Clinical efficacy of laparoscopic sleeve gastrectomy in obese adolescents / 中华消化外科杂志

Objective:To investigate the clinical efficacy of laparoscopic sleeve gastrectomy in obese adolescents.Methods:The retrospective and descriptive study was conducted. The clinical data of 37 obese adolescents who were admitted to Drum Tower Hospital Affiliated to Nanjing University Medical School between July 2016 and August 2020 were collected. There were 18 males and 19 females, aged 18(range, 13?19)years. All patients underwent laparoscopic sleeve gastrec-tomy. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. The patients were followed up by outpatient review to detect body weight, blood glucose, blood lipid, blood pressure, nutrition situation and related complications at 3, 6 and 12 months after operation. The follow-up was up to August 2021. Measurement data with normal distribution were represented as Mean± SD. Repeated measurement data were analyzed by Repeated Measures Anova. Measurement data with skewed distribution were represented by M(range). Count data were expressed as absolute numbers or percentages. Results:(1) Surgical and postoperative situations. All 37 patients under-went laparoscopic sleeve gastrectomy successfully, the operative time was (50±7)minutes, the volume of intraoperative blood loss was (53±17)mL, and the duration of postoperative hospital stay was (3.0±0.5)days. Of the 37 patients, 2 cases had puncture infection. There was no complication such as bleeding occurred. (2) Follow-up. Of the 37 patients, 35, 31 and 22 cases were followed up at postoperative 3, 6 and 12 months, respectively. There was no anemia, malnutrition, trace element deficiency or other nutrition-related complications during the follow-up, and there was no death. The body mass, body mass index, homeostasis model assessment-insulin resistance, triglyceride, total cholesterol, systolic pressure, diastolic pressure, vitamin D, folate of the 37 patients were (117±19)kg, (40±5)kg/m 2, 6.59(range, 2.84?28.02), (1.6±0.7)mmol/L, (4.5±0.7)mmol/L, (141±22)mmHg (1 mmHg=0.133 kpa), (84±18)mmHg,(14±5)μg/L, (10±5)μg/L before the surgery, and (81±15)kg, (27±4)kg/m 2, 2.69(range, 1.08?9.71), (0.9±0.5)mmol/L, (4.5±0.7)mmol/L, (115±15)mmHg, (70±11)mmHg, (23±10)μg/L, (9±5)μg/L at postoperative 12 months. There were significant differences in the time effect of above indicators ( Ftime=214.14, 160.37, 12.66, 11.77, 2.90, 18.08, 11.32, 8.61, 5.04, P<0.05). The percentages of excess of body mass index lost of the 37 patients were 48%±19%, 77%±28% and 89%±24% at postoperative 3, 6 and 12 months, the percentages of excess weight loss were 42%±13%, 63%±17% and 75%±18%, the percentages of total body weight loss were 18%±5%, 26%±6% and 34%±7%, respectively. There were significant differences in the time effect of above indicators ( Ftime=83.96, 107.24, 109.06, P<0.05). The hemoglobin A1c was 4.8%, 5.0%, 5.1% and 4.9%, 5.2%, 5.2% in the 2 patients with type 2 diabetes at postoperative 3, 6 and 12 months, respectively, and they were relieved without drug treatment. Conclusion:Laparoscopic sleeve gastrectomy has definite short-term clinical efficacy in the treatment of adolescent obesity, which can effectively reduce excess body weight and improve the metabolic complications of insulin resis-tance, dyslipidemia and hypertension.

Estadía abreviada poscirugía bariátrica: una posibilidad real sin incrementar complicaciones ni readmisión de pacientes / Abbreviated Hospitalization after bariatric surgery

Resumen Introducción: Nuevas técnicas en cirugía bariátrica han permitido disminuir las complicaciones y la mortalidad quirúrgica. Estas mejoras han hecho posible disminuir la estadía hospitalaria y acelerar el proceso de recuperación permitiendo un potencial protocolo de alta temprana. Objetivos: Describir la experiencia en la utilización de un protocolo diseñado de estadía abreviada, en pacientes posoperados de cirugía bariátrica. Materiales y Método: Estudio analítico, retrospectivo de cohorte. Se consideró una cohorte de pacientes en que se realizó cirugía bariátrica, en Clínica Santa María, por un solo cirujano, entre julio de 2014 y abril de 2019, sometidos a un protocolo diseñado de alta temprana. Fueron registradas la morbilidad, la mortalidad, las readmisiones y reintervenciones en el periodo de tiempo registrado. Resultados: Se incluyeron un total de 775 pacientes, 654 pacientes sometidos a gastrectomía en manga laparoscópica (GEM) y 101 pacientes sometidos a bypass gástrico en Y de Roux (RYGB). Hubo 8 complicaciones, sin mortalidad registrada. La tasa de readmisión/reintervención fue de 4,13%/2,27% para GEM y 4,55%/3,53% para RYGB. Conclusiones: En este grupo de pacientes pudimos demostrar una baja tasa de complicaciones, lo que apoya la idea de que un protocolo de alta temprana en pacientes sometidos a cirugía bariátrica es una alternativa factible y segura.

