Laparoscopic Sleeve Gastrectomy for Obesity: Can It Be Considered a Definitive Procedure?

Edward Chao, MD, Yana Etkin, MD, Lynn Merklinger, NP, Jayne A Lieb, MD, Ajay K Chopra, MD. Jacobi Medical Center, Albert Einstein College of Medicine

Providing bariatric surgical services is a challenge with an inner-city population. In some areas of NYC, the incidence of super obesity and multiple obesity related co-morbidities is high. Laparoscopic Sleeve Gastrectomy (LSG) has been proposed as a simpler operation with low incidence of morbidity and mortality especially for severely obese. We have offered LSG as an alternative to other bariatric procedures since June 2006.
One hundred and seventy nine LSG’s were performed from June 2006 to February 2010 by a single surgeon. It consisted of 152 females and 27 males. All operations were completed laparoscopically. Mean age was 39.0 years (range: 18-64), with mean pre-operative BMI of 49.2 kg/m² (range 35.0-77.3). Mean excess weight loss at 3 months was 31% (12-57%), at 6 months was 46% (20-100%), at 12 months was 57% (19-108%), at 2 years was 62% (14-114%) and 3 years was 62.3% (43-90%). Resolution/improvement of co-morbidities post-operatively was 55.7% for hypertension, 74.13% for diabetes, 45.65% for asthma/shortness of breath, 48.8% for obstructive sleep apnea, and 20.9% for gastroesophageal reflux disease. There were no mortalities. There were 26 (14.5%) complications – 4 anastomotic leaks (2.23%), 3 intra-operative hemorrhages (1.7%), 4 sleeve obstructions (2.23%) and 6 patients with new onset acid reflux (4.4%). Ten patients (5.6%) required conversion to gastric bypass for refractory reflux or obstructive symptoms.
CONCLUSIONS: In this unique experience, LSG is a safe and effective bariatric operation, with satisfactory weight loss and modest complication rates. Although long term data are still not available, it appears to be a definitive alternative to other bariatric procedures.

Session: SS09
Program Number: S042

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