Laparoscopic Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy as a Definitive Surgical Procedure for Morbid Obesity. Mid-Term Results

Background

Laparoscopic sleeve gastrectomy (LSG) has been gaining acceptance because it has shown good short- and mid-term results as a single procedure for morbid obesity. The aim of this study was to compare short- and mid-term results between laparoscopic Roux-en-Y gastric bypass (LRYGB) and LSG.

Methods

Observational retrospective study from a prospective database of patients undergoing LRYGB and LSG between 2004 and 2011, where 249 patients (mean age 44.7 years) were included. Patients were followed at 1, 3, 6, 12, and 18 months, and annually thereafter. Short- and mid-term weight loss, comorbidity improvement or resolution, postoperative complications, re-interventions, and mortality were evaluated.

Results

One hundred thirty-five LRYGB and 114 LSG were included. Significant statistical differences between LRYGB and LSG were found in operative time (153 vs. 93 min. p?<?0.001), minor postoperative complications (21.5 % vs. 4.4 %, p?=?0.005), blood transfusions (8.8 % vs. 1.7 %, p?=?0.015), and length of hospital stay (4 vs. 3 days, p?<?0.001). There were no differences regarding major complications and re-interventions. There was no surgery-related mortality. The percentage of excess weight loss up to 4 years was similar in both groups (66?±?13.7 vs. 65?±?14.9 %). Both techniques showed similar results in comorbidities improvement or resolution at 1 year.

Conclusions

There is a similar short- and mid-term weight loss and 1-year comorbidity improvement or resolution between LRYGB and LSG, although minor complication rate is higher for LRYGB. Results of LSG as a single procedure need to be confirmed after a long-term follow-up.     

A Randomized Clinical Trial of Laparoscopic Roux-en-Y Gastric Bypass and Sleeve Gastrectomy for the Treatment of Morbid Obesity in China: a 5-Year Outcome

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.     

Efficacy of Laparoscopic Sleeve Gastrectomy and Intensive Medical Management in Obese Patients with Type 2 Diabetes Mellitus

Background

There are a dearth of studies comparing laparoscopic sleeve gastrectomy (LSG) and intensive medical treatment (IMT) in obese type 2 diabetes mellitus (T2DM) patients. This study compares these modalities in terms of weight loss, metabolic parameters and quality of life (QOL) score.

Methods

We evaluated the efficacy of LSG (n?=?14) vs. IMT (n?=?17) comprising of low calorie diet, exenatide, metformin and if required insulin detemir in 31 obese T2DM patients with BMI of 37.9?±?5.3kg/m² and target HbA1c?<?7 %. The mean (±SD) age of the patients was 49.6?±?11.9 years and 74 % were women. The mean duration of diabetes was 8.5?±?6.1 years and mean HbA1c was 8.6?±?1.3 %. Primary end point was excess body weight loss (EBWL) at the final follow-up.

Results

The mean duration of follow-up was 12.5?±?5.0 (median 12) months. EBWL was 61.2?±?17.6 % and 27.4?±?23.6 % in LSG and IMT group respectively (p?<?0.001). Glycemic outcomes improved in both with mean HbA1c of 6.6?±?1.5 % in LSG and 7.1?±?1.2 % in IMT group. In LSG group, there was resolution of diabetes and hypertension in 36 and 29 % of patients respectively while none in the IMT group. HOMA-IR, hsCRP, ghrelin and leptin decreased while adiponectin increased significantly in LSG compared to IMT group. QOL score improved in LSG as compared to IMT.

Conclusions

In obese T2DM patients, LSG is superior to IMT in terms of weight loss, resolution of comorbidities and QOL score.     

Impact of Restrictive (Sleeve Gastrectomy) vs Hybrid Bariatric Surgery (Roux-en-Y Gastric Bypass) on Lipid Profile

Background

Few studies have evaluated the impact of hybrid versus purely restrictive bariatric surgery on lipid profile, with the results being contradictory. The effect of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) on lipid profile was compared.