Introduction: New techniques in bariatric surgery have allowed to reduce complications and surgical mortality. These improvements have made it possible to reduce the hospital stay and accelerate the recovery process, allowing a potential early discharge protocol. Aim: To describe the experience in the use of a protocol designed for an abbreviated stay, in post-operated bariatric surgery patients. Materials and Method: Analytical, retrospective cohort study. A cohort of patients who underwent bariatric surgery, at the Santa María Clinic, by a single surgeon, between July 2014 and April 2019 and submitted to a designed early discharge protocol was considered. Morbidity, mortality, readmissions, and reoperations were recorded in the established period of time. Results: A total of 775 patients were included, 654 patients undergoing laparoscopic sleeve gastrectomy (GEM) and 101 patients undergoing Roux-en-Y gastric bypass (RYGB). There were 8 complications, with no recorded mortality. The readmission/reoperation rate was 4.13%/2.27% for GEM and 4.55%/3.53% for RYGB. Conclusions: In this group of patients we were able to demonstrate a low rate of complications, which supports the idea that an early discharge protocol in patients undergoing bariatric surgery is a feasible and safe alternative.

Meta-analysis of effects of laparoscopic sleeve gastrectomy on vitamins and trace elements in obese patients / 中华临床营养杂志

Objective:To evaluate the changes in vitamins and trace elements in obese patients after laparoscopic sleeve gastrectomy (LSG).Methods:A systematic retrieval of the available literature was performed using Pubmed, Embase, Cochrane library, Web of Science, WanFang data and CNKI databases and studies were selected per predefined eligibility criteria. Statistical analysis was performed using Stata 13.0.Results:A total of 22 studies with 5320 individuals with obesity who underwent LSG were identified as eligible for inclusion. A significant increase was observed in serum 25(OH)D ( SMD = 0.59, 95% CI: 0.16 to 1.03, P = 0.007), phosphorus ( SMD = 0.28, 95% CI: 0.09 to 0.47, P = 0.004) and iron ( SMD = 0.46, 95% CI: 0.31 to 0.61, P < 0.01) after LSG. A significant decrease in serum zinc ( SMD = -0.41, 95% CI: -0.81 to -0.01, P = 0.044) was observed after LSG. But no significant changes in serum calcium ( SMD = 0.11, 95% CI: -0.14 to 0.36, P = 0.385), folate ( SMD = 0.27, 95% CI: -0.08 to 0.62, P = 0.133), vitamin B 12 ( SMD = 0.11, 95% CI: -0.25 to 0.47, P = 0.563) and magnesium ( SMD = 0.53, 95% CI: -0.08 to 1.14, P = 0.09) were observed. Conclusions:The changes of serum nutritional measurements in individuals with obesity who underwent LSG are uncertain. Therefore, it is recommended to monitor the nutritional laboratory values and add supplements when necessary to prevent postoperative malnutrition.

Clinical efficacy of laparoscopic sleeve gastrectomy in treatment of obesity associated nonal-coholic fatty liver disease / 中华消化外科杂志

Objective:To investigate the clinical efficacy of laparoscopic sleeve gastrec-tomy (LSG) in the treatment of obesity associated nonalcoholic fatty liver disease (NAFLD).Methods:The retrospective and descriptive study was conducted. The clinical data of 40 patients with obesity associated NAFLD who were admitted to Xijing Hospital of Digestive Diseases of Air Force Medical University from January 2018 to June 2019 were collected. There were 19 males and 21 females, aged (27±8)years. Patients underwent LSG after preoperative examinations and evaluations. Observation indicators: (1) surgical and postoperative conditions; (2) follow-up. Follow-up was conducted by telephone interview, WeChat, and outpatient review to detect the liver function, glucose and lipid metabolism-related status as well as the relief of comorbidities of patients at 6 and 12 months after LSG. The follow-up was up to June 2020. Measurement data with normal distribu-tion were represented as Mean± SD. Repeated measurement data were analyzed by the repeated measures ANOVA. Count data were represented as absolute numbers, and chi-square test was used for comparison between groups. Results:(1) Surgical and postoperative conditions: 40 patients underwent LSG successfully, without intraoperative conversion to laparotomy or death. The operation time, volume of intraoperative blood loss, and duration of postoperative hospital stay were (83±12)minutes, (19±7)mL and (3.7±0.7)days. Among the 40 patients, 1 case had fat liquefac-tion after LSG and 2 had abdominal distension within a month, who were improved after symp-tomatic and supportive treatment. (2) Follow-up: 40 patients were followed up at postoperative 6 and 12 months. The body mass of 40 patients was (112±17)kg, (85±16)kg, (73±11)kg before operation, at postoperative 6 and 12 months, respectively. The body mass index was (39.7±4.2)kg/m 2, (30.0±4.5)kg/m 2, (25.9±2.9)kg/m 2 before operation, at postoperative 6 and 12 months, respectively. The alanine aminotransferase was (56.40±39.51)U/L, (30.15±17.93)U/L, (26.45±9.44)U/L before operation, at postoperative 6 and 12 months, respectively. The aspartate amino-transferase was (34.03±19.62)U/L, (28.20±10.27)U/L, (24.90±8.44)U/L before operation, at post-operative 6 and 12 months, respectively. The gamma-glutamyltransferase was (48.68±28.45)U/L, (43.30±18.56)U/L, (32.80±12.09)U/L before operation, at postoperative 6 and 12 months, respectively. The fasting blood-glucose was (6.51±2.38)mmol/L, (5.64±1.51)mmol/L, (4.98±0.91)mmol/L before operation, at postoperative 6 and 12 months, respectively. The triglyceride was (1.81±0.95)mmol/L, (1.48±0.57)mmol/L, (1.17±0.44)mmol/L before operation, at postoperative 6 and 12 months, respectively. The total cholesterol was (4.77±0.98)mmol/L, (4.58±0.75)mmol/L, (4.10±0.68)mmol/L before operation, at postoperative 6 and 12 months, respectively. The low density lipoprotein cholesterin was (2.99±0.81)mmol/L, (2.79±0.54)mmol/L, (2.48±0.40)mmol/L before operation, at postopera-tive 6 and 12 months, respectively. The high density lipoprotein cholesterin increased was (1.08±0.20)mmol/L, (1.15±0.18)mmol/L, (1.45±0.21)mmol/L before operation, at postoperative 6 and 12 months, respectively. Compared with preoperative indicators, there were significant differences in postoperative body mass, body mass index, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase, fasting blood-glucose, triglyceride, total cholesterol and low density lipoprotein cholesterin ( F=472.439, 533.730, 26.791, 11.029, 25.545, 27.994, 27.534, 36.220, 18.596, P<0.05), showing a downward trend. There was a significant difference between preoperative and postoperative high density lipoprotein cholesterin ( F=68.974, P<0.05), showing a upward trend. The excess weight loss of 40 patients at 6 months and 12 months after LSG were 61%±18% and 85%±15%. The preoperative ultrasonography of 40 patients showed no, mild, moderate and severe fatty liver in 0, 2, 15 and 23 cases, respectively. The above indicators were 8, 9, 12, 11 cases at post-operative 6 months, and 23, 11, 6, 0 cases at postoperative 12 months, respectively. There was a significant difference of the grade of NAFLD between patients before and after surgery ( χ2=68.210, P<0.05). Conclusion:LSG has an accurate short-term clinical efficacy for obesity associated NAFLD, which can reduce body mass, improve liver function, alleviat the disorders of glucose and lipid metabolism and the severity of medium-severe fatty liver.

