Laparoscopic Sleeve Gastrectomy as Treatment for Morbid Obesity: Technique and Short-Term Outcome

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) and laparoscopic adjustable gastric banding (LAGB) are the most commonly performed surgical procedures for weight reduction in the United States. Currently, laparoscopic sleeve gastrectomy (LSG) is being explored. The aim of this study was to assess the safety and short-term efficacy of LSG as a treatment option for weight reduction. Methods: Data of all patients who underwent LSG for treatment of morbid obesity between November 2004 and March 2006 and completed the 3- and 6-month follow-up visits at the time of the study, were retrospectively reviewed. Data collected included demographics, operative time, length of stay, postoperative complications, and degree of weight reduction. Results: Of the 62 patients who underwent LSG performed by two surgeons, the data of 30 patients (7 males and 23 females) were further analyzed. Mean preoperative BMI was 41.4 (33-59) kg/m². Mean operative time was 80 min (range 65-130). Mean hospital stay was 3.2 days (range 2 to 25). Mean weight loss at 3 and 6 months following the procedure was 22.7 kg and 30.5 kg respectively, and mean % excess weight loss (EWL) was 40.7 and 52.8, respectively. Three patients were considered to have mild complications, and one patient had a major complication that necessitated surgical intervention. There was no mortality. Conclusions: In the short-term, LSG is a safe and effective treatment option.     

Laparoscopic sleeve gastrectomy: does bougie size affect mean %EWL? Short-term outcomes

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has been increasingly offered to high-risk bariatric patients as the first-stage procedure before gastric bypass or biliopancreatic diversion or as the primary weight loss procedure. The bougie size has varied by surgeon during LSG. The aim of this study was to determine whether short-term weight loss correlates with the bougie size used during creation of the sleeve. METHODS: We retrospectively reviewed the data from all patients who had undergone LSG at our institution between 2003 and 2006. Revision LSG for failed bariatric procedures was excluded. The data analyzed included preoperative age, body mass index (BMI), bougie size, and percentage of excess weight loss (%EWL). RESULTS: A total of 135 patients underwent LSG during the 4-year period. Most of these patients (79%) underwent LSG as part of a 2-stage operation (either gastric bypass or duodenal switch within a mean of 11 months). The mean preoperative age and BMI was 43.5 years and 60.1 kg/m(2), respectively. The mean BMI and %EWL at 6 months was 47.1 kg/m(2) and 37.9%, respectively. The mean BMI and %EWL at 12 months was 44.3 kg/m(2) and 47.3%, respectively. When stratifying the %EWL by bougie size (40F versus 60F), we did not find a significant difference at 6 months (38.8% versus 40.6%, P = NS) or 12 months (51.9% versus 45.4%, P = NS). CONCLUSION: LSG results in significant weight loss in the short term. When stratifying outcomes by bougie size, our results suggested that a bougie size of 40F compared with 60F does not result in significantly greater weight loss in the short term. However, longer follow-up of the primary LSG group is required to determine whether a difference becomes evident over time.     

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

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

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

Aim

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

Methods

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

Results

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

Conclusions

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

三孔法在腹腔镜胃袖状切除术中的应用

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

Feasibility of Laparoscopic Sleeve Gastrectomy as a Revision Procedure for Prior Laparoscopic Gastric Banding

Background: Laparoscopic sleeve gastrectomy (LSG), initially described by Gagner's group as the first stage of the laparoscopic duodenal switch in super-obese patients, is now gaining wide diffusion among bariatric surgeons as a new restrictive operation. Methods: From January 2005 to January 2006, 8 obese patients with BMI 37-74 kg/m² underwent LSG for conversion from a prior complicated or failed laparoscopic adjustable gastric banding (LAGB). Three patients had severe symptomatic esophageal dilation, while 5 patients had unsuccessful weight loss with poor "band compliance". After de-banding, LSG was calibrated upon a 34-Fr gastric bougie, and blue and green linear staplers were used. The staple-line was buttressed by placing a sero-serosal running suture in all but one patient, and methylene blue dye was used to test for leaks. All the patients underwent upper GI series with water-soluble contrast medium 2 days after the surgery. Results: The average operating-time for LSG was 90 minutes (range 60-120 min). The average hospital stay was 4 days (range 3-7). There were no perioperative complications, no conversion, and no mortality. No intraoperative or postoperative blood transfusions were required. Conclusions: LSG proved to be feasible and safe after LAGB. Longer follow-up and larger series are needed to assess weight loss results.     

