Early laparoscopic sleeve gastrectomy outcomes in terms of weight loss

Objective: To investigate the outcomes of laparoscopic sleeve gastrectomy [LSG] in terms of weight loss. Study Design: Descriptive cohort study. Place and Duration of Study: Department of Surgery, Shifa International Hospital, Islamabad, from January 2009 to January 2015

Methodology: A total of 100 consecutive patients were included in the study through retrospective chart review. A 5-port technique was utilized with the gastric sleeve being created using endostapler. Postoperatively, patients gradually progressed from clear liquid diet and oral rehydration salts to nutritional supplements over three days. By two weeks postoperatively, patients had progressed to a solid diet. SPSS was used for data entry and analysis. Body mass index [BMI] and weight in kg were determined

Results: From 100 patients, 17 were lost to follow-up less than a week into the postoperative period. Of the remaining, average age of the patients was 34.7 +/- 11.3 years at the time of surgery. The majority of patients were females [72%]. Mean preoperative and postoperative BMI was 45.3 +/- 10.4 kg/m[2] and 35.0 +/- 10 kg/m[2], respectively. Of the 83 patients, 62 were followed-up for longer than 1 month [average 419 days]. For patients in this category, mean reduction in BMI was 10.3 +/- 6.5 kg/m[2] with average weight loss of 34.3 +/- 18.2 kg. There were no mortalities associated with LSG

Conclusion: Laparoscopic sleeve gastrectomy is a safe and effective intervention in young Pakistani females with encouraging outcomes at a mean follow-up of over one year

Outcome of laparoscopic cholecystectomy for gall stones disease in patients with liver cirrhosis

Laparoscopic cholecystectomy [LC], a gold standard procedure for cholelithiasis, is associated with higher incidence of bile duct injuries and perioperative bleeding. These complications are of further concern when LC is carried out on patients with liver cirrhosis. Although LC is now increasingly being performed for cholelithiasis in cirrhotic patients, the safety of the procedure is debatable in this group of patients. We retrospectively analysed 82 LCs, performed between January 2002 and December 2011, in cirrhotic patients with gall stone disease for perioperative complications. Patients were sub-classified into Class A, B and C based on child-Pugh classification of severity of liver cirrhosis. Intergroup comparisons were carried out using ANOVA, and p?0.05 was considered significant. LC was successfully completed in all but 3 patients [3.7%]. None of the cirrhotic patients had bile duct injury. Class C patients [n=27] had higher frequency of perioperative bleeding than Class B and A [p=0.03]. Class C patients had comparatively longer stay [5.42 days; range 4-8 days] than Class B [3 days; range 2-6] and Class A [2.74 days; range 2-4], [p=0.01]. There was no mortality in our series. The outcome in Child A and B cirrhosis is comparable to noncirrhotic patients undergoing LC for gall stone disease. Conversion rate and perioperative bleeding in these groups of patients is acceptable in relevance to LC in non-cirrhotic patients. Child C patients however need careful assessment and determination of operative risk versus advantages