Long term outcomes of the laparoscopic sleeve gastrectomy

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  • 1. Long-Term Outcomes of the Laparoscopic Sleeve Gastrectomy as a Definitive Bariatric Procedure Abeezar Sarela, Ashok Menon, Mary O’Kane, Simon Dexter, Michael McMahon The General Infirmary at Leeds & The Leeds Nuffield Hospital
  • 2. Sleeve Gastrectomy Current Status
    • Updated Position Statement on Sleeve Gastrectomy as a Bariatric Procedure
      • Clinical Issues Committee of the ASMBS. SOARD 2010 In press .
    • Systematic review of sleeve gastrectomy as staging and primary bariatric procedure.
      • Brethauer, Hammel, Shauer. SOARD 2009;5:469-475
  • 3. Sleeve Gastrectomy Available Long-Term Follow-Up Data
    • 36 studies-2570 patients
    • BMI 37-69 (51.2)
    • % EWL 33-85 (55)
    • 12 studies >100 patients
    • FU>36 months –3 studies
    • FU>60 months –1 study
    • SOARD 2009;5:469-475
    • Follow-up Intervals
    • 3 y 123 patients
    • 4 y 26 patients
    • 5 y 8 patients
      • SOARD 2010. In press
  • 4. Aim
    • To examine weight-loss outcomes from laparoscopic sleeve gastrectomy as a definitive bariatric procedure at prolonged follow-up
  • 5. Study Design
    • Period: 2000-2007
    • Hospitals
      • The General Infirmary at Leeds
      • The Leeds Nuffield Hospital
    • 3 consultant surgeons
    • Exclusion
      • Initial explicit intent as a staging procedure and subsequent completion of duodenal switch
  • 6. Patient Characteristics
    • 77 patients
    • Men: 27%
    • Median Age: 46 y (19-71)
    • 26% aged ≥50 y
    • Previous gastric band
      • 4 patients
    • Median Weight: 144 kg (89-283)
    • BMI ≥50 kg/m 2 : 57%
    • Median BMI
    • 53 kg/m 2 (29-83)
  • 7. Technique
    • Calibration with 32F bougie
    • Preservation of 5-7 cm of antrum
    • Staple line reinforcement with Peristrips ™ or SeamGuard ™
  • 8. Post-operative Complications
    • Staple line leakage 5 patients (6%)
    • No mortality
  • 9. 2 nd Stage Procedure (Intent not explicitly stated initially)
      • Median interval: 30 months (18-96)
      • 9 patients (12%)
        • Roux-en-Y gastric bypass 7
          • Initial BMI ≥50 kg/m 2 5 patients
        • Duodenal Switch 2
          • Initial BMI ≥50 kg/m 2 1 patient
  • 10. Weight Loss after Sleeve Gastrectomy as a Primary Procedure 55 70 74 76 74 61 69 66 51 25 20 15 9 8 8 5 Number of patients
  • 11. BMI<50kg/m 2 vs. Super-Obese 1 year after Sleeve Gastrectomy 77 49 P=0.02 22 29 Number of patients
  • 12. BMI<50kg/m 2 vs. Super-Obese 3 years after Sleeve Gastrectomy 74 74 P=0.7 10 10 Number of patients
  • 13. Conclusion
    • Sleeve gastrectomy, as a stand-alone procedure, provided median EWL >60% for up to 8 years
    • Super-obese patients had significantly less excess weight loss at one year (49% vs. 77% for BMI <50 kg/m 2 ) but no apparent difference at three years