One Year After Laparoscopic “Tight” Sleeve Gastrectomy: Technique and Outcome

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is currently gaining ground as a new option for the treatment of morbid obesity. The main advantages of this procedure are less postoperative food restrictions, no vomiting, and absence of late complications due to the lack of foreign implants. The aim of this study is to present our experience with this new bariatric technique. METHODS: Ninety three obese patients (65 females and 28 males) who underwent LSG between September 2005 and September 2007 were studied in terms of postoperative complications and weight loss. RESULTS: Mean age was 38.37 +/- 10.81 years (range 19-69) and mean preoperative weight and body mass index (BMI) were 139.12 +/- 24.03 kg (range 100-210) and 46.86 +/- 6.48 kg/m(2) (range 37-66), respectively. Mean follow-up was 12.51 +/- 4.15 months (range 3-24). There were no mortalities, but there were four major and four minor postoperative complications. The mean postoperative excess weight loss (EWL) was 58.32 +/- 16.54%, while mean BMI dropped to 32.98 +/- 6.54 kg/m(2). Mean EWL 3, 6, 12, and 24 months after the operation was 31%, 53%, 67%, and 72%, respectively. Superobese patients (BMI > 50 kg/m(2)) lost less weight. CONCLUSION: In the short term, LSG is a safe and highly effective bariatric operation more suitable for intermediate morbidly obese patients with BMI between 40 and 50 kg/m(2).     

腹腔镜胃肠部分切除术治疗重度肥胖症

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

Long-term outcomes of laparoscopic sleeve gastrectomy as a primary bariatric procedure

BackgroundLaparoscopic sleeve gastrectomy (LSG) has been established as a reliable bariatric procedure, but questions have emerged regarding its long-term results. Our aim is to report the long-term outcomes of LSG as a primary bariatric procedure.MethodsRetrospective analysis of patients submitted to LSG between 2005 and 2007 in our institution. Long-term outcomes at 5 years were analyzed in terms of body mass index (BMI), excess weight loss (EWL) and co-morbidities resolution. Surgical success was defined as %EWL>50%. Also, we compared long-term results according to preoperative BMI, using Mann-Whitney test.ResultsA total of 161 LSG were analyzed, and 114 patients (70.8%) were women. The median age was 36 years old (range 16–65), median preoperative BMI was 34.9 kg/m² (interquartile range [IQR], 33.3–37.5). A total of 112 patients (70%) completed 5 years of follow-up. At the fifth year, median BMI and %EWL was 28.5 kg/m² (IQR: 25.8–31.9) and 62.9% (IQR: 45.3–89.6), respectively, with a surgical success of 73.2% of followed patients. According to preoperative BMI, surgical success was achieved in 80% of patients with BMI<35 kg/m², 75% of BMI 35–40 kg/m², and 52.6% of BMI>40 kg/m², with significant lower %EWL in patients with BMI>40 kg/m² (P = .001 and .004). Dyslipidemia and insulin resistance resolution was 80.7% and 84.7%, respectively. A total of 26.7% of patients reported new-onset gastroesophageal reflux symptoms at 5 years.ConclusionLSG as a primary procedure is a reliable surgery. We observed positive long-term outcomes of %EWL and co-morbidities resolution. In our series, best results are seen in patients with preoperative BMI<40 kg/m².     

