Laparoscopic sleeve gastrectomy in Morbid obesity and Type 2 Diabetes – Outcome in Chinese

Simon K Wong, MD, Shirley Y Liu, MD, Candice C Lam, RN, Enders K Ng, MD

The Chinese University of Hong Kong

Background: Laparoscopic sleeve gastrectomy (LSG) is increasingly advocated as a primary bariatric procedure for morbid obesity. This study aims to evaluate the outcomes of LSG as a stand-alone operation in achieving weight reduction and T2DM in Chinese.

Methods: We conducted a retrospective review of a prospectively collected database of LSG in a single institute. Data regarding patient demographics, operative outcomes, postoperative percentage of excess weight loss (%EWL) and glycemic control of T2DM patients were analyzed. Fasting ghrelin levels compared in 8 patients before operation, 3 months and 24 months afterwards.

Results: Between May 2006 and August 2012, one hundred and five patients (41males, mean age of 38.3±10.7years) underwent LSG for morbid obesity. Their preoperative mean body weight was 113.4±22.4kg and body-mass-index was 41.8±7.7kg/m2. Forty-seven patients (45%) suffered from T2DM and 32 (70%) of them cannot achieve optimal glycemic control (HbA1c <7%) and 16 of them require insulin therapy (34%). There was no open conversion or operative mortality and complications occurred in 11 (10%) patients, including 4 gastric tube stricture, 2 staple line leakage, two intra-abdominal hematomas and 3 wound infection. The mean %EWL were 69.5±28.4%, 64.2±24.5%, 61.5±21.7% ,51.7±20.7% and 43.3±30.7% at 1-year, 2-year, 3-year, 4-year and 5 year follow-up respectively. Fasting ghrelin level is significantly reduced at 3 months (279.7 ±109.9pg/ml to 125.1 ±44.2pg/ml, p=0.008) 3months but raise again at 2 years after surgery (171.7±34.1pg/ml, p=0.011). At mean follow-up of 22.7±18.9 months, diabetes remission occurred in 49% of T2DM patients, with 23 patients (24%) still have suboptimal DM control and 7 patients (43%) can stop insulin therapy after surgery. Six (5.7%) patients required revisional laparoscopic gastric bypass due to insufficient weight loss (n=1) and gastric tube stricture (n=2) and poor control DM (n=3).

Conclusion: Laparoscopic sleeve gastrectomy is effective as a stand-alone procedure in achieving significant weight reduction. Some weigh regain is noted which is associated with increase of ghrelin level after 2 years. Diabetes resolution and improvement is evident in majority of the treated patients.

Session: Poster Presentation

Program Number: P399

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