Emanuela Silva Alvarenga, MD, Konstantinos Alfaras-Melainis, MD, Katia Rodriguez, MD, Esteban Ivanoff, MD,, Sean Johnson, MD,, Emanuelle Lo Menzo, MD, FACS, Samuel Szomstein, MD, FACS, Raul Rosenthal, MD, FACS. Clevelan Clinic Florida
Introduction
The technical simplicity associated to good short-term outcomes of the laparoscopic sleeve gastrectomy (LSG) has led it to be performed as a final surgical treatment of obesity. and its co-morbidities by a mounting number of bariatric surgeons. However, weather the success of the LSG endures along the years has not being consistently demonstrated.
We aim to present a large series of consecutive laparoscopic sleeve gastrectomy performed at this center of excellence in bariatric surgery.
Methodology
A retrospective study with prospectively collected data was conducted, after institutional review board approval, on all patients who underwent LSG for morbid obesity between January 2005 and February 2014 at the Bariatric & Metabolic Institute of the Cleveland Clinic Florida.
Status of comorbid conditions including type-2 diabetes, hypertension, sleep apnea, hyperlipidemia, degenerative joint disease, and gastroesophageal reflux disease was determined on the basis of medical records, when available, or patient’s interview by a health care provider.
Results
A total of 1040 LSG have been performed during the study period. Twenty patients were not incorporated into the analysis due to insufficient available data. The patients included were, 66.6% female, mean age of 38.4 ± 16.5 years at the time of surgery. Over the entire follow-up period, 57% of diabetic patients had either significant improvement or remission of their diabetes. Similar results were seen with hypertensive patients, 91% of whom experienced major improvement or remission of their disease. 99% showed improvement of sleep apnea and 79% of the hyperlipidemia.
There were no postoperative deaths. Mean hospital length of stay was of 3.4 ± 2.1 days, with 3.8% overall rate of early readmissions, most commonly for dehydration due vomiting (table 1).
Long term morbidity as leak, stricture, and gastroesophafic reflux disease-GERD) occurred at 0.1% (n=1), 0.73% and 6%, respectively (table 1).
Conversion rate to Roux-en-Y gastric bypass was of 1.25% (0.52% due to GERD and 0.43% for weight regain). Loss of follow up at 3, 5 and 8 years was of 81%, 87% and 92%, respectively. Mean % EWL at 3 to months, 1, 3, 5 and 8 years was of 72±16.8, 86±22.3, 63±19, 61±11 and 52 ± 9.2, respectively.
The overall success rate (%EWL> 50%) was of 92% after 1 year, 89% after 3 years, 75% after 5 years and 73% after 8 years (Figure 1, table 2). The overall mean follow-up was of 24.2 ± 26.2 months..
Conclusions
Sleeve gastrectomy is an effective weight loss procedure with high success rates, and significant improvement of obesity-related comorbid conditions. It has been shown to present with very low rates of early and long term complications on large volume centers.