Effects of sleeve gastrectomy on body composition and glucose and lipid metabolism in early postoperative patients / 中华临床营养杂志

Objective:To observe early postoperative changes in body composition in patients receiving laparoscopic sleeve gastrectomy (LSG) and to explore the relationship between body composition and glycolipid metabolism, so as to provide stage-specific information for doctors in the weight loss team on metabolic surgery effect assessment and postoperative follow-up and guidance.Methods:The study was a retrospective cohort study. According to inclusion and exclusion criteria, a total of 44 patients who underwent LSG in the Department of Gastrointestinal Surgery, General Hospital of Ningxia Medical University from December 1, 2017 to May 30, 2021 were included. Body composition was measured using bio-electrical impedance analysis at baseline and after surgery.Results:The patients' body composition changed significantly at 1 month and 3 months after surgery, and glucose and lipid metabolism indicators improved significantly. Body composition indicators, including body mass index (BMI), the amount of moisture in the body, inorganic salts, body fat, skeletal muscle mass, fat free mass, body fat percentage, waist-to-hip fat ratio, visceral fat, basal metabolic rate and bone mineral content, decreased significantly within 3 months after surgery ( P<0.05). The ratio of upper and lower limb muscle to body weight (U/W, L/W) increased significantly after surgery ( P<0.05). The ratio of trunk muscle to body weight (T/W) decreased within 3 months after surgery ( P<0.05). Pearson and Spearman correlation analyses showed that skeletal muscle mass and U/W were positively correlated with triglyceride ( r=0.637 and 0.304, respectively, both P<0.05) in 3 months after operation. L/W was positively correlated with fasting blood glucose ( r=0.454, P<0.05). T/W was negatively correlated with triglyceride ( r=-0.643, P<0.05). Conclusions:Patients undergoing LSG displayed significant changes in body composition in the early postoperative period. Changes in muscle mass of different body parts varies and showed different effects on glucose and lipid metabolism parameters. The trunk muscle mass is negatively correlated with glucose and lipid metabolism indicators, while limb muscle mass and skeletal muscle mass are positively. It is suggested that the changes of body composition in different parts should be observed when evaluating patient outcomes after LSG and the trunk body mass should be preserved as far as possible.

Is body mass index and obesity surgery mortality score important in perioperative complications of laparoscopic sleeve gastrectomy before discharge? / Os índices de mortalidade, de massa corporal e da cirurgia da obesidade são importantes nas complicações perioperatórias de gastrectomia vertical laparoscópica antes da alta?

ABSTRACT Background: Morbid obesity surgery and related complications have increased with time. Aim: To evaluate the relationship between perioperative complications before discharge and preoperative body mass index and obesity surgery mortality score in laparoscopic sleeve gastrectomy. Method: 1617 patients who met the inclusion criteria were evaluated retrospectively. The patients were examined in terms of demographic data, presence of comorbidities, whether there were complications or not, type of complications and obesity surgery mortality score. Results: Complications were seen in 40 patients (2.5%) and mortality wasn't seen in the early postoperative period before discharge. The mean age of patients with complications was 36.3±10.02 years (19-57) and without complications 34.12±9.54 (15-64) years. The preoperative mean BMI values of patients with and without complications were 45.05±3.93 (40-57) kg/m2 and 44.8±3.49 (35-67) kg/m2 respectively. According to BMI groups 40-45 kg/m2, 45-50 kg/m2 and 50 and over, there was not any statistical significance seen in three groups in terms of complication positivity and major-minor complication rates. There was not any statistical significance seen between the patients with and without major-minor complications and obesity surgery mortality score. Conclusion: There was not any relation between perioperative laparoscopic sleeve gastrectomy complication rates before discharge and BMI and obesity surgery mortality scores.

