Outcomes of primary sleeve gastrectomy versus conversion sleeve gastrectomy in morbidly obese patients

PURPOSE: Our aim for this study was to evaluate early and late complications and outcomes of primary sleeve gastrectomy (PSG) versus conversion sleeve gastrectomy (CSG). METHODS: From February 2013 to December 2016, a total of 180 patients underwent sleeve gastrectomy (150 PSG and 30 CSG). All patients received a metal clipping at the end of the stapling line and a continuous seromuscular suture at the resection margin, for reinforcement. RESULTS: There were no differences in the percentages among males and females or age between the 2 groups, but the body mass index (BMI) of the PSG group was higher at 36.8 ± 4.7 than that of the CSG group (32.4 ± 5.7, P < 0.001). Three early postoperative complications were noted in the PSG group; 1 patient underwent repeat laparoscopic exploration due to pancreatic injury, and 2 other patients developed pulmonary atelectasis. On the contrary, 2 early minor complications were noted in the CSG group. Thirty-eight patients (25.3%) in the PSG group developed 43 late, minor complications, while 9 patients (30.0%) developed 11 late minor and 1 major complication in the CSG group. However, there was no difference in complication rate between PSG and CSG. Percentage excess BMI loss at 3, 6, and 12 months after surgery was comparable between the groups. CONCLUSION: PSG and CSG were comparable in terms of postoperative complications and loss of weight. Therefore, CSG could be used for failed primary restrictive bariatric surgery. However, the durability of these outcomes remains unknown.

Feasibility and Safety of Conversion Sleeve Gastrectomy after Failed Primary Adjustable Gastric Banding or Sleeve Gastrectomy

PURPOSE: Adjustable gastric banding (AGB) and sleeve gastrectomy (SG) are restrictive bariatric surgeries that are popular in Korea. However, patients often require further conversion surgeries because weight loss failure and surgical complications tend to occur. The aim of this study was to evaluate the feasibility and safety of conversion sleeve gastrectomy (CSG) after failed primary AGB (PAGB) or primary SG (PSG). MATERIALS AND METHODS: From February 2010 to April 2016, 21 consecutive patients who underwent CSG after failed PAGB or PSG were enrolled in this study. This study was a retrospective analysis of our prospectively collected database. Demographic, intra and post-operative data were collected and analyzed. RESULTS: Twenty-one patients were enrolled in this study. This comprised 20 women and 1 man, with an average BMI of 31.8±7.8 kg/m². Eighteen patients underwent PAGB and 3 underwent PSG. The mean operative time was 243.6±76.8 minutes, and the estimated blood loss was 190.9±233.2 ml. The mean hospital stay was 4.7±1.7 days. The mean follow-up after CSG was 9.3±1.0 months. Two cases developed immediate postoperative complications: one was a stricture (Clavien-Dindo surgical complication grade II) and the other, a pleural effusion (Grade I). CONCLUSION: CSG is a feasible and safe treatment option after failed PAGB or PSG. Further prospective studies are required to establish the strategy for conversion operations after failed primary restrictive bariatric surgery.

One-Year Outcomes of Laparoscopic Adjustable Gastric Banding Based on Bariatric Analysis and Reporting Outcome System (BAROS) in Morbidly Obese Korean Patients

PURPOSE: This study aimed to compare amount of weight loss, serum laboratory results, and bariatric analysis and reporting outcome system (BAROS) scores obtained before surgery with those obtained 1 year after laparoscopic adjustable gastric banding (AGB). MATERIALS AND METHODS: From January 2013 to November 2014, 32 consecutive patients who underwent AGB were enrolled in this study. This study was a retrospective analysis of our prospectively collected database. The BAROS score included BAROS weight, medical condition, quality of life, and complications recorded 1 year after AGB. Demographic and post-operative data were also collected and analyzed. RESULTS: Thirty-two patients were enrolled in this study, comprising 26 women and 6 men, with an average body mass index of 39.0±6.1 kg/m². The total BAROS score 1 year post AGB was 4.6±1.7, and it was classified as excellent grade. Among them, the quality of life score was 1.8±0.6. Four minor complications were noted. The serum laboratory values improved 1 year post surgery, including hemoglobin A1c, c-peptide, insulin, Homeostatic model assessment of estimated insulin resistance (HOMA IR), Homeostatic model assessment of beta-cell function (HOMA B), triglyceride, total protein, and uric acid. CONCLUSION: AGB showed that it is acceptable in aspect of BAROS outcome as well as weight loss, and serum laboratory result in short-term period.

The Clinical Analysis of 12 Cases of Bezoars

PURPOSE: Bezoars are the uncommon result of ingestion of poorly digestible or indigestible substances. It is defined as retained concretions of animal or vegetable material in the gastrointestinal tract. The aim of this study was to review and analyze in these cases with reviewing literature. METHODS: The medical records of 12 cases, treated between May 1999 and April 2009, were reviewed. The clinical characteristics, as well as the diagnostic evaluations and results of medical and surgical treatment, were also analyzed retrospectively. RESULTS: Of the 12 cases, 6 men and 6 women, the bezoars were in the stomach, jejunum and ileum or in both stomach and jejunum in 1, 2, 7 and 2 cases, respectively. 4 patients (33.3%) had a history of gastric or duodenal ulcer following previously received gastric surgery such as subtotal gastrectomy or truncal vagotomy with pyloroplasty. In 3 cases, the bezoars were found in operative field under the impression of intestinal obstruction due to adhesive ileus, which could not be found by preoperative radiologic evaluation. Among the 12 cases, 11 cases were successfully treated by operative and endoscopic removal, but 1 case expired due to sepsis. CONCLUSION: A bezoar occurs mainly in patients who have previously undergone a gastric operation. Surgeons should keep in mind the possibility of bezoars in patients presenting an intestinal obstruction following a past gastric operation. The principle of treatment for bezoars used to be surgery, but recently gastric bezoars are often treated by gastrofiberscopy.