Methods

A nonrandomized prospective cohort study was conducted on severely obese patients undergoing bariatric surgery. Indication for the type of surgical procedure was based on clinical criteria. Patients on lipid-lowering drugs and those that could not be matched for age, sex, and body mass index were excluded. Finally, 51 patients who underwent LSG and 51 undergoing LRYGB completed this study.

Results

During the first year post-surgery, no differences in percentage of excess weight loss and triglyceride reduction were found between groups. After LRYGR, low-density lipoprotein (LDL) cholesterol concentrations fell significantly (125.9?±?29.3 to 100.3?±?26.4?mg/dl, p?p?=?0.220). High-density lipoprotein (HDL) cholesterol increase was significantly greater after LSG (15.4?±?13.1?mg/dl) compared with LRYGB (9.4?±?14.0?mg/dl, p?=?0.032). Factors independently associated with LDL cholesterol reduction were higher baseline total cholesterol and undergoing LRYGB. A greater increase in HDL cholesterol was associated with LSG, older age, and baseline HDL cholesterol.

Conclusions

LRYGB produces an overall improvement in lipid profile, with a clear benefit in all lipid fractions. Although LSG does not alter LDL cholesterol levels, its effect on HDL cholesterol is comparable to or greater than that obtained with malabsorptive techniques.     

Early Post-operative Complications: Incidence, Management, and Impact on Length of Hospital Stay. A Retrospective Comparison Between Laparoscopic Gastric Bypass and Sleeve Gastrectomy

Background

Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are the most common obesity surgeries. Their early complications may prolong hospital stay (HS).

Methods

Data for patients who underwent LRYGB and LSG in our clinic from 2009 through August 2012 were collected. Early post-operative complications prolonging HS (>5 days) were retrospectively analyzed, highlighting their relative incidence, management, and impact on length of HS.

Results

Sixty-six patients (4.9 %) after 1,345 LRYGB operations vs. 49 patients (7.14 %) after 686 LSG operations developed early complications. This difference is statistically significant (p?=?0.039). Male gender percentage was significantly higher in complicated LSG group vs. complicated LRYGB group [23 patients (46.9 %) vs. 16 patients (24.2 %)] (p?=?0.042). Mean BMI was significantly higher in the complicated LSG group (54.2?±?8.3) vs. complicated LRYGB group (46.8?±?5.7; p?=?0.004). Median length of HS was not longer after complicated LSG compared with complicated LRYGB (11 vs. 10 days; p?=?0.287). Leakage and bleeding were the most common complications after either procedure. Leakage rate was not higher after LSG (12 patients, 1.7 %) compared with LRYGB (22 patients, 1.6 %; p?=?0.304). Bleeding rate was significantly higher after LSG (19 patients, 2.7 %) than after LRYGB (10 patients, 0.7 %; p?=?0.004). Prolonged elevation of inflammatory markers was the most common presentation for complications after LSG (18 patients, 36.7 %) and LRYGB (31 patients, 46.9 %).

Conclusions

LSG was associated with more early complications. This may be attributed to higher BMI and predominance of males in LSG group.     

Impact of Different Criteria on Type 2 Diabetes Remission Rate After Bariatric Surgery

Background

Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) achieve similar type 2 diabetes mellitus (T2DM) remission rates. Since a great variability exists in defining T2DM remission, an expert panel proposed partial and complete remission criteria that include the maintenance of fasting plasma glucose (FPG) and glycosylated hemoglobin (A1c) objectives for at least 1 year. The 2-year T2DM remission rate and time needed to reach it after LSG or LRYGB were compared using different remission criteria.

Methods

This was a prospective cohort study of 55 T2DM subjects operated on with LSG (n?=?21) or LRYGB (n?=?34). Four models for defining remission were used: Buchwald criteria (FPG <100 mg/dl or A1c <6 %), American Diabetes Association (ADA) complete (FPG <100 mg/dl plus A1c <6 % maintained for at least 1 year), ADA partial (FPG <125 mg/dl with A1c <6.5 % maintained for at least 1 year), and ADA complete without time requirement.