RESUMO Racional: A cirurgia da obesidade mórbida e complicações relacionadas aumentaram com o tempo. Objetivo: Avaliar a relação entre as complicações perioperatórias antes da alta e o índice de massa corporal pré-operatório e o escore de mortalidade da cirurgia de obesidade na gastrectomia vertical laparoscópica. Método: 1.617 pacientes que atenderam aos critérios de inclusão foram avaliados retrospectivamente. Os pacientes foram examinados quanto aos dados demográficos, presença de comorbidades, ocorrência ou não de complicações, tipo de complicações e escore de mortalidade cirúrgico da obesidade. Resultados: Complicações foram observadas em 40 pacientes (2,5%) e mortalidade não foi observada no período pós-operatório imediato antes da alta. A média de idade dos pacientes com complicações foi de 36,3±10,02 anos (19-57) e sem complicações de 34,12±9,54 (15-64) anos. Os valores médios de IMC pré-operatórios dos pacientes com e sem complicações foram 45,05±3,93 (40-57) kg/m2 e 44,8±3,49 (35-67) kg/m2, respectivamente. De acordo com os grupos de IMC 40-45 kg/m2, 45-50 kg/m2 e 50 e mais, não houve qualquer significância estatística observada em três grupos em termos de positividade de complicações e taxas de complicações maiores-menores. Não houve significância estatística entre os pacientes com e sem complicações maiores e menores e o escore de mortalidade da cirurgia de obesidade. Conclusão: Não houve qualquer relação entre as taxas de complicações da gastrectomia vertical laparoscópica perioperatória antes da alta e os escores de mortalidade da cirurgia de obesidade e IMC.

Impact of Laparoscopic Sleeve Gastrectomy on Obese Type 2 Diabetic Patients and Role of Gut Hormones Peptide Tyrosine Tyrosine and Glucagon Like Peptide 1on Remission of Diabetes

Our Study Aimed: To investigate the effect of laparoscopic sleeve gastrectomy (LSG) on obese T2DM patients, its effect in remission of diabetes and role of gastrointestinal Glucagon like peptide 1(GLP1) and Peptide tyrosine tyrosine (PYY) hormones.Metabolic surgery should be recommended as an option in type 2 diabetic patients (T2DM) with body mass index (BMI) ≥40 Kg/m2, in patients who have BMI ≥35 Kg/m2and in selected patients with BMI < 35 Kg/m2, if not achieving diabetes control with maximum tolerated anti-hyperglycemic treatment. Methods:30 T2DM patients with BMI ≥ 40 kg/m2underwent laparoscopic sleeve gastrectomy after full clinical evaluation, routine blood tests, glucagon like peptide 1, Peptide tyrosine tyrosine (fasting, 0.5-hour post-mixed meal test (MMT) serum levels) and upper GIT endoscopy. Follow-up visits were at 3, 6and 9 months postoperatively to evaluate body weight, BMI and glycated hemoglobin (HbA1C) and at 18thmonth for confirmation of diabetes remission. Gut hormones were measured at 15 days and 9 months postoperatively.Results: (53.3%) of patients had partial remission of T2DM according to HbA1C remission criteria. There was significant increase in fasting and post-MMT levels of peptide tyrosine tyrosine, glucagon like peptide 1 postoperatively. The only independent predictors for remission of T2DM were the baseline serum low density lipoprotein cholesterol (LDL-Ch), duration of diabetes, preoperative post MMT Peptide tyrosine tyrosine plasma level, serum thyroid stimulating hormone (TSH) and age. Conclusions: laparoscopic sleeve gastrectomycan induce partial remission of diabetes in younger patients who had shorter duration of diabetes, higher level of preoperative post-MMT peptide tyrosine tyrosine,lower levels of preoperative serum LDL-Ch and thyroid stimulating hormone

Postoperative outcomes of patients with severe obesity who underwent laparoscopic sleeve gastrectomy: Case series

@#Globally, especially in the Asian and African regions, there has been a rising burden of obesity due to high consumption of energy-dense foods and the increase of physical inactivity caused by urbanization and sedentary lifestyle changes.1 Bariatric surgery, or weight-loss surgery, remains to be the most effective treatment for morbid obesity, and it also has resulted in a substantial improvement of obesity-related comorbidities, especially type 2 diabetes mellitus.

Application value of caesarean section scar or bikini line incisional approach in laparoscopic sleeve gastrectomy / 中华消化外科杂志