Laparoscopic Sleeve Gastrectomy: Surgical Technique, Indications and Clinical Results

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has been introduced as a multipurpose restrictive procedure for obese patients. Variations of the surgical technique may be important for the late results. METHODS: 50 patients submitted to LSG from January 2005 to December 2006 were studied. Mean age was 38.2 years, preoperative weight was 103.4 +/- 14.1 kg (78 to 146 kg), and preoperative BMI was 37.9 +/- 3.4 (32.9 to 46.8). Important co-morbidities were present in 39 patients (78%). RESULTS: Operative time was 110 +/- 15 min. Intraoperative difficulties were observed in 7 patients. Volume of the resected specimen was 760 +/- 55 ml and capacity of the gastric remnant was 108.5 +/- 25 ml. There was no conversion to open surgery. Histology of the resected stomach was normal in 8 patients, while chronic gastritis was found in 42 patients. At 6 and 12 months postoperatively, weight loss was 28.0 +/- 6.4 kg and 32.6 +/- 6.8 kg respectively. In the 18 patients who have reached 1 year follow-up, % excess BMI loss reached 85 +/- 0.7%. Most of the medical diseases associated with the obesity resolved after 6 to 12 months. CONCLUSION: LSG may be an acceptable operation. It is easy to perform, safe, and has a lower complication rate than other bariatric operations. Further studies are necessary for the clinical results at long-term follow-up.     

Laparoscopic Sleeve Gastrectomy: Standardized Technique of a Potential Stand-alone Bariatric Procedure in Morbidly Obese Patients

BACKGROUND: The aim of this study was to define a standardized technique for laparoscopic sleeve gastrectomy in the morbidly obese patient. METHODS: There are several surgical options for the morbidy obese patient. In general, there are the restrictive procedures [e.g., laparoscopic adjustable gastric banding (LAGB)] and the malabsorptive procedures [e.g. laparoscopic Roux-en-Y gastric bypass (LRYGBP)]. Those techniques are already standardized. The laparoscopic sleeve gastrectomy (LSG) seems to have some advantages over both procedures, but it is not standardized yet, and so there can be no comparison between the different techniques. In our center we have standardized the LSG technique with respect to abdominal access and narrowness of the gastric sleeve. After dissection of the greater omentum and the short gastric vessels, the greater curvature is resected along a 34-Fr gastric tube using the Endo-GIA. The remaining gastric sleeve has a volume of about 100 ml. RESULTS: The standardized LSG procedure is presented step by step. A comparison of operative data and early outcome with a matched group of patients with adjustable gastric banding showed no difference between the two techniques with respect to operating time, surgical complications, and weight loss 6 months after surgery. CONCLUSION: With our standardized LSG technique it is possible to evaluate the positive aspects of the LSG compared with other standardized bariatric procedures like LAGB or LRYGBP.     

Does Gastric Dilatation Limit the Success of Sleeve Gastrectomy as a Sole Operation for Morbid Obesity?

Background: Sleeve gastrectomy as the sole bariatric operation has been reported for high-risk super-obese patients or as first-step followed by Roux-en-Y gastric bypass (RYGBP) or duodenal switch (DS) in super-super obese patients. The efficacy of laparoscopic sleeve gastrectomy (LSG) for morbidly obese patients with a BMI of <50 kg/m² and the incidence of gastric dilatation following LSG have not yet been investigated. Methods: 23 patients (15 morbidly obese, 8 super-obese) were studied prospectively for weight loss following LSG. The incidence of sleeve dilatation was assessed by upper GI contrast studies in patients with a follow-up of >12 months. Results: Patients who underwent LSG achieved a mean excess weight loss (EWL) at 6 and 12 months postoperatively of 46% and 56%, respectively. No significant differences were observed in %EWL comparing obese and super-obese patients. At a mean follow-up of 20 months, dilatation of the gastric sleeve was found in 1 patient and weight regain after initial successful weight loss in 3 of the 23 patients. Conclusion: LSG has been highly effective for weight reduction for morbid obesity even as the sole bariatric operation. Gastric dilatation was found in only 1 patient in this short-term follow-up. Weight regain following LSG may require conversion to RYGBP or DS. Follow-up will be necessary to evaluate long-term results.     