Results

Both groups were comparable, except for higher A1c levels in the LSG group. The remission rate ranged from 43.6 % using ADA complete remission to 92.7 % with Buchwald criteria, with no differences between surgical procedures. Differences were found in the time to achieve remission only when ADA complete remission criteria (5.1?±?2.9 months LRYGB and 9.0?±?3.8 months LSG, p?=?0.014) and ADA without time requirement criteria (4.9?±?2.7 months LRYGB and 8.4?±?3.9 months LSG, p?=?0.005) were used.

Conclusions

T2DM remission rate varies widely depending on the criteria used for its definition. Remission occurred sooner after LRYGB when the strictest criteria to define remission were used.     

Glycemic Control after Sleeve Gastrectomy and Roux-En-Y Gastric Bypass in Obese Subjects with Type 2 Diabetes Mellitus

Background

Roux-en-Y gastric bypass (LRYGB) has weight-independent effects on glycemia in obese type 2 diabetic patients, whereas sleeve gastrectomy (LSG) is less well characterized. This study aims to compare early weight-independent and later weight-dependent glycemic effects of LRYGB and LSG.

Methods

Eighteen LRYGB and 15 LSG patients were included in the study. Glucose, insulin, GLP-1, and GIP levels were monitored during a modified 30 g oral glucose tolerance test before surgery and 2 days, 3 weeks, and 12 months after surgery. Patients self-monitored glucose levels 2 weeks before and after surgery.

Results

Postoperative fasting blood glucose decreased similarly in both groups (LRYGB vs. SG; baseline—8.1?±?0.6 vs. 8.2?±?0.4 mmol/l, 2 days—7.8?±?0.5 vs. 7.4?±?0.3 mmol/l, 3 weeks—6.6?±?0.4 vs. 6.6?±?0.3 mmol/l, respectively, P <?0.01 vs. baseline for both groups; 12 months—6.6?±?0.4 vs. 5.9?±?0.4, respectively, P <?0.05 for LRYGB and P <?0.001 for LSG vs. baseline, P =?ns between the groups at all times). LSG, but not LRYGB, showed increased peak insulin levels 2 days postoperatively (mean?±?SEM; LSG +?58?±?14%, P <?0.01; LRYGB ??8?±?17%, P =?ns). GLP-1 levels increased similarly at 2 days, but were higher in LRYGB at 3 weeks (AUC; 7525?±?1258 vs. 4779?±?712 pmol?×?min, respectively, P <?0.05). GIP levels did not differ. Body mass index (BMI) decreased more after LRYGB than LSG (??10.1?±?0.9 vs. ??7.9?±?0.5 kg/m², respectively, P <?0.05).

Conclusion

LRYGB and LSG show very similar effects on glycemic control, despite lower GLP-1 levels and inferior BMI decrease after LSG.

     

The Impact of Preoperative Weight Loss Before Laparoscopic Gastric Bypass

Background

The impact of preoperative weight loss on outcomes following laparoscopic Roux-en-Y gastric bypass (LRYGB) is a controversial issue. We evaluated our outcomes of LRYGB in patients who lost different amount of weight prior to surgery.

Methods

Patients who underwent primary LRYGB were divided in three groups on the basis of preoperative weight loss percentage. Group A comprised 166 patients, who lost <5 % of their weight preoperatively; group B comprised 239 patients who lost >5 to 10 % and group C included 143 patients who lost >10 %. Intra- and postoperative complications at 30 days, hospital stay, and outcomes were evaluated.

Results

Significant difference was found in operative (mean ± SD) time [104.43?±?36.40 min in group A, 80.08?±?23.07 min in group B, and 76.99?±?23.23 min in group C; p?<?0.001 in group A versus group B or group C; p?=?0.210 in group B versus group C]. Difference in hospital stay was significant (3.33?±?3.22 days in group A, 2.10?±?2.77 in group B, and 1.87?±?1.44 in group C; p?<?0.001 in group A versus groups B or C). Overall postoperative morbidity rate was 33.13 % in group A, 19.25 % in group B, and 11.89 % in group C, with significant difference in group A versus groups B or C (p?=?0.002 and p?<?0.001). Mean excess weight loss was significantly higher (72.7 %) in group C versus group A (63.1 %) (p?=?0.015) at 12 months.