Objective@#To investigate the application value of caesarean section scar or bikini line incisional approach in laparoscopic sleeve gastrectomy.@*Methods@#The retrospective cohort study was conducted. The clinical data of 162 patients with obesity and metabolic diseases who were admitted to the First Affiliated Hospital of Jinan University between March 2018 and April 2019 were collected. There were 51 males and 111 females, aged (35±8)years, with a range from 12 to 47 years. Of 162 patients, 72 undergoing laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incisional approach and 90 undergoing laparoscopic sleeve gastrectomy via traditional incisional approach were respectively allocated into concealed incision group and traditional incision group. Observation indicators: (1) surgical situations; (2) intraoperative situations; (3) postoperative situations; (4) follow-up. Follow-up using outpatient examination, telephone interview, and WeChat was performed to detect the postoperative complications at 1, 3, 6 months and 1, 2, 5 years postoperatively up to May 2019. Measurement data with normal distribution were represented as Mean±SD, and the t test was used for comparison between groups. Count data were represented as absolute numbers, and were analyzed by the chi-square test or fisher exact probability. Ordinal data were analyzed by the Wilcoxon rank sum test.@*Results@#(1) Surgical situations: patients in the concealed incision group and traditional incision group underwent successfully laparoscopic sleeve gastrectomy, without conversion to open surgery, reoperation, or perioperative death. (2) Intraoperative situations: the operation time and volume of intraoperative blood loss of the concealed incision group were (102±17)minutes and (11±4)mL, respectively, versus (105±19)minutes and (11±4)mL of the traditional incision group (t=-1.232, -0.676, P>0.05). There were 6 cases and 21 cases with additional surgical ports during operation in the concealed incision group and traditional incision group, respectively, with a significant difference between the two groups (χ2=6.280, P<0.05). (3) Postoperative situations: in the concealed incision group, 56 patients were very satisfied with scar appearance and 16 patients were satisfied with scar appearance. In the traditional incision group, 42 patients were very satisfied with scar appearance and 48 patients were satisfied with scar appearance. There was a significant difference in the overall satisfaction with the incision scar between the two groups (Z=-4.012, P<0.05). Duration of postoperative hospital stay and total hospital expenses of the concealed incision group were (4.9±0.9)days and (64 408±5 123)yuan, versus (5.2±1.5)days and (64 953±3 477)yuan of the traditional incision group (t=-1.788, -0.804, P>0.05). There were 19 and 14 patients with gastroesophageal reflux in the concealed incision group and traditional incision group, respectively, with no significant difference between the two groups (χ2=2.894, P>0.05). There was no postoperative complication such as infection, hemorrhage or anastomotic leakage in either group. (4) Follow-up: 32 of 162 patients were lost to follow-up, including 10 in the concealed incision group and 22 in the traditional incision group; other 130 patients were followed up for 1-14 months, with a median follow-up time of 7 months. During the follow-up, 1 patient in the traditional incision group was hospitalized again at 3 months after surgery due to upper gastrointestinal bleeding, and was cured after symptomatic supportive treatment. One patient in the concealed incision group was admitted to the local hospital for functional obstruction at 1 month after surgery and was discharged after symptomatic treatment. Other patients had no readmission due to postoperative complications.@*Conclusion@#Laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incision is safe and feasible, with good cosmetic effects.

Application value of caesarean section scar or bikini line incisional approach in laparoscopic sleeve gastrectomy / 中华消化外科杂志

Objective To investigate the application value of caesarean section scar or bikini line incisional approach in laparoscopic sleeve gastrectomy.Methods The retrospective cohort study was conducted.The clinical data of 162 patients with obesity and metabolic diseases who were admitted to the First Affiliated Hospital of Jinan University between March 2018 and April 2019 were collected.There were 51 males and 111 females,aged (35± 8)years,with a range from 12 to 47 years.Of 162 patients,72 undergoing laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incisional approach and 90 undergoing laparoscopic sleeve gastrectomy via traditional incisional approach were respectively allocated into concealed incision group and traditional incision group.Observation indicators:(1) surgical situations;(2) intraoperative situations;(3) postoperative situations;(4) follow-up.Follow-up using outpatient examination,telephone interview,and WeChat was performed to detect the postoperative complications at 1,3,6 months and 1,2,5 years postoperatively up to May 2019.Measurement data with normal distribution were represented as Mean±SD,and the t test was used for comparison between groups.Count data were represented as absolute numbers,and were analyzed by the chisquare test or fisher exact probability.Ordinal data were analyzed by the Wilcoxon rank sum test.Results (1) Surgical situations:patients in the concealed incision group and traditional incision group underwent successfully laparoscopic sleeve gastrectomy,without conversion to open surgery,reoperation,or perioperative death.(2) Intmoperative situations:the operation time and volume of intraoperative blood loss of the concealed incision group were (102± 17) minutes and (11±4) mL,respectively,versus (105± 19) minutes and (11 ±.4) mL of the traditional incision group (t=-1.232,-0.676,P＞0.05).There were 6 cases and 21 cases with additional surgical ports during operation in the concealed incision group and traditional incision group,respectively,with a significant difference between the two groups (x2=6.280,P＜0.05).(3) Postoperative situations:in the concealed incision group,56 patients were very satisfied with scar appearance and 16 patients were satisfied with scar appearance.In the traditional incision group,42 patients were very satisfied with scar appearance and 48 patients were satisfied with scar appearance.There was a significant difference in the overall satisfaction with the incision scar between the two groups (Z =-4.012,P＜0.05).Duration of postoperative hospital stay and total hospital expenses of the concealed incision group were (4.9±0.9) days and (64 408±5 123) yuan,versus (5.2± 1.5) days and (64 953± 3 477)yuan of the traditional incision group (t =-1.788,-0.804,P＞0.05).There were 19 and 14 patients with gastroesophageal reflux in the concealed incision group and traditional incision group,respectively,with no significant difference between the two groups (x2=2.894,P＞0.05).There was no postoperative complication such as infection,hemorrhage or anastomotic leakage in either group.(4) Follow-up:32 of 162 patients were lost to follow-up,including 10 in the concealed incision group and 22 in the traditional incision group;other 130 patients were followed up for 1-14 months,with a median follow-up time of 7 months.During the follow-up,1 patient in the traditional incision group was hospitalized again at 3 months after surgery due to upper gastrointestinal bleeding,and was cured after symptomatic supportive treatment.One patient in the concealed incision group was admitted to the local hospital for functional obstruction at 1 month after surgery and was discharged after symptomatic treatment.Other patients had no readmission due to postoperative complications.Conclusion Laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incision is safe and feasible,with good cosmetic effects.

