Laparoscopic Sleeve Gastrectomy Outcomes (LSG): Experience from Kuwait

Salman Al Sabah, MD, MBA, FRCSC, Ahmed Al-Mulla, MD, FACS, Sulaiman Almazeedi, MD, Talib Jumaa, MD, FACS, Khaled Al-Enezi, MD, FRCSC, Waleed Bastaki, MD, FACS. Amiri Hospital, Kuwait.

Background
With 80% of its population overweight, 47.5% obese, and having the 8th fattest population worldwide, Kuwait has a serious obesity problem. This has led to a widespread practice of bariatric surgery specially LSG. This study aims to look at clinical outcomes, role of preoperative endoscopy, abdominal ultrasound and gastric histopathologies of patients who have undergone LSG at Al-Amiri Hospital, Kuwait.

Methods
A retrospective study was conducted of the gastric pathology specimen results of 1202 patients who underwent LSG at Al-Amiri Hospital from 2008 to 2012 (5 years).

Results
A total of 1202 patients, the average age were 34 years, and 889 (74%) were female while 313 (26%) were male, 135 (11%) adolescences age (12-21). Median BMI was 45 (30-105). Percentage Excess weight loss was 77% at 4 years. 185 patients (15%) were diabetics with 54% resolution rate. The histopathology results of 656 patients identified 488 (74.4%) cases with chronic gastritis, 63 (9.6%) with follicular gastritis, 12 (1.8%) with atrophic gastritis and 12 (1.8%) cases showed rare significant findings. H. Pylori was discovered in 48 (7.3%) of the patients. No statistical significance (p=0.71) was seen between the overall complication rate and H. Pylori. 747 patients had pre-operative ultrasonography; 240 patients (32.1%) had normal results, 83 (11.1%) were found to have gallstones, 427 (57.2%) had fatty liver, and 55 (7.4%) had other pathologies. There was no statistically significant association between BMI and gallstones (p=0.545) and BMI and fatty liver (p=0.418). Morbidity and mortality was recorded.

Conclusions
Our experience with LSG indicates that this is an effective and safe procedure for the treatment of obesity in Kuwait it resulted in a 53.3% remission of Type 2 DM. In view of gastric histopathology results, routine histological examination of the gastric specimens is highly recommended. No association between H. Pylori infection and post-LSG complications. Trans-abdominal ultrasonography screening does not add significant information to the pre-operative workup and should be reserved for indicated patients.

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