.5 % after RYGB (p?=?0.010). There were three (2.5 %) early reoperations after SG and four (3.3 %) after RYGB (p?=?0.719).Conclusions
At 30-day analysis SG is associated with a shorter operating time and fewer early minor complications compared to RYGB. There were no significant differences in major complications or early reoperations. Long-term follow-up is required to determine the effect on weight loss, resolution of obesity-related comorbidities, and improvement of quality of life. 相似文献18.
Manish Parikh Joseph Eisner Nicole Hindman Emil Balthazar John K. Saunders 《Surgical endoscopy》2012,26(12):3548-3551
Background
Previous studies have shown accelerated gastric emptying after sleeve gastrectomy. This study aimed to determine whether a correlation exists between immediate postoperative gastroduodenal transit time and weight loss after laparoscopic sleeve gastrectomy (LSG). Specifically, correlation tests were conducted to determine whether more rapid transit after LSG correlated with increased weight loss.Methods
Data were collected from an institutional review board-approved electronic registry. All LSGs were performed over a 40-Fr bougie, starting 5 to 7?cm proximal to the pylorus. Gastroduodenal transit time (antrum to duodenum) was calculated from a postoperative day 1 esophagram. Pearson??s correlation coefficient was used for statistical analysis.Results
The analysis included 62 consecutive LSG patients. The mean gastroduodenal transit time was 12.3?±?19.8?s. Almost all the patients (99?%) had a transit time less than 60?s. The mean percentage of excess weight loss (%EWL) was 23.8?±?9.8?% at 3?months, 37.9?±?11.8?% at 6?months, and 52.2?±?10.8?% at 12?months. No correlation was found between gastroduodenal transit time and %EWL at 3, 6, or 12?months.Conclusion
No correlation was found between gastroduodenal transit time and weight loss after LSG. 相似文献19.
Omar Khan Shashidhar Irukulla Nimalan Sanmugalingam Georgios Vasilikostas Marcus Reddy Andrew Wan 《Obesity surgery》2013,23(4):585-587
Background
The aim of the study was to prospectively evaluate the feasibility and clinical efficacy of a strategy of performing simultaneous balloon removal and sleeve gastrectomy in the super-super obese patients.Methods
Forty consecutive super-super obese patients underwent intra-gastric balloon insertion followed by simultaneous balloon removal and sleeve gastrectomy 6 months later.Results
Balloon insertion resulted in a reduction in mean body mass index from 69.3?±?1.4 to 62.3?±?1.3 kg/m2. Simultaneous balloon removal and sleeve gastrectomy was achieved in 39 cases. There were no operative mortality and no leaks. Six months following sleeve gastrectomy, the mean BMI of the cohort had fallen to 54.1?±?1.2 kg/m2.Conclusions
Simultaneous balloon removal and sleeve gastrectomy in the super-super obese patients is feasible as a single-stage procedure with good perioperative outcomes. 相似文献20.
Alberto Arezzo Carsten Zornig Hamid Mofid Karl-Hermann Fuchs Wolfram Breithaupt José Noguera Georg Kaehler Richard Magdeburg Silvana Perretta Bernard Dallemagne Jacques Marescaux Catalin Copaescu Florin Graur Andrei Szasz Antonello Forgione Raffaele Pugliese Gerhard Buess Hemanga K. Bhattacharjee Giuseppe Navarra Mario Godina Kirill Shishin Mario Morino 《Surgical endoscopy》2013,27(9):3073-3084