Laparoscopic sleeve gastrectomy for morbidly obese adolescents in Singapore

INTRODUCTION@#Laparoscopic sleeve gastrectomy (LSG) outcomes among adolescents and factors associated with adolescent obesity in Singapore were evaluated.@*METHODS@#Prospectively collected data of patients aged 16-19 years who underwent LSG was retrospectively reviewed. A lifestyle questionnaire, Berlin and Epworth scores, and Patient Health Questionnaire-9 scores were collected. Preoperative anthropometrics, comorbidities, weight loss and body composition outcomes were recorded.@*RESULTS@#Among 208 LSGs, 13 (6.3%) were performed on obese adolescents. Mean age and body mass index (BMI) at first presentation were 19.1 ± 0.9 (range 16.8-19.8) years and 46.2 ± 6.3 (range 36-57) kg/m, respectively. There was family history of obesity (n = 7) and regular consumption of high-calorie drinks (n = 12). Most patients had comorbidities (n = 12), including hypertension (n = 5), asthma (n = 4), diabetes mellitus (n = 3), hernia (n = 3) and obstructive sleep apnoea requiring continuous positive airway pressure support (n = 3). At one year, excess weight loss was 64.3% ± 34.7% (range 21.8%-101.5%), while BMI and fat mass dropped to 31.2 ± 7.6 (range 23-40) kg/m and 17.4 kg, respectively. Pain score was 2/10 at 24 hours after surgery. Mean postoperative stay was 2.7 days. No complications or readmissions occurred. Remission of diabetes mellitus and hypertension was reported in two of three and four of five adolescents, respectively, within one year of surgery.@*CONCLUSION@#LSG is a safe option for adolescents with good short-term weight loss outcomes and remission of metabolic comorbid conditions.

Does Contouring of the Sleeve Help Prevent de novo GERD after Laparoscopic Sleeve Gastrectomy? A Nonrandomized Study

PURPOSE: The authors undertook this study to compare their modified version of sleeve gastrectomy with conventional sleeve gastrectomy in terms of the severity and incidence of gastroesophageal reflux. MATERIALS AND METHODS: This study was conducted for the patients that underwent primary laparoscopic sleeve gastrectomy in a single center from 2011 to 2015. Patients that underwent conventional LSG were allocated to Group A (n=46), and sleeve contouring gastrectomy to Group B (n=45). Postoperatively %EBMIL, PPI use, and endoscopy findings, and receipt of conversion surgery were compared. RESULTS: Age, gender (F:M), and baseline BMI in groups A and B were 34.2±10.5 years vs. 30.9±8.9 years (P=0.142), 28:18 vs. 30:15 (P=0.565), and 36.8±8.9 kg/m² vs. 35.5±5.8 kg/m² (P=0.046), respectively. %EBMIL values at 1 year postoperatively were not different (P=0.946), mean durations of PPI use were 141.2±240.3 (30–1160) days vs. 71.9±24.3 (60–128) days, respectively (P=0.058). Endoscopic findings at 1 year were LA-M in 22/32 (68.8%) vs 19/24 (79.2%), LA-A in 7/32 (21.9%) vs. 5/24 (20.8%), LA-B in 1/32 (3.1%) vs. 0/24 (0.0%), and LA-C in 2/32 (6.3%) vs. 0/24 (0.0%) (P=0.483). Numbers of patients used PPIs over 1 year were 4/46 (8.77%) vs. 0/45 (0.0%) (P=0.043), and conversions to RYGP were 1/46 (2.21%) vs. 0/45 (0.0%), respectively (P=0.320). CONCLUSION: Contouring of the sleeve in LSG in this study might reduce the incidence of de novo GERD without compromising weight loss.

Short-Term Outcomes of Laparoscopic Greater Curvature Plication and Laparoscopic Sleeve Gastrectomy in Patients with a Body Mass Index of 30 to 35 kg/m²

PURPOSE: The aim of this study was the compare the midterm outcomes of laparoscopic greater curvature plication (LGCP) and laparoscopic sleeve gastrectomy (LSG) in obese patients with a body mass index (BMI) of 30 to 35 kg/m². MATERIALS AND METHODS: This single center, retrospective review of prospectively collected data was conducted for obese patients that underwent LGCP or LSG from March 2013 to February 2016. These two patient groups were compared in terms of demographics, perioperative outcomes, weight loss [percent excess weight loss (%EWL)], comorbidity resolution, and immediate and long-term complications. RESULTS: A total of 149 patients were eligible for the study. Seventy-five patients underwent LGCP (group A) and 74 LSG (group B). These two groups were matched for age, gender, and baseline BMI. Three patients in each group were readmitted for complications within 30 days postoperatively. %EWL in groups A and B were 51.1±16.9 and 47.8±20.8 at 3 months (p=0.084), 71.1±20.2 and 74.5±21.8 at 6 months (p=0.165), 77.1±18.4 and 87.8±25.1 at 12 months (p=0.002), 70.5±18.5 and 83.4±28.7 at 24 months (p=0.005), and 67.3±15.3 and 78.6±31.7 at 36 months (p=0.054), respectively. Intergroup differences in resolution rates of metabolic comorbidities between the two groups were not significant. CONCLUSION: Although mean weight loss after LGCP was inferior to that after LSG, especially after six months postoperatively, it was acceptable, and LGCP had an excellent metabolic comorbidity resolution rate in patients with BMIs, ranging from 30 to 35 kg/m².

Effect of Nutrition Intervention on Macronutrient and Micronutrient Intake in a Group of Sleeve Gastrectomy Patients

There are several approaches to treat obesity including surgery in case of morbid obesity. The number of bariatric surgery patients has increased in Jordan, but in most cases there is a lack of proper nutrition intervention, monitoring, and follow up of patients. Our aim in this study was to assess the intakes of energy, macronutrients and certain micronutrients after 3 and 6 months post-operatively. Methods: A conventional sample of 50 patients from Jordan University Hospital participated in the study; 25 in the intervention group, and 25 in the control group. The intervention group patients were counseled regarding the use of an adequate low caloric balanced diet, post-operatively. Dietary assessment based on 3-day food intakes was carried out among all the participants before surgery and 3 and 6 months post-operatively. Results: There were no significant differences between the control and the intervention groups in the intakes of macronutrients and selected micronutrients (calcium, iron, zinc, B12 and folic acid) after 3 months postoperatively. However, there were significant increases (P< 0.05) in the intakes of protein, iron, zinc, and folate in the intervention group compared with the control group after 6 months post-operatively. Conclusion: Nutrition intervention enhanced the intake of some nutrients, especially protein intake.

