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.

Attitudes and Concerns of Diabetic Patients towards Bariatric Surgery as Treatment of Diabetes

<p><b>INTRODUCTION</b>Bariatric surgery is increasingly recognised as an effective treatment for type 2 diabetes that significantly improves glycaemic control, even achieving remission. This study examined perceptions and concerns of diabetic patients towards bariatric surgery as a treatment option for diabetes.</p><p><b>MATERIALS AND METHODS</b>A total of 150 patients were recruited from a specialised diabetic outpatient clinic and completed a questionnaire (items were rated on a Likert scale from slightly important [lowest score of 1] to extremely important [maximum score of 5]). Logistic regression was performed to identify factors influencing decision for surgery.</p><p><b>RESULTS</b>The 74 males and 76 females had mean age of 50 (range 20 to 78) and body mass index (BMI) of 29.6 kg/m(range 18.1 to 51); 61% considered surgery favourably. Predictive factors for interest in surgery: higher educational levels (OR = 2.3; 95% CI, 1.2 to 4.4), duration of diabetes (OR = 0.4; 95% CI, 0.2 to 1.0) and use of insulin (OR = 2.1; 95% CI, 1.1 to 4.1). Reasons for surgery: desire for remission (Likert scale 4.7 ± 0.7), to prevent complications (Likert scale 4.5 ± 0.9) and to reduce medications (Likert scale 4.3 ± 1.1). For those not keen on surgery, main reasons were fear of surgery (Likert scale 4 ± 1.5) and satisfaction with current therapy (Likert scale 3.7 ± 1.6).</p><p><b>CONCLUSION</b>Many diabetic patients would consider surgery as an option to improve their metabolic disorder (greater interest in patients with higher educational levels, currently using insulin and with shorter duration of diabetes). Surgical complications, length of recovery and duration of benefits were the main concerns.</p>

Surgical management of obesity - National University Hospital experience

<p><b>INTRODUCTION</b>The Singapore National Survey of 2004 reported the prevalence of obesity to have increased to 6.9%, thus reflecting the profound changes in our society's lifestyle and eating habits. Bariatric surgery has steadily been increasing to counter the ill effects of obesity.</p><p><b>MATERIALS AND METHODS</b>We audited our prospective series of 31 patients who had laparoscopic adjustable gastric banding (LABG) for morbid obesity performed by our multidisciplinary team at the National University Hospital, Singapore, between August 2004 and December 2006.</p><p><b>RESULTS</b>The median age at presentation was 40 years old including 6 males and 25 females. Their median BMI was 42.35 kg/m(2). At a median follow-up of 26 months, the median percentage of excess weight loss (%EWL) was 41.95%. The positive impact of gastric banding on comorbidities are evident whereby 15 (94%) of the diabetics had improved glycaemic control with HbA(1)C of 7.7% preoperatively improving to 5.9% postoperatively, and also 8 (58%) now take smaller doses of oral hypoglycaemic agents. Hypertension improved in 4 patients and 2 (11%) were cured. All our patients with dyslipidaemia had their statin doses reduced with marked lowering of serum lipid levels. We had 2 patients (6.45%) with band erosion and another 2 with reflux oesophagitis. Our article also summarises the available surgical procedures while discussing the pros and cons of each.</p><p><b>CONCLUSION</b>Our results showed that a multidisciplinary programme can achieve significant weight loss for obese patients in Singapore. To achieve long-term weight loss, a commitment of both the medical team and the patient is necessary. Laparoscopy has revolutionised the practice of bariatric surgery worldwide. LAGB is an effective and safe procedure.</p>