Prognostic factors of weight loss after sleeve gastrectomy: Multi centre study in Spain and Portugal. / Factores predictivos de pérdida ponderal tras la gastrectomía vertical. Estudio multicéntrico hispano-portugués.

INTRODUCTION: Sleeve gastrectomy (SG) has become a technique in its own right although a selective or global indication remains controversial. The weight loss data at 5 years are heterogeneous. The aim of the study is to identify possible prognostic factors of insufficient weight loss after SG. METHODS: A SG retrospective multicenter study of more than one year follow-up was performed. Failure is considered if EWL>50%. Univariate and multivariate study of Cox regression were performed to identify prognostic factors of failure of weight loss at 1, 2 and 3 years of follow up. RESULTS: A total of 1,565 patients treated in 29 hospitals are included. PSP per year: 70.58±24.7; 3 years 69.39±29.2; 5 years 68.46±23.1. Patients with EWL<50 (considered failure): 17.1% in the first year, 20.1% at 3 years, 20.8% at 5 years. Variables with influence on the weight loss failure in univariate analysis were: BMI>50kg/m2, age>50years, DM2, hypertension, OSA, heart disease, multiple comorbidities, distance to pylorus> 4cm, bougie>40F, treatment with antiplatelet agents. The reinforcement of the suture improved results. In multivariate study DM2 and BMI are independent factors of failure. CONCLUSION: The SG associates a satisfactory weight loss in 79% of patients in the first 5 years; however, some variables such as BMI>50, age>50, the presence of several comorbidities, more than 5cm section of the pylorus or bougie>40F can increase the risk of weight loss failure.

Factores predictivos de pérdida ponderal tras la gastrectomia vertical. Estudio multicéntrico hispano-portugués / Prognostic factors of weight loss after sleeve gastrectomy: Multicenter study in Spain and Portugal

INTRODUCCIÓN: La gastrectomía vertical (GV) se ha convertido en una técnica con entidad propia cuya indicación selectiva o global sigue siendo objeto de controversia. Los resultados ponderales a 5 años son heterogéneos. El objetivo del estudio es identificar posibles factores pronósticos de pérdida de peso insuficiente tras GV. MÉTODOS: Estudio multicéntrico retrospectivo de GV con seguimiento mayor de un año. Se considera fracaso si el PSP < 50%. Se realiza estudio univariado y multivariado de regresión de Cox para determinar los factores que influyen en el fracaso ponderal a 1, 2 y 3 años de seguimiento. RESULTADOS: Se incluye a 1.565 pacientes intervenidos en 29 hospitales. PSP al año: 70,58 ± 24,8; a los 3 años 69,39 ± 29,2; a los 5 años 68,46 ± 23,1. Pacientes con PSP <50 (considerado fracaso ponderal): 17,1% en el primer año, 20,1% a 3 años, 20,8% a 5 años. Las variables que mostraron relación con el fracaso ponderal en el estudio univariado fueron: IMC > 50 kg/m2, edad > 50 años, DM2, HTA, SAOS, cardiopatía, varias comorbilidades asociadas, distancia a píloro > 5 cm, bujía >40 F, tratamiento con antiagregantes. La sobresutura mejora los resultados. Las variables que mostraron ser factores predictivos de fracaso en el seguimiento fueron la DM2 y el IMC. CONCLUSIÓN: La GV asocia una pérdida de peso satisfactoria en el 79% de los pacientes en los primeros 5 años; sin embargo, algunas variables como el IMC > 50, la DM2, la edad > 50, la presencia de varias comorbilidades, la sección a más de 4cm del píloro o la bujía > 40 F pueden aumentar el riesgo de fracaso ponderal

INTRODUCTION: Sleeve gastrectomy (SG) has become a technique in its own right although a selective or global indication remains controversial. The weight loss data at 5 years are heterogeneous. The aim of the study is to identify possible prognostic factors of insufficient weight loss after SG. METHODS: A SG retrospective multicenter study of more than one year follow-up was performed. Failure is considered if EWL > 50%. Univariate and multivariate study of Cox regression were performed to identify prognostic factors of failure of weight loss at 1, 2 and 3 years of follow up. RESULTS: A total of 1,565 patients treated in 29 hospitals are included. PSP per year: 70.58 ± 24.7; 3 years 69.39 ± 29.2; 5 years 68.46 ± 23.1. Patients with EWL< 50 (considered failure): 17.1% in the first year, 20.1% at 3 years, 20.8% at 5 years. Variables with influence on the weight loss failure in univariate analysis were: BMI > 50 kg/m2, age > 50 years, DM2, hypertension, OSA, heart disease, multiple comorbidities, distance to pylorus> 4cm, bougie > 40F, treatment with antiplatelet agents. The reinforcement of the suture improved results. In multivariate study DM2 and BMI are independent factors of failure. CONCLUSION: The SG associates a satisfactory weight loss in 79% of patients in the first 5 years; however, some variables such as BMI > 50, age > 50, the presence of several comorbidities, more than 5 cm section of the pylorus or bougie > 40F can increase the risk of weight loss failure

