Laparoscopic Sleeve Gastrectomy: A Community Surgeon’s Initial Experience, Technique and Outcomes

John S Nelson, MD, John P Sharpe, MD, Nathaniel F Stoikes, MD, David Webb, MD, Guy R Voeller, MD, George Woodman, MD

Midsouth Bariatrics and University of Tennessee Health Science Center, Memphis, Tennessee

INTRODUCTION
Laparoscopic sleeve gastrectomy (LSG) has been gaining popularity as more data is reported on its effectiveness and safety profile. With increased experience the rate of gastric staple line leaks, bleeds and strictures seem to be decreasing. LSG is an attractive option due to the quick recovery time and effectiveness. In addition, there are not the persistent life-long risks associated with other bariatric procedures that often require emergent surgery such as internal herniation, marginal ulceration, and slipped or eroded gastric bands. The purpose of this study is to assess the safety and efficacy of LSG during the initial 130 cases performed by a single community surgeon as the definitive treatment for obesity.

METHODS AND PROCEDURES
From April 2008 to August of 2012, prospectively collected data was retrospectively reviewed on 130 patients undergoing LSG. Patients meeting NIH consensus guidelines for bariatric surgery were offered gastric bypass, adjustable gastric banding (GB) or LSG. The patients included in this study elected to undergo LSG as primary definitive procedure and were followed prospectively after their operation. The data examined includes length of procedure, percent excess weight loss (%EWL), complications, and patient reported resolution of co-morbidities.

RESULTS
The average pre-operative BMI was 46.3 (29% with BMI ≥50) and included 42 (37.7%) African Americans. Average length of procedure was 60.25 minutes. There were no mortalities, no leaks, no staple line bleeds and no strictures. There were three complications giving a complication rate of 2%. One patient underwent a negative diagnostic laparoscopy to rule out leak, one patient had a port site infection and one patient had an uneventful re-admission with pneumonia. Follow-up ranges from 1 month to 4 years (mean of 1 year), with an average %EWL of 63.3, 70.8, and 29.4 at 1, 2 and 3 years respectively (p values 0.0001).

CONCLUSIONS
LSG can be performed safely in the community setting with results equal to or superior to the laparoscopic roux-en-y or GB. LSG does not carry the long term complications associated with other bariatric procedures and therefore should be considered as the first line therapy for bariatric surgery in the community setting.

Session: Poster Presentation

Program Number: P427