Long term outcomes of the laparoscopic sleeve gastrectomy

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Long term outcomes of the laparoscopic sleeve gastrectomy

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

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