Brian Housman, MD, James Nguyen, MD, Krystyna Kabata, PA, Matthew Lippel, BA, Piotr Gorecki, MD. New York Methodist Hospital
INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) is recognized as a reliable surgical option for weight loss in morbidly obese patients. There are several factors that have been associated with poor weight loss following bariatric procedures. While many studies examine the benefits of early post-operative ambulation, few examine the association with long term weight loss. We evaluate these relationships.
METHODS: All patients undergoing LSG between September 2014 and August 2016 at a single institution were included. Patients, residents and staff were all instructed on the benefits of early ambulation (which we define within twenty-four hours) and formal protocols were established. Routine orders were given to assist and ambulate patients postoperatively. Surveys were given to both nurses and patients. All patients then followed in an outpatient clinic, and their weights were recorded at 1 week, 1 month, and 3 month intervals until 18 months. Weight loss was then stratified by early ambulators versus non-ambulators who walked 2 hours after surgery, 6 hours after surgery, and every 4 hours during the night.
RESULTS: There were 237 patients who underwent LSG by a single surgeon (PG), at a single institution included in the study. In the first 24 hours, 232 (98%) patients ambulated; 192 (81%) within 2 hours, 222 (94%) within 6 hours, and 174 (73%) every 4 hours. Among the reasons for not ambulating, Fatigue (19%) was the most common followed by pain (11%), dizziness (8.0%), and breathing difficulty (3.0%).
All 237 patients had positive weight loss following LSG. Average weight loss at each time point is calculated as 12.76 lbs. at 1 week, 29.10 lbs. at 1 month, 40.85 lbs. at 3 months, 48.2 lbs. at 6 months and 59.2 lbs. at 9 months. There was no significant difference in weight loss between early ambulators and non-ambulators at any time interval. There was, however, an observable trend of higher weight loss at 6 months (54.8 and 33.2 lbs.) and 9 months (64.4 and 43.4 lbs.) for patients who ambulated at 6 hours following surgery (p = 0.45 and 0.69, respectively).
None of the patients experienced thromboembolic or pulmonary complications.
DISSCUSSION: There is an observable relationship between early post LSG ambulation protocols and post-operative weight loss. More patients with longer follow ups are required to describe this relationship more definitively.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79794
Program Number: P518
Presentation Session: Poster (Non CME)
Presentation Type: Poster