long term outcomes of the laparoscopic sleeve gastrectomy
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Long-Term Outcomes of the Laparoscopic Sleeve
Gastrectomy as a Definitive Bariatric Procedure
Abeezar Sarela, Ashok Menon, Mary O’Kane, Simon Dexter, Michael McMahonThe General Infirmary at Leeds & The Leeds Nuffield Hospital
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Sleeve GastrectomyCurrent Status
Updated Position Statement on Sleeve Gastrectomy as a Bariatric Procedure
– Clinical Issues Committee of the ASMBS.
SOARD 2010 In press.
•Systematic review of sleeve gastrectomy as staging and primary bariatric procedure.
– Brethauer, Hammel, Shauer. SOARD 2009;5:469-475
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Sleeve GastrectomyAvailable Long-Term Follow-Up Data
• 36 studies-2570 patients
• BMI 37-69 (51.2)
• % EWL 33-85 (55)
• 12 studies >100 patients
• FU>36 months –3 studies
• FU>60 months –1 studySOARD 2009;5:469-475
Follow-up Intervals
•3 y 123 patients
•4 y 26 patients
•5 y 8 patients
SOARD 2010. In press
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Aim
To examine weight-loss outcomes from
laparoscopic sleeve gastrectomy as a
definitive bariatric procedure at prolonged
follow-up
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Study Design
• Period: 2000-2007
• Hospitals–The General Infirmary at Leeds–The Leeds Nuffield Hospital
• 3 consultant surgeons
• ExclusionInitial explicit intent as a staging procedure and subsequent completion of duodenal switch
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Patient Characteristics
• 77 patients• Men: 27%• Median Age:
46 y (19-71)• 26% aged ≥50 y• Previous gastric band
– 4 patients
• Median Weight: 144 kg (89-283)
• BMI ≥50 kg/m2: 57%
Median BMI
53 kg/m2 (29-83)
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Technique
• Calibration with 32F bougie
• Preservation of 5-7 cm of antrum
• Staple line reinforcement with Peristrips™ or SeamGuard™
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Post-operative Complications
• Staple line leakage 5 patients (6%)
• No mortality
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2nd Stage Procedure(Intent not explicitly stated initially)
•Median interval: 30 months (18-96)
•9 patients (12%)
• Roux-en-Y gastric bypass 7• Initial BMI≥50 kg/m2 5 patients
• Duodenal Switch 2 • Initial BMI≥50 kg/m2 1 patient
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Weight Loss after Sleeve Gastrectomyas a Primary Procedure
55
70 74 76 74
6169 66
51 25 20 15 9 8 8 5
Number of patients
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BMI<50kg/m2 vs. Super-Obese1 year after Sleeve Gastrectomy
77
49
P=0.02
22 29Number of patients
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BMI<50kg/m2 vs. Super-Obese3 years after Sleeve Gastrectomy
74 74
P=0.7
10 10Number of patients
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Conclusion
• Sleeve gastrectomy, as a stand-alone
procedure, provided median EWL >60%
for up to 8 years
• Super-obese patients had significantly less
excess weight loss at one year (49% vs.
77% for BMI <50 kg/m2) but no apparent
difference at three years