Influence of laparoscopic sleeve gastrectomy on nutritional status in patients with obesity / 中华临床营养杂志

Objective To assess the influence of laparoscopic sleeve gastrectomy (LSG) on the nutritional status in patients with obesity.Methods From August 2014 to July 2015, 24 obese patients underwent LSG in Dongfang Hospital Affiliated to Tongji University.Weight and nutritional status of these patients were measured pre-operatively and 3, 6, and 12 months after surgery.Results The mean body weight of the 24 obesity patients was (81.94±21.39) kg, (78.83±24.49) kg, (62.67±10.79) kg 3, 6, and 12 months after surgery, respectively, which were significantly lower than the preoperative body weight [(99.02±23.92)kg] (P=0.004).The serum levels of albumin, hemoglobin, and trace elements (including calcium, iron, zinc, magnesium, and copper) showed no significant change after surgery (all P>0.05).Plasma vitamin D[25(OH)D] increased significantly from (13.1±4.1)μg/L preoperatively to (19.8±5.3)μg/L 12 months after surgery (P=0.031).Folic acid was (6.2±3.9)μg/L before LSG and significantly increased to (14.2±9.2) μg/L 3 months later surgery (P=0.009);the folic acid level gradually decreased 6 and 12 months after LSG but was still higher than the preoperative level.Conclusion Vitamin D deficiency is present in obese patients before LSG.After surgery, while the serum albumin and trace elements have no obvious change, the vitamin D and folic acid levels remarkably increase.

Endoscopia preoperatoria en cirugía bariátrica: es realmente necesaria / Preoperative endoscopy in bariatric surgery: it is really necessary

Patologías esofagogástricas son reconocidas antes y después de procedimientos bariátricos, pero frecuentemente y severamente debatidos. Se realizó un estudio con la finalidad de comparar los hallazgos endoscópicos del aparato digestivo superior con los resultados de anatomía patológica en pacientes sometidos a bypass gástrico laparoscópico en Y de Roux y gastrectomía en manga por obesidad mórbida. Un total de 142 pacientes fueron incluidos en el estudio, todos bajo un régimen de seguimiento. Se hicieron análisis retrospectivos con hallazgos endoscópicos preoperatorios. Los reportes endoscópicos estuvieron disponibles para el total de los pacientes incluidos, asimismo los reportes de biopsias endoscópicas. El promedio de edad fue 34.7 años, 88 (61.9 por ciento) pacientes eran mujeres y 54 (38 por ciento) hombres. El hallazgo endoscópico patológico predominante fue gastritis erosiva 56.3 por ciento (80/142), seguida por gastritis nodular 17.6por ciento (25/142), hernia hiatal tipo I 3.5 por ciento (5/142), esofagitis 3.5 por ciento (5/142), duodenitis inespecífica 2.8 por ciento (4/142), pólipos gástricos 2,8 por ciento (4/142), y 18 estudios normales 12.6 por ciento. En cuanto a resultados de biopsias reportamos 243 hallazgos y el total no se corresponde con el número de casos en vista que algunos pacientes tenían más de una patología. El hallazgo más frecuente fue gastritis crónica 96.4% (137/142), infección por Helicobacter pylori 40.8 por ciento (58/142), hiperplasia foveolar difusa 14.7 por ciento (21/142), hiperplasia foveolar focal 15.4 por ciento (22/142), pólipos hiperplásicos 2.8 por ciento (4/142) y acantosis irregular 0.7 por ciento (1/142). Concluyendo de los 142 pacientes estudiados, solo 18 (12.6 por ciento) estudios resultaron normales, sin embargo, no se corresponden con biopsias indemnes, pero los hallazgos patológicos no tienen relevancia clínica, por lo que ni la endoscopia preoperato.(AU)

Esophagogastric diseases are recognized before and after bariatric procedures, but frequently and severely debated. A study with aim to compare the endoscopic findings of the upper digestive tract with the results of pathology in patients undergoing Roux en Y laparoscopic gastric bypass and sleeve gastrectomy for morbid obesity was performed. A total of 142 patients were included in the study, all under a monitoring regime. Retrospective analysis with preoperative endoscopic findings were made. Endoscopic reports were available for all patients included also reports of endoscopic biopsies. The average age was 34.7 years, 88 (61.9 percent) patients were female and 54 (38 percent) men. The predominant pathological endoscopic finding was erosive gastritis 56.3m percent (80/142), followed by nodular gastritis 17.6 percent (25/142), type I hiatal hernia 3.5 percent (5/142), esophagitis 3.5 percent (5/142), unspecific duodenitis 2.8 percent (4/142), gastric polyps 2.8 percent (4/142), and 18 normal studies 12.6 percent. As biopsy results we report total findings 243 does not correspond to the number of cases in view some patients had more than one pathology. The most common finding was chronic gastritis 96.4 percent(137/142), Helicobacter pyloriinfection 40.8 percent (58/142), foveal diffuse hyperplasia 14.7 percent (21/142), foveal focal hyperplasia 15.4 percent (22/142), hyperplastic polyps 2.8 percent (4/142) and irregular acanthosis 0.7 percent (1/142). In conclusion of the 142 patients studied, only 18 (12.6 percent) studies were normal, however the pathological findings have no clinical relevance, so neither preoperative endoscopy in the obese patient and the histological study of the stomach and duodenum appear to be justified in our population.(AU)

