sleeve gastrectomy. when ? indications contraindications ?
Post on 03-Jan-2016
257 Views
Preview:
TRANSCRIPT
Sleeve Gastrectomy
• First step in Super Super Morbidly Obese Patient
– Followed by RYGBP or BPD
• First step to a Non Bariatric second procedure
– Followed by Hip replacement, Recurrent
Incisional Hernia, pull through procedure for
UC, etc
Indications
Sleeve Gastrectomy
• Final step in ASA IV Morbidly Obese Patient
– Low EF, Heart ort Kidney transplant
• Final step if that is the patients choice
• Final step in Cohn's disease
• Final step in extremes of age
– Adolescents ( no needles !!!!!!)
– Elderly
Indications
Sleeve Gastrectomy
• Final Step after failed Malabsorptive procedure
– Reversal of JIBP
• Final step in poor candidate for RYGBP/BPD
– Smoker, Coumadin, etc
• Final step in high risk stomach
– Chile, Colombia, Japan. High incidence of
gastric cancer !!
Indications
Sleeve GastrectomyProbability of Developing Complications after Gastric Bypass according to
Weight
Livingston et al. Annals of Surg. Nov 2002. 576-582
Sleeve Gastrectomy
Review of the Literature
• Almogy G, Crookes PF, Anthone GJ. Longitudinal
gastrectomy as a treatment for the high-risk super-obese
patient. Obes Surg. 2004 Apr;14(4):492-7
RESULTS:
• At 12months: Median weight loss: 44.5 kg,
• % EWL 45.1%.
• After 1 year: 40% of the followed patients achieved
more than 50% EWL and another 50% needed less
medications for their associated co-morbidities
Sleeve Gastrectomy
Sleeve to LGB
January 2002 to February 2004
N 2186 Primary bariatric procedures
performed.
N 123 Consecutive laparoscopic sleeve
gastrectomies using a 50 F Bougie
N 23 Patients completed the second stage
LRYGBP.
Schauer et al
Sleeve Gastrectomy
Results of LSG
Operative time 174 ± 51 min
Length of stay 3 ± 1.7 days
Death 0
EWL one year 46 %
Schauer et al
Sleeve Gastrectomy
Down staging Pre-SGL Pre-LRYGB
BMI 63 48
ASA IV 56% 1%
ASA III 43% 34%
ASA II 65 % 0%
Co morbidities 10 6
Sleep Apnea 82% 43%
T2DM 60% 23%
Peripheral edema 100% 0%
Schauer et al
Sleeve Gastrectomy
RESULTS
N 130 N 130
LSG between Nov 04 and Jan 07LSG between Nov 04 and Jan 07
2.4 2.4 femalefemale : 1 male : 1 male
Mean age Mean age 45.645.6 (12 -79) years (12 -79) years
Mean preop. weight was Mean preop. weight was 122.4122.4 (95.5 - (95.5 -
206.1) Kg206.1) Kg
The mean BMI was The mean BMI was 43.243.2 (30.2 - 75.4) Kg/m2 (30.2 - 75.4) Kg/m2
Sleeve Gastrectomy
RESULTS
Mean operative time Mean operative time 9797 (range: 58 – 180) (range: 58 – 180)
minsmins
No conversionsNo conversions
Mean hospital stay was Mean hospital stay was 3.23.2 (range: 1 – 19) (range: 1 – 19)
days.days.
There was There was no mortality no mortality in this series.in this series.
Sleeve Gastrectomy
RESULTS
N 130Initial 3 m 6 m 12 m 18 m
24 m
BMI (Kg/m2)
WL (Kg) *
%EWL
43.2
0
0
36.9
21.0
33.1
32.8
31.2
50.8
29.5
37.4
62.2
28.0
39.5
64.4
27.1
41.7
67.9
Sleeve Gastrectomy
Results
Table 1. Total Sample Demographic Characteristics (N=30)
Age (Yrs) Gender Type of DM Duration
(N=30) (N=30) (N=30) (N=30)
42.3 F - 21(70%) Type I - 3 (10%) <5 years-16(53%)
(21-69) M - 9 (30%) Type II - 27 (90%) >5 years-14(47%)
Sleeve Gastrectomy
DISCUSSIONAuthor No Initial BMI
(g/m2)
Follow up in
(Months)
%EWL
1 to 2 years
Baltasar
Cottam
Han
Himpens
Hammoui
Lee
Mognol
Silecchia
Rosenthal
31
126
60
40
118
216
10
41
130
*
65
37
39
55
49
64
57
43.2
3 – 27
12
12
12
12
24
12
12
24
62.3/NR
45/NR
81/NR
58/NR
49/NR
58 / 83
51/NR
NR/NR
62.2 / 67.9
Sleeve Gastrectomy
Questions that remain open to be answered:
• What will be the %EWL at 15 years when compared
to RGBP ?
• Will the gastric tube dilate ?
• What is the best size of the boogie ?
• Will Ghrelin levels drop and stay down as expected ?
Sleeve Gastrectomy
Questions that remain open to be answered:
• What % of SG will be converted to RYGBP ?
• Will the long term results be as good as other
purely restrictive procedures as LAGB/VBG
Sleeve Gastrectomy
Conclusions
• Not all bariatric patients face the same
operative risk
• Sleeve Gastrectomy is a valid surgical option
for weight loss with excellent short term
outcomes
Sleeve Gastrectomy
Conclusions
• Unknown long term outcomes
• May be an option for the very low and very
high risk patients
• Excellent option for the elderly and
adolescents
top related