Conclusions

Weight loss >5 % prior to LRYGB may reduce morbidity, and preoperative weight loss >10 % may improve weight loss outcomes at 1-year follow-up.     

Morbidity Rates and Weight Loss After Roux-en-Y Gastric Bypass,Sleeve Gastrectomy,and Adjustable Gastric Banding in Patients Older Than 60 Years old: Which Procedure to Choose?

Background

As life expectancy increases, more elderly patients fit into the criteria for bariatric procedures. The aim of our study is to evaluate and compare the safety and efficacy of Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic adjustable gastric banding (LAGB) in patients older than 60.

Material and Methods

Between January 2005 and December 2013, 68 LAGB, 73 LSG, and 212 RYGB patients were 60 years or older at the time of primary procedure. A retrospective review was performed in these patients.

Results

Mean age and body mass index (BMI) was 62.7?±?2.2, 64.1?±?2.9, and 62.6?±?2.3 years and 42.7?±?5.6, 44.0?±?7.0, and 45.2?±?6.7 kg/m² for LAGB, LSG, and RYGB at the time of procedure, respectively.Seven (10.3 %) patients from the LAGB, 3 (4.1 %) from the LSG, and 29 (13.8 %) from the RYGB group required readmissions. Reoperation rate was 10.3, 1.4, and 9.5 % in LAGB, LSG, and RYGB, respectively. The difference in reoperation rates was statistically significant (p?<?0.03) while that in readmission rates was not (p?>?0.58). Procedure-related mortality rate was 1.4 % in the RYGB group, while no mortality was observed in LSG and LAGB groups. At 6, 12, and 18 months postoperatively, mean percentage of excess weight loss were highest in the RYGB group, followed by LSG and LAGB group (p?<?0.01). Mean number of comorbidities at the last follow-up significantly decreased in LSG and RYGB patients.

Conclusions

LSG showed the lowest readmission and reoperation rate, and RYGB patients had the highest mortality rate. Weight loss and comorbidity resolution were effectively achieved in RYGB and LSG patients.

     

Outcomes of Laparoscopic Roux-en-Y Gastric Bypass Versus Laparoscopic Adjustable Gastric Banding in Adolescents

Background

The goal of this study is to compare the outcomes of laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in obese adolescents.

Methods

We performed a retrospective review of all adolescents between the ages of 15 and 19 who underwent LAGB or LRYGB at our university affiliated Bariatric Center of Excellence from 2002 to 2011. Postsurgical weight loss at 1, 3, 6, 12, 18, and 24?months was noted and expressed as percentage of excess weight loss (% EWL).

Results

Thirty-two patients underwent LRYGB and 23 underwent LAGB. The LAGB group was younger (18.6?±?0.6 versus 17.2?±?1.5) than the LRYGB group. Other preoperative demographic factors including body mass index, gender, ethnicity, and comorbidities were similar between the two groups. The average % EWL was superior in the LRYGB group compared to the LAGB group at all time points studied (p?<?0.05), although at 2-year follow-up, only 16?% (5/32) LRYGB and 30?% (7/23) LAGB patients were available for follow-up. Three patients with type II diabetes mellitus underwent LRYGB and all experienced remission of their diabetes. The number of complications requiring interventions was similar between the two groups.

Conclusions

In our study, adolescents undergoing LRYGB achieved superior weight loss compared to LAGB in the short-term follow-up. The complication rate for LAGB was similar compared to LRYGB. More studies are needed to monitor the long-term effects of these operations on adolescents before definitive recommendations can be made.     

Laparoscopic Sleeve Gastrectomy Using 42-French Versus 32-French Bougie: The First-Year Outcome

Background

The optimal size of bougie in laparoscopic sleeve gastrectomy (LSG) remains controversial. The aim of this study was to evaluate the first-year outcome of LSG using two different sizes of bougies.