Laparoscopic gastric greater curvature plication versus laparoscopic sleeve gastrectomy: early outcome in 140 patients

BackgroundLaparoscopic gastric greater curvature plication (LGGCP) is a novel bariatric procedure. Its outcome as a standalone procedure has been studied in the literature. We herein describe a comparative study between LGGCP versus laparoscopic sleeve gastrectomy (LSG). The objective of this study was to analyze %excess weight loss (%EWL), co-morbidity improvement and complication rate in both groups at 1, 3, 6, 12 months follow-up.MethodsRetrospective study of 140 patients undergoing LGGCP and LSG between July 2011 and March 2012 at University of Alexandria, Egypt. Data on patient demography, operative time, length of stay, body mass index (BMI) were collected.ResultsBaseline characteristics were similar for both groups, except for preoperative BMI that was higher among the LSG group. Follow up rate was 98% (n = LGCCP: 68 – LSG: 69) at 6 months and 81% (n = LGGCP: 54 – LSG: 60) at 1 year. The mean operative time and mean length of stay were longer in the LSG group (P = .03) and (P = .02), respectively. There were 4 (6.5%) readmissions and 2 (3.2%) reoperations in the LGGCP group compared to 3 (3.8%) readmission and 2 (2.6%) reoperations in the LSG group. At 6 months follow-up the mean %EWL for LGGCP and LSG was 40.4±11.9% and 47.1±13.9% (P<.001), while at 1 year it was 52.1±15.1% and 68.1±15.8% (P<.001), respectively. Both techniques showed similar results in co-morbidity improvement at 1 year.ConclusionIn the short term, both techniques were comparable as regards to co-morbidity resolution. However, LSG appears to have achieved a higher weight loss.     

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

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

Review of long-term weight loss results after laparoscopic sleeve gastrectomy

Sleeve gastrectomy (SG) has gained enormous popularity both as a first-stage procedure in high-risk super-obese patients and as a stand-alone procedure. The objective of this study was to evaluate the long-term weight loss results after SG published in the literature and compare them with the well-documented short-term and mid-term weight loss results. A detailed search in PubMed using the keywords “sleeve gastrectomy” and “long-term results” found 16 studies fulfilling the criteria of this study. A total of 492 patients were analyzed, with a follow-up of at least 5 years after laparoscopic sleeve gastrectomy (LSG) (373 at 5 years, 72 at 6 years, 13 at 7 years, and 34 at 8 or more years). Of the total number of patients, 71.1% were women (15 studies, n = 432 patients). Mean patient age was 45.1 years (15 studies, n = 432 patients). Mean preoperative body mass index in all 16 studies was 49.2 kg/m². The mean percentage excess weight loss (%EWL) was 62.3%, 53.8%, 43%, and 54.8% at 5, 6, 7, and 8 or more years after LSG, respectively. The overall mean %EWL (defined as the average %EWL at 5 or more years after LSG) was 59.3% (12 studies, n = 377 patients). The overall attrition rate was 31.2% (13 studies). LSG seems to maintain its well-documented weight loss outcome at 5 or more years postoperatively, with the overall mean %EWL at 5 or more years after LSG still remaining>50%. The existing data support the role of LSG in the treatment of morbid obesity.     

Outpatient laparoscopic sleeve gastrectomy in a free-standing ambulatory surgery center: First 250 cases

BackgroundA growing body of evidence supports the laparoscopic sleeve gastrectomy (LSG) as a safe and effective procedure for sustained weight loss and amelioration of weight-related co-morbidities. Procedures performed in ambulatory surgery centers (ASC) can provide several advantages over hospital-based surgery. We present our results of 250 consecutive patients undergoing LSG in an ASC. The objective of this study was to assess the safety and efficacy of outpatient LSG in a freestanding ASC.MethodsData was collected prospectively from 250 consecutive patients who underwent LSG at a freestanding ASC. Patients were excluded from the ASC if they weighed>450 pounds, if anticipated operative time was>2 hours, if the patient had impaired mobility limiting early ambulation, or if there were medical problems requiring postoperative monitoring beyond 23 hours. Revisions were not included in this study.ResultsMean age was 47 years (range, 23–74 yr). Mean preoperative body mass index (BMI) was 43 kg/m² (29–71 kg/m²). Mean operative time was 60 minutes (31–161 min). Mean recovery room time was 131 minutes (30–385 min). Mean percent excess weight loss (%EWL) was 60% at 1 year and 63% at 2 years. Nine patients (3.6%) were readmitted within 30 days. Two patients (.8%) were transferred from the ASC to a hospital. There was 1 staple line leak (.4%). There were no open conversions and no deaths.ConclusionsLSG can be performed safely in a freestanding ASC in select patients with outcomes comparable to the inpatient standard. Additional studies are needed to formulate selection criteria and guidelines to maximize patient safety and outcomes.     

