Early results of a Canadian laparoscopic sleeve gastrectomy experience.

BACKGROUND: Sleeve gastrectomy (SG) is a relatively new bariatric procedure with a number of advantages compared with Roux-en-Y gastric bypass. However, SG also has a number of disadvantages and associated risks. We sought to examine perioperative complications and outcomes of laparoscopic SG (LSG) in a single major Canadian bariatric surgery centre (Victoria, BC). METHODS: Since June 2008, LSG has been performed at our centre and we reviewed the cases of all patients. We conducted a retrospective chart review in April 2010. RESULTS: Thirty-four patients had LSG, and none was lost to follow-up. Indications for LSG over other bariatric procedures were patient preference (n=28), severe obesity with a body mass index (BMI) greater than 60 kg/m(2) (n=5) and severe upper abdominal adhesions (n=1). All but 1 of the cohort were women, and the average age was 48 (standard deviation [SD] 11) years. Preoperatively, the average BMI was 50.3 (SD 7.7) kg/m(2). Preoperative obesity-related comorbidity rates were 56% (n=19) for type 2 diabetes mellitus (T2DM), 50% (n=17) for hypertension, 32% (n=11) for dys lipidemia, 62% (n=21) for obstructive sleep apnea (OSA), 62% (n=21) for knee and/or hip pain and 44% (n=15) for depression and/or anxiety. The mean duration of surgery was 74 (SD 21) minutes. There were 2 major perioperative complications: 1 staple line leak and 1 staple line hemorrhage. The median stay in hospital was 1 day. Postoperative upper gastrointestinal imaging studies were conducted in 11 patients; 1 was positive for staple line leak. Histopathology on the excised gastric segments revealed chronic helicobacter pylori gastritis in 2 patients and small gastrointestinal stromal tumours in 1 patient. The mean postoperative follow-up interval was 10 months. Weight loss averaged 27.4 (SD 9.0) kg. Overall weight loss was 3.3 (SD 1.8) kg/month. Resolution occurred in 74% of patients with T2DM, 53% with hypertension, 45% with dyslipidemia, 76% with OSA, 38% with joint pain and 20% with depression/anxiety. Overall satisfaction was rated as excellent by 68% of patients, good by 29% and poor by 3% of patients. CONCLUSION: Preliminary analysis of our experience with LSG indicates that this is an effective and safe procedure for the treatment of obesity.

A five year Canadian laparoscopic adjustable gastric band experience.

BACKGROUND: The aim of this study was to review 5 years of laparoscopic adjustable gastric band (LAGB) procedures in which low-pressure bands were used. METHODS: All LAGB cases at the authors' center were retrospectively analyzed. A survey of these patients was conducted in 2008 and 2009. RESULTS: Of 90 LAGB patients, 86 were surveyed. Follow-up averaged 17.5 months. Weight loss averaged 24.8 +/- 19.4 kg. Weight loss averaged 2.7 kg/mo and did not significantly drop over the last 10.7 months (2.7 vs 1.5 kg/mo, P = .16). Excess body weight loss was 27.5%, 39.1%, and 67.2% in the first, second, and following years, respectively. Patients averaged 4.14 adjustments of their bands and vomited 2.13 times per week. The mortality rate was 0%. No band slippages or band erosion occurred. Resolution or improvement occurred in most obesity-related illness. Gastroesophageal reflux disease symptoms worsened in 25% of patients. CONCLUSIONS: These results replicate world LAGB literature. Low complication rates result either from the authors' band or their techniques.

Laparoscopic Roux-en-Y gastric bypass surgery: initial results of 120 consecutive patients at a single British Columbia surgical center.

BACKGROUND: The prevalence of obesity in Canada is increasing, therefore, it has become imminently important to treat these patients in a timely manner. METHODS: A total of 120 consecutive patients who underwent a laparoscopic Roux-en-Y gastric bypass procedure (2004 to 2006), with a mean postoperative follow-up period of 19 months, were divided into 2 chronologic groups and analyzed retrospectively. RESULTS: The overall postoperative excess weight loss was 78.1% (SD, 14.3%) from the time of inclusion into the study preoperatively (average wait time, 21 mo) to 12 months postoperatively. No preoperative weight loss was recorded. A surgeon-dependent learning curve was shown with a decrease in surgical time as well as surgery-related complications. Obesity-associated comorbidities decreased whereas quality of life increased. CONCLUSIONS: Despite a structured multidisciplinary approach to alter lifestyle and daily caloric intake preoperatively, only laparoscopic Roux-en-Y gastric bypass showed effective weight loss and reduced associated comorbidities.