Methods

This study used a single institute retrospective case-control study of two groups of patients. Group A (N?=?66) underwent LSG using 42-Fr and group B (N?=?54) using 32-Fr bougies. A medication score was applied to assess the change in comorbid conditions.

Results

Groups A and B's age (39.5?±?12 vs. 43.6?±?12.3 years), weight (119?±?17 vs. 120?±?20), and BMI (42.8?±?3.8 vs. 43.6?±?6.9 kg/m²), respectively, were comparable (p?=?NS). Comorbid conditions were type 2 diabetes (T2DM) in 19 (29 %) vs. 23 (43 %) patients, hypertension in 22 (33 %) vs. 18 (33 %) patients, and gastroesophageal reflux (GERD) in 28 (42 %) vs. 10 (19 %) patients, respectively. At 1 year, group A vs. B BMI was (29.4?±?5 vs. 30?±?5 kg/m²) and excess weight loss was 67 vs. 65 %, respectively (p?=?NS). Postoperatively, T2DM (79 vs. 83 %), hypertension (82 vs. 61 %), and GERD (82 vs. 60 %) (p?=?NS), respectively, in groups A vs. B did not require previous medications anymore. Complications were comparable.

Conclusions

Our data suggest that using a 42-Fr or 32-Fr bougie does not influence LSG first-year weight loss or resolution of comorbid conditions. Long-term data is needed to conclude this issue.     

Two Stages Conversion of Failed Laparoscopic Adjustable Gastric Banding to Laparoscopic Roux-En-Y Gastric Bypass. A Study of One Hundred Patients

Introduction

Conversion to laparoscopic gastric bypass (LRYGB) appears to be the treatment of choice after failed LAGB. To reduce the risk of postoperative complications, some surgeons routinely adopt a two-stage strategy. The purpose of this study was to analyze our institution’s experience with the two-stage procedure for LAGB conversion to LRYGB

Materials and Methods

The bariatric database of our institution was reviewed to identify patients who had undergone conversion of LAGB to LRYGB from November 2007 to June 2012.

Results

One hundred patients were included. Of these, 62 (62 %) required conversion to LRYGB for inadequate weight loss or weight regain and 38 for band-related complications. All the procedures were performed in two stages and laparoscopically. The average time between band removal and LRYGB was 17.3 months. The mean follow-up after LRYGB was 31?±?18.7 months. The mean BMI prior to LRYGB conversion was 45.3?±?5.2. Early complications occurred in 15 patients (15 %), while late complications occurred in only 3 patients (3 %). The average %EWL at 24 months and 48 months after conversion was 70.1 and 69.4 %, respectively.

Conclusion

Although a two-stage conversion strategy increases the number of operations and hospital stay without decreasing the rate of early complications compared to one-stage conversion; it has shown to be associated with low rates of GJA stenosis and excellent %EWL.     

Laparoscopic Sleeve Gastrectomy: Co-morbidity Profiles and Intermediate-Term Outcomes

Background

Bariatric surgery is effective at achieving sustained weight loss and improving the control and resolution of obesity-related co-morbidities. Most studies that have demonstrated co-morbidity resolution in patients undergoing laparoscopic sleeve gastrectomy (LSG) only follow patients for the short term (less than 1 year) or follow a relatively small cohort (<100 patients) for the intermediate or long term (more than 5 years). We report our experience following a large cohort of morbidly obese patients who underwent LSG with intermediate-term follow-up.

Methods

We retrospectively reviewed 435 consecutive patients who underwent LSG from January 2004 to November 2013. Co-morbidities investigated included diabetes mellitus (DM), hypertension (HTN), and hyperlipidemia (HL). A co-morbidity was determined to be resolved if the patient was no longer taking any medication to treat that specific co-morbidity.

