Peri-operative Outcomes of Laparoscopic Sleeve Gastrectomy and Effectiveness Short to Medium Term Weight Loss and Improvement of Diabetes Mellitus

C M Hoogerboord, MBChB MMed FCSSA FRCSC, S Wiebe, MD FRCSC, D Klassen, MD FRCSC, D Lawlor, NP, J Ellsmere, MD MSc FRCSC. Department of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada

 

 Introduction Laparoscopic Sleeve Gastrectomy (SG) is increasingly being performed as a one stage procedure with short and medium term weight loss and improvement in obesity associated co-morbidities comparable to Roux-en-Y Gastric Bypass (RYGB). The aim of our study was to evaluate our experience with SG in terms of peri-operative outcomes and improvement of glucose control and decrease in hypoglycemic medication use over the short to medium term.

 Methods and Procedure A retrospective review of all SGs performed at a university teaching hospital was conducted. A six port technique was used. A 15mm optical trochar was placed in the left upper quadrant (LUQ) for insufflation. The distal transection point was 5cm from the pylorus. A 42 F bougie was used to size the sleeve. At the gastro-esophageal junction (GEJ), 1cm of fundus was preserved. Routine buttress material was not used. Selective clipping and suturing was performed for staple line bleeding with routine endoscopy to assess for luminal bleeding and extraluminal leaks.

Results Between September 2007 to July 2011, 166 consecutive patients underwent SG.  The majority of patients were female (82%), mean age was 44 years (16-68, range). Mean pre-operative BMI was 49.6 kg/m2 (29.3-73.5, range). Most patients had previous abdominal operations (63%). Median operative time was 93 min (56-232, range). One case (0.6%) was converted to an open operation. Mean hospital stay was 2 days.
   There was no deaths. Intra-operative blood loss was negligible except for four cases, two of which were managed non-operatively. Two patients (1.2%) required intervention; one patient returned to OR the day of surgery and was managed laparoscopically, one returned on day one, requiring laparotomy and splenectomy. A water soluble contrast study was performed in all patients on post op day one. There were no early staple line leaks. One patient (0.6%) presented with a delayed leak 7 days post op and required surgical drainage of an abscess. Early complications (within 30 days post op) included three cases (1.8%) of superficial site infections, one patient developed a urinary tract infection (UTI). There were two cases of gluteal nerve neuropraxia. One patient was re-admitted with dehydration secondary to vomiting.
   Follow up was 98% (158/162) at 1 month, 64% (90/140) at 6 months, 38% (41/109) at 12 months, 13% (10/78) at 18 months and 11% (5/44) at 24 months. Mean BMI and percent excess weight loss (%EWL) were 43.6 (27-68, range) and 25.3% (0.34-45.9, range) at 1 month, 38.0 (26-57.7, range) and 49.3% (18.9-92.4, range) at 6 months, 36.0 (26.0-48.5, range) and 54.2% (21.7-95.9, range) at 12 months, 36 (26-50 range) and 60% (42-95 range) at 18 months and 37 (29-51range) and 64.4% (38.3-101 range) at 24 months.  Of the study group, 87 (52%) had diabetes mellitus. Glucose control improved in 79 (91%) patients and hypoglycemic medications were either stopped or significantly decreased in 66 (77%) patients.

Conclusions SG is a safe and effective primary weight loss procedure with improvement of diabetes mellitus up to one year. A national bariatric surgery data registry would improve long term follow-up.

 


Session Number: Poster – Poster Presentations
Program Number: P457
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