Measurement of Gastric Volume Before and After Laparoscopic Sleeve Gastrectomy / 中国微创外科杂志

[Summary] Laparoscopic sleeve gastrectomy ( LSG) as a sole and definitive bariatric surgery has achieved well results in terms of decreasing the body mass index ( BMI ) and percentage of excess weight loss (%EWL ) , therefore reducing the obesity-related complications , but the mechanism remains unclear .As a restrictive surgical procedure , the most important mechanism of LSG might be the reduction of the volume of the stomach resulting in a limited food intake .Therefore, to achieve the best weight loss after surgery , measuring the gastric volume is an indispensable technology .Currently, gastric capacity measurement methods include imaging measurements and intraoperative direct measurement . Imaging methods include upper gastrointestinal radiography , CT three-dimensional reconstruction , MRI and radionuclide scanning , with each having its advantages and disadvantages .In this article, the measurement methods of gastric capacity before and after LSG were reviewed .

Laparoscopic Sleeve Gastrectomy for Morbid Obesity: UAE Tertiary Care Hospital Initial Experience.

Aim: To study efficacy of Laparoscopic Sleeve Gastrectomy (LSG) for morbid obesity as a measure of weight reduction over a period of one year from May 2011 – 2012. Materials and Methods: Morbidly obese patients (n=109) referred from clinics with primary problem of obesity and consequent co-morbidities underwent the procedure LSG during a period of one year. The data included; demographics, weight of patients/BMI, Comorbid conditions, preoperative work up, indications for surgery, length of hospital stay, duration of surgery, postoperative complication and reduction of weight at 3 weeks, 3, 6 and 12 months. Results: Out of 109 patients, 94 (86%) are below 40 years of age, reflecting high prevalence of obesity in the younger population in UAE. As per gender, 67 (61.5%) are female and 42 (38.5%) male. Preoperatively, mean weight is 121±16 kg; 68 (62.4%) patients have BMI 40-50 kg/m2 and 41 (37.6%) of 35-40 kg/m2, 12 (11%) patients are diabetics (DM), 9 (8.3%) hypertensive (HTN), 12 (11%) have symptoms of Gastritis, 3 (2.8%) have shown Clo test +ve., 7 (6.4%) complaining Knee Joint pain, 3 (2.8%) with Backache, 2 (1.8%) patients are diagnosed cases of gastroesophageal reflux disease (GERD), though 58 (53.2%) have no comorbidities. Among those 107 (98.2%) patients are referred to dietitian. All patients underwent laparoscopic sleeve gastrectomy (LSG). Postoperatively, 104 (95.4%) patients were without any complication. 1 (0.9%) patient has bleeding while 4 (3.7%) has minor issues (nausea, vomiting) and there was no leak in this group of patients. On follow up, there was a significant weight loss and improvement of comorbidities: At 3 weeks post op, the mean weight was 113±16 kg, at 3 months 103±13 kg, at 6 months 92±12 kg and at 1 year 82±10 kg. Complete resolution of Diabetes Mellitus (DM) observed in 7 (58.33%) out of 12 patients and improvement in 5 (41.55%). Complete resolution of hypertension (HTN) in 5 (55.55) and improvement in 4 (44.44). Gastritis completely resolved in 10 (83.33) and improved in 2 (16.66). The patients who had knee joint pain and backache, all improved. Conclusion: LSG has clearly proven its efficacy for morbid obesity in term of weight reduction and consequent co-morbidities. It’s gaining popular in community being an acceptable and safe procedure.

Gastrectomía en manga: estudio por imágenes de sus complicaciones / Laparoscopic sleeve gastrectomy: imaging study of its complications

The incidence of obesity in Chilean adult population reaches up to 25.1 percent, according to statistics from 2013. Bariatric surgery is an alternative that has proven weight loss and resolution of comorbidities significant long term. For this reason are routine procedures in different health institutions. However, its massification and safety are not free of complications, which can be detected and treated early with the help of radiological images. The aim of this paper is to describe the most common postoperative complications of the sleeve gastrectomy and its diagnosis using different imaging techniques, mainly fluoroscopic study contrasted of the the esophagus-stomach-duodenum and contrasted enhanced computed tomography (CT) of the abdomen and pelvis. Bariatric surgeries are now routine procedures for treatment of morbid obesity. Knowledge of early and late complications and diagnosis of these using different imaging techniques allow adequate treatment, control and decreased postoperative morbidity and mortality.

La incidencia de obesidad en la población adulta chilena alcanza hasta un 25,1 por ciento, de acuerdo a cifras del año 2013. Las cirugías bariátricas son una alternativa que ha demostrado una baja de peso y resolución de comorbilidades significativas a largo plazo. Por este motivo son procedimientos rutinarios en las diferentes instituciones de salud. No obstante su masificación y seguridad, no están exentas de complicaciones, las que se pueden detectar y tratar precozmente con la ayuda de imágenes radiológicas. El objetivo de este trabajo es describir las complicaciones postquirúrgicas más frecuentes de la gastrectomía en manga y el diagnóstico mediante diferentes técnicas de imagen, principalmente el estudio fluoroscópico contrastado del esófago-estómago-duodeno y tomografía computada (TC) contrastada de abdomen y pelvis. El conocimiento de las complicaciones tempranas y tardías, así como el diagnóstico de éstas mediante las diferentes técnicas de imagen permitirá un adecuado tratamiento, control post operatorio y disminución de la morbimortalidad.