Results

Mean follow-up was 26?±?25 months (range?=?1–112). Mean postoperative total weight loss (%TWL) at 6, 12, 24, 36, 48, 60, and 72 months were 23.6, 29.9, 29.5, 25.2, 26.7, 25.4, and 24.3 %, respectively. The incidence of all three co-morbidities was found to be significantly lower at the last patient follow-up. The resolution rates for DM, HTN, and HL were 59, 31, and 50 %, respectively. In patients who continued to have co-morbidities, the mean numbers of medications for DM (1.2?±?0.7 vs. 0.5?±?0.7, p?<?0.0001), HTN (1.8?±?1.1 vs. 1.3?±?1.2, p?<?0.0001), and HL (0.9?±?0.7 vs. 0.6?±?0.6, p?<?0.0001) postoperatively were all significantly less.

Conclusions

LSG is effective at achieving significant and sustained weight loss, improvement in co-morbidity profiles, and a reduction in poly-pharmacy for these conditions over intermediate-term follow-up.

     

Increased Metabolic Benefit for Obese,Elderly Patients Undergoing Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy

Purpose

We sought to assess outcomes of laparoscopic sleeve gastrectomy (LSG) vs laparoscopic Roux-en-Y gastric bypass (LRYGB) in a cohort of morbidly obese, elderly patients.

Materials and Methods

Retrospective review was conducted of all patients age 60 years or greater undergoing LSG or LRYGB at our institution between 2007 and 2014.

Results

A total of 134 patients who underwent LSG (n = 65) or LRYGB (n = 69) were identified. Groups were similar with respect to age (64 years, range 60–75 years), BMI (44.0 ± 6.1), and ASA score (91% ≥ ASA 3). There were no differences in major post-operative complications (3, 4.7% LSG vs 4, 5.8% LRYGB, p = 0.75). Median follow-up was 39 months (IQR 14–64 months) with no patients lost to follow-up. Patients undergoing LRYGB had improvement in each of diabetes mellitus 2 (DM2), hypertension (HTN), hyperlipidemia (HL), and gastroesophageal reflux disease (GERD) as well as a significant decrease in insulin use (16/47, 34.0% pre-operatively vs 7/47, 15.2% post-operatively; p = 0.03). Patients undergoing LSG had improvement in DM2 and HTN but not in HL or GERD; there was no reduction in insulin dependence. Weight loss was not significantly different between groups; mean percent total weight loss at 36 months was 26.9 ± 9.0% in the LSG group and 23.9 ± 9.3% in the LRYGB group, p = 0.24.

Conclusions

Both LSG and RYGB can be safely performed on morbidly obese, elderly adults. At intermediate follow-up, there is an increased metabolic benefit for elderly patients undergoing LRYGB over LSG.

     

Long-Term Effects of Laparoscopic Roux-en-Y Gastric Bypass on Diabetes Mellitus,Hypertension and Dyslipidaemia in Morbidly Obese Patients

Background

Severely obese patients have an increased risk for developing metabolic complications such as type 2 diabetes mellitus (T2DM), dyslipidaemia (DL) and hypertension (HT). The aim of the present study is to research the effect of a primary laparoscopic Roux-en-Y gastric bypass (LRYGB) on T2DM, HT and DL in the long-term.

Methods

Fifty-two out of 89 (58 %) adult severely obese patients with T2DM who had received a LRYGB between January 2000 and December 2008 were evaluated. Primary outcome of evaluation was remission of T2DM according to the definition of 2009 consensus statement. Complete remission was defined as achievement fasting plasma glucose (FPG) of <5.6 mmol/l (<100.8 mg/dL) and HbA1c <42 mmol/mol (<6.0 %)) without glucose-lowering medication for at least 1 year. Partial remission was defined as a FPG of 5.6–6.9 mmol/l (100.8–124.2 mg/dL) and HbA1c 42–48 mmol/mol (6.0–6.5 %), without glucose-lowering medication for at least 1 year. Remission of T2DM was considered if the patient met the criteria for complete or partial remission. Secondary outcomes were remission of HT, DL and changes in medication use.