Laparoscopic Sleeve Gastrectomy — Influence of Sleeve Size and Resected Gastric Volume

Background Although the efficacy of laparoscopic sleeve gastrectomy (LSG) for morbidly obese patients with a BMI of < 50 kg/m², the incidence of weight gain by change of eating behaviors, and gastric dilatation following LSG have not been investigated thus far, LSG is becoming more common as a single-stage operation for the treatment morbid obesity. Methods This is a prospective study of the initial 120 patients who underwent isolated LSG. Initially, the LSG was performed without a calibration tube and resulted in high sleeve volumes (group 1: n = 25). In group 2 (n = 32), a calibration tube of 44 Fr and in group 3 (n = 63) a calibration tube of 32 Fr were used. The study group consists of 101 patients with high BMI who were scheduled for a two-step LBPD-DS, but rejected the second step after 1 year. Study endpoints include estimated sleeve volume, volume of removed stomach, operative time, complication rates, length of hospital stay, changes in co-morbidity, percentage of excess BMI loss (%EBL) and changes in BMI (kg/m²). Results All 3 groups were comparable regarding age, gender, and co-morbidities. There was no hospital mortality, but there was one case of late mortality (0.8%). 2 early leaks (1.7%) were seen. % excess BMI loss was significantly higher for patients who underwent LSG with tube calibrations. LSG with large sleeve volume showed a slight weight gain during 5 years of observation. A total of 16 patients (13.3%) underwent a second stage procedure within a period of 5 years (2 redo-sleeves, 7 LBPD-DS, 3 LRYGBP). Conclusion Early weight loss results were not different between the groups, but after 2 years the more restrictive LSG (groups 2, 3) results were significantly better than in patients without calibration. A removed gastric volume of < 500 cc seems to be a predictor of failure in treatment or early weight regain. A statistically significant improved health status and quality of life were registered for all groups. The general introduction of LSG as a one-stage restrictive procedure in the bariatric field can be considered only if the procedure is standardized and long-term results are available.     

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。     

日间腹腔镜胃袖状切除手术可行性及安全性研究

目的 探讨开展日间腹腔镜胃袖状切除术（LSG）的可行性及安全性。方法 回顾性分析2018年8月至2019年8月上海交通大学医学院附属第九人民医院行LSG的45例BMI≤40的肥胖合并代谢综合征病人的临床资料。其中日间手术16例（日间LSG组）,常规手术29例（常规LSG组）。对比分析两组病人手术时间、住院时间、住院费用、并发症发生率及术后多余体重减少百分比（%EWL）等临床数据。结果 日间LSG占同期LSG病人的35.6%。两组病人均顺利完成手术并出院。日间LSG组总住院时间及术后住院时间均明显短于常规LSG组［（1.9±0.3）d vs. （4.5±2.4）d,P<0.01;（0.9±0.2）d vs. （1.5±0.7）d,P<0.05］、总住院费用明显低于常规LSG组［（41535.0±2312.9）元vs. （50476.1±5053.5）元,P<0.01］;两组间术后并发症发生率、再入院率、术后第6和12个月%EWL差异无统计学意义（P>0.05）。结论 通过严格选择适应证、积极术前准备,日间LSG能够安全有效地开展,可明显缩短住院时间,降低住院费用,且不增加并发症发生率。