Institutional Improvement in Weight Loss Following Laparoscopic Sleeve Gastrectomy

Christopher W Mangieri, MD, Matthew Strode, DO, William Sherman, MD, Yong Choi, MD, Byron Faler, MD. Dwight D. Eisenhower Army Medical Center

Background: Laparoscopic sleeve gastrectomy (LSG) is a recent addition to the bariatric surgery armamentarium. It has been well demonstrated to be an efficacious stand-alone bariatric procedure in regards to weight loss and comorbidity improvement. This study evaluates the progress of our initial experience with LSG at Dwight D. Eisenhower Army Medical Center (DDEAMC) during the time period of 2008-2010.

Methods: This is a retrospective review of prospective data from our LSG caseload at DDEAMC from 2008-2010. During that time, we performed 159 LSG. In our review, we compared data between our first operative year of experience with LSG (2008) and our third year of experience (2010). We compared data for up to 3 years post-operatively. Our focus endpoint was in post-operative weight loss, specifically percentage of excess body weight loss (%EWL) and percentage of excess BMI loss (%EBL).

Results: We found an institutional improvement in our %EWL and %EBL rates as our collective experience increased with LSG. There was a mean increase in %EWL of 14% and mean increase of %EBL of 22% when we compared our first year of surgical experience to our third year of experience with LSG. We also found that as an institution in our first year performing LSG, we attained an average of <50% EWL which is often cited as a benchmark level for “success” following bariatric surgery. By our third year of experience with LSG, however, we did achieve >50% EWL at all years of post-operative follow-up.

Conclusion: As an institution, we achieved improvement in our weight loss results with LSG as the collective experience increased. Since there was no identifiable technical or patient related factor which could adequately account for this, we hypothesize that several factors could have contributed to this observation. A surgical mentorship program and the institution of formal and more rigorous pre- and post-operative nutritional education are possible causes. Overall, our surgeons performing LSG benefited from the collective experience of the institution regardless of whether they had established experience with LSG or if they recently started performing the procedure. This study demonstrates that institutional experience is a significant factor in weight loss results with LSG.