Results

Patients had a mean age of 47.5?±?9.6 years, body mass index of 46.6?±?6.4 kg/m² and a mean duration of T2DM of 6.1?±?5.4 years at the time of surgery. The mean post-operative follow-up period was 6.9?±?2.3 years. At the end of the follow-up, mean weight loss was 60?±?24 % excess weight loss (EWL) and 26?±?10 % total body weight loss (TBWL). Mean HbA1c level had significantly decreased from 64.8?±?19.7 mmol/mol to 46.4?±?12.9 mmol/l (p?p?p?p?=?0.020) and duration of T2DM (odds ratio 0.637, p?=?0.010) were independent risk factors for failed remission of T2DM. The number of patients with HT was significantly reduced from 73 % to 54 % (p?=?0.042), and number of patients with DL was non-significantly decreased from 71 % to 54 % (p?=?0.068).

Conclusions

The laparoscopic RYGB operation results in a sustained EWL of 60 % (26 % TBWL) with 52 % long-term remission of T2DM. However, 19 % of the patients had a relapse of their T2DM. Furthermore, HT and DL improved markedly.     

Influence of Eating Profile on the Outcome of Laparoscopic Sleeve Gastrectomy

Background

The aim of this study was to assess the eating profile of patients after laparoscopic sleeve gastrectomy (LSG) and its impact on weight loss.

Methods

One hundred ten patients who underwent LSG were interviewed using Suter questionnaire and revised Questionnaire on Eating and Weight Patterns in follow-up visits. Eating patterns were assessed preoperatively and postoperatively. Patients were divided into six groups according to the timing point of assessment. Group 1 (n?=?10) included patients <3 months, group 2 (n?=?11) 3–6 months, group 3 (n?=?11) 6–12 months, group 4 (n?=?39) 1–2 years, group 5 (n?=?23) 2–3 years, and group 6 (n?=?16) >3 years. The excess weight loss (EWL) was correlated with the results.

Results

The total score of the Suter questionnaire was 15.0?±?5.87, 20.3?±?7.07, 26.2?±?1.54, 23.8?±?4.25, 24.65?±?2.8, and 23.43?±?4.14 for the groups 1–6, respectively (p?<?0.0001). No significant differences were denoted when long-term follow-up groups 3 to 6 were compared. No association was found between the preoperative eating pattern and EWL. Postoperatively, 91 patients modified their eating pattern. Postoperative eating pattern was significantly correlated with EWL (p?=?0.015). Patients with normal and snacking eating pattern achieve the best EWL (63.57?±?21.32 and 60.73?±?20.62, respectively). Binge eating disorder and emotional patterns had the worst EWL (42.84?±?29.42 and 34.55?±?19.34, respectively).

Conclusions

Better food tolerance is detected after the first postoperative year after LSG. The postoperative eating patterns seem to affect excessive weight loss.     

Laparoscopic Roux-en-Y Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy for the Treatment of Morbid Obesity. A Prospective Study with 5 Years of Follow-Up

Background

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most widely used bariatric procedures today, and laparoscopic sleeve gastrectomy (LSG) is becoming increasingly popular. The aim of this study was to compare mid-term results of both procedures.

Methods

From January 2008 to December 2008, 117 obese patients were assigned by patient choice after informed consent to either a LRYGB procedure (n?=?75) or a LSG procedure (n?=?42). We determined operative time, length of stay, morbidity, comorbidity outcomes, failures, and excess weight loss at 5 years.

Results

Both groups were comparable in demographic characteristics and comorbidities at baseline. No significant statistical differences were found in length of stay and early major morbidity, but mean operative time was shorter in LSG group, p?p?>?0.05. Five years after surgery, the percentage of excess weight loss was similar in both groups (69.8 % for LRYGB and 67.3 % for LSG, p?>?0.05). Failures were more common for LSG group, 22.2 versus 12.7 % for LRYGB group, but this difference was not significant, p?>?0.05.

Conclusions

Both techniques are comparable regarding safety and effectiveness after 5 years of follow-up, so not one procedure is clearly superior to the other.     

