Pawanindra Lal, MSFRCSEdFRCSGlasgFRCSEngFACS, Anubhav Vindal, MSMRCSEd, FCLS, Lovenish Bains, MSFCLS. Division of Minimal Access Surgery, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi.
Surgical treatment of morbid obesity comprises of restrictive, malabsorptive and combined restrictive and malabsorptive procedures. Laparoscopic sleeve gastrectomy (LSG) has evolved as a stand-alone procedures for treatment of morbid obesity in obese & super-obese patients. We present our initial experience with laparoscopic sleeve gastrectomy from a tertiary care university teaching hospital in a developing country.
Methods and Procedures
Over a period of 3 years, LSG was performed in 50 patients attending the metabolic surgery clinic of a tertiary care university teaching hospital. The standard 5 port technique was used and the gastric sleeve was fashioned over a 36 F bougie. The patients were orally allowed on first post operative day after performing an oral contrast study to check for any staple line leaks. Patients were evaluated for operative time, intra and post operative complications, post-operative recovery and hospital stay. All patients were periodically assessed for weight loss, resolution of comorbidities and nutritional deficiencies on follow up.
Out of the 50 patients, 13 were males and 37 were females with an average age of 37.04 years (range 21 – 54). The average BMI was 47.19 (range 34.89 – 65.43). There were 37 morbidly obese patients with an average BMI of 44.18 (range 34.89 – 49.9) and 13 super obese patients with an average BMI of 53.47 (range 50.22 – 65.43). All the patients had one or more comorbidities at the time of presentation, including hypertension, diabetes mellitus, hypothyroidism, obstructive sleep apnoea and osteoarthritis. In the post operative period, no patient had wound infection, chest complications, staple line bleeding or leak. One patient had an iatrogenic rupture of the lower oesophagus due to inadvertent inflation of the balloon of the gastric bougie in the lower oesopagus. Another patient had drain erosion into the gastrooesophageal junction with a resultant oesophageal fistula formation. Both were managed conservatively with endoscopic means. There was instant resolution of hypertension and diabetes in all the patients with no patient requiring any medications post operatively. The mean percent excess weight loss was 29.13 at 6 weeks (range 9.6 – 50), 41.47 at 3 months (range 25.93 – 67.3), 53.62 at 6 months (range 37.28 – 78.8), 64.75 at 12 months (range 43.6 – 90.38), 67.69 at 18 months (range 33.33 – 85.41) and 59.82 at 24 months (range 23.66 – 86.2). Fifteen patients were evaluated for nutritional deficiencies at follow up. Vitamin D deficiency was found in 7 patients at 6 weeks, in 4 patients at 6 months and in 2 patients at 12 months. Vitamin B12 deficiency was seen in 2 patients at 6 weeks, in 5 patients at 3 months, in 2 patients at 6 months and in 1 patient at 12 months. Iron deficiency was seen in 5 patients at 6 months. All patients experienced significant improvement in quality of life.
LSG was found to be an effective and safe procedure for achieving excess weight loss, resolving co-morbidities, and improving the quality of life in both morbidly obese and super obese patients.