Sleeve gastrectomy in patients with BMI between 30 and 35

Marcos Berry, MD, Patricio Lamoza, MD, Lionel Urrutia, MD, Eduardo Luna, MD, Macarena Haddad, MD. Clinica Las Condes.

 
Introduction
The laparoscopic sleeve gastrectomy is a well-recognized bariatric procedure for the obese population. It has been adopted worldwide. There are a large group among obese patients, with grade I obesity (BMI of 30-35 kg/m2) who are not candidates for bariatric surgery, based on NIH recommendations. However it is well known, that many of these patients have metabolic syndrome and increased cardiovascular risk. The development of this technique in some cases has been extended to patients with BMI under 35 with associated comorbidities that are similar or even worse compared to higher BMI population. There are clinical studies reported elsewhere with good results with the LSG in these patients.
In this report, we show our experience performing LSG in patients with BMI between 30 and 35 and show the results in regards to safety, weight loss and resolution of their comorbidities

Methods and Procedures
Descriptive and retrospective study. We analyzed 347 patients, analyzing gender, age, comorbidities, preoperative BMI, EWL, EWL% and BMI postoperatively at 1, 6, 12 and 24 months, morbidity and mortality.

Results
Mean preoperative BMI 34.1 (30, 9–34, 9), mean weight 90.6 (73–107) kg, Mean postoperative BMI at 24 months 27, surgical time 86.2 (40-120) min.
Comorbidities: Insulin resistance 76.2%, Dyslipidemia 66,2%, Fatty liver 57,1%, Hypertension 33,4%, Obstructive sleep apnea 17%, Hyperuricemia 9,5%, Hypothyroidism 14,5%, Type 2 Diabetes mellitus 7,4%.
Remission of comorbidities: Insulin resistance 90%, Dyslipidemia 90%, Fatty liver 70%, Hypertension 70%, Obstructive sleep apnea 70%, T2DM 82% and improvement 18%.
Morbidity: 7 (2%); Hemoperitoneum = 5, Portal vein thrombosis = 1, Bile peritonitis (Lushka-cholecystectomy) = 1, Leaks = 0, Reoperations = 0, Mortality = 0.

Conclusions
LSG is a safe and reproducible technique in patients with BMI under 35, with low morbidity and mortality . In our series this results are very encouraging with excellent weight loss in the midterm. So we believe that it should be considered as a good surgical alternative in this group of patients.

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