Thirteen-Year Experience of Laparoscopic Sleeve Gastrectomy: Surgical Risk,Weight Loss,and Revision Procedures

Background

Laparoscopic sleeve gastrectomy (LSG) has been validated as a safe and effective treatment for morbid obesity. However, data of the long-term outcome remains lacking.

Methods

A total of 1759 LSG was performed as primary bariatric procedure from 2005 to 2017 with mean age of 35.2?±?10.3 years old (14–71), female 69.7%, mean body mass index (BMI) 37.9?±?7.7 kg/m², and mean waist width 113.7?±?17.9 cm. All patients were evaluated and managed under a strict multidisciplinary team approach. A retrospective analysis of a prospective bariatric database and telephone interview of patients who defaulted clinic follow-up at 10 years was conducted.

Results

The mean operating time, intraoperative blood, and hospital stay of LSG were 121.5?±?36.5 min, 40.8?±?69.7 ml, and 2.8?±?2.7 days, respectively. The 30-day postoperative major complication occurred in 25 (1.4%) patients. The major complication rate was 15% at first year and 0% at the last year. The follow-up rate at 1, 5 and 10 years were 89.3%, 52.1 and 64.4%. At postoperative 1, 5, and 10 years, the mean percentage of total weight loss (%TWL) and excess weight loss (EWL%) of LSG patients were 33.4, 28.3, and 26.6% and 92.2, 80.1, and 70.5%, respectively. The mean BMI became 27, 26.2, and 27.1 kg/m² at postoperative 1, 5, and 10 years. At follow-up, a total 69 patients needed surgical revision due to reflux disease (n?=?45), weight regain (n?=?19), persistent diabetes (n?=?2), and chronic fistula (n?=?3). The type of revision procedures were hiatal repair and gastropexy (n?=?29), Roux-en Y gastric bypass (RYGB) (n?=?23), and single anastomosis bypass (n?=?17) with median time to revision 33 months (range 3–62). At 10 years, the overall revision rate was 21.5% (14/65) and 11(16.9%) of 65 patients were converted to RYGB. The other 54 patients remained at LSG anatomy, but 45% of them required proton pump inhibitor for reflux symptoms.

Conclusions

Our results showed that primary LSG is a durable primary bariatric procedure with sustained weight loss and a high resolution of comorbidities at 10 years, but about half the patients had de novo GERD. The need for conversion to RYGB was 16.9% at 10 years.

     

Long-term Metabolic Effects of Laparoscopic Sleeve Gastrectomy

Objective

Obesity is one of the major health challenges throughout the world. The association between obesity and diabetes is well established because 90% of patients with type 2 diabetes mellitus (T2DM) show excess body weight. The aim of the study was to evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on morbid obesity and type 2 diabetes (T2DM) in the long-term follow-up.

Methods

One hundred ninety-five obese patients, 78 with T2DM, were evaluated before and after LSG up to 10 years, to identify complete diabetes remission (FPG?<?100 mg/dl, A1c?<?6.0%), partial remission (FPG 100–125 mg/dl, A1c?<?6.5%), or relapse.

Results

Before surgery, body weight and BMI were 123?±?21 kg and 44.6?±?6.8 kg/m² respectively; at a mean follow-up of 7 years (range 4–10), body weight was 104.9?±?18 kg and BMI 37?±?6 kg/m². Minimum weight was reached after 2 years. T2DM remission was observed in 66, 57, and 52% at short (<?2 years), medium (2–5 years), and long-term (>?5 years) follow-up respectively. Furthermore, 45.2% maintained complete remission for at least 5 years and about 36% showed a persistent but improved diabetes. None of the patients cured from diabetes had a duration disease greater than 8 years and a glycemic control requiring insulin. The prevalence of hypertension and dyslipidemia significantly decreased from 49 to 35% and from 51 to 40% respectively.

Conclusions

LSG significantly improves body weight, diabetes, hypertension, and dyslipidemia in long-term follow-up.