Prognostic Factors for Morbimortality in Sleeve Gastrectomy. The Importance of the Learning Curve. A Spanish-Portuguese Multicenter Study.

BACKGROUND: Complications in sleeve gastrectomy (SG) can cast a shadow over the technique's good results and compromise its safety. The aim of this study is to identify risk factors for complications, and especially those that can potentially be modified to improve safety. METHODS: A retrospective multicenter cohort study was carried out, involving the participation of 29 hospitals. Data was collected on demographic variables, associated comorbidities, technical modifications, the surgeon's experience, and postoperative morbimortality. A multivariate logistic regression analysis was carried out on risk factors (RFs) for the complications of leak/fistula, hemoperitoneum, pneumonia, pulmonary embolism, and death. RESULTS: The following data were collected for 2882 patients: age, 43.85 ± 11.6. 32.9 % male; BMI 47.22 ± 8.79; 46.2 % hypertensive; 29.2 % diabetes2; 18.2 % smokers; bougie calibre ≥40 F 11.1 %; complications 11.7 % (2.8 % leaks, 2.7 % hemoperitoneum, 1.1 % pneumonia, 0.2 % pulmonary embolism); and death 0.6 %. RFs for complications were as follows: surgeon's experience < 20 patients, OR 1.72 (1.32-2.25); experience > 100 patients, OR 0.78 (0.69-0.87); DM2, OR1.48(1.12-1.95); probe > 40 F, OR 0.613 (0.429-0.876). Leak RFs were the following: smoking, OR1.93 (1.1-3.41); surgeon's experience < 20 patients, OR 2.4 (1.46-4.16); experience of 20-50 patients, OR 2.5 (1.3-4.86); experience >100 patients, OR 0.265 (0.11-0.63); distance to pylorus > 4 cm, OR 0.510 (0.29-0.91). RFs for death were as follows: smoking, OR 8.64 (2.63-28.34); DM2, OR 3.25 (1.1-9.99); distance to pylorus < 5 cm, OR 6.62 (1.63-27.02). CONCLUSIONS: The safety of SG may be compromised by nonmodifiable factors such as age >65, patient comorbidities (DM2, hypertension), and prior treatment with anticoagulants, as well as by modifiable factors such as smoking, bougie size <40 F, distance to the pylorus <4 cm, and the surgeon's experience (<50-100 cases).

Cirugía Monopuerto en patología colorrectal: resultados preliminares / Single port access surgery in colorectal disease: preliminary results

Introducción El objetivo del estudio es la evaluación de la técnica monopuerto en patología colorrectal en cuanto su adecuación a criterios oncológicos, fiabilidad, seguridad y reproducibilidad de la técnica. Se realiza un estudio descriptivo y prospectivo de casos describiendo los resultados preliminares de nuestra experiencia. Material y métodos Presentamos una serie de 24 pacientes con patología colorrectal intervenidos mediante abordaje monopuerto con dispositivo Gel point® durante el periodo de tiempo comprendido entre junio y diciembre del año 2010. Se realizaron 9 hemicolectomías derechas, 9 resecciones de sigma, 4 resecciones anteriores altas, 1 hemicolectomía izquierda por tumor de ángulo esplénico y una colectomía subtotal. Resultados El tiempo quirúrgico medio, para el colon derecho, fue de 82,77 min (rango 40-170), de 122,14 min (rango 75-200) para el colon izquierdo y el recto y de 270 min en la colectomía subtotal. La mediana de número de ganglios resecados fue de 22 (rango 3-27) para colon derecho y 21 (rango 11-28) para el colon izquierdo y el recto, la media de longitud de la pieza quirúrgica fue de 20,37cm (rango 16,20-27,50) para el colon derecho y de 24,92cm (rango 14,50-31) para el colon izquierdo y el recto, la mediana de estancia hospitalaria global fue de 6 días (rango 5-13). La morbilidad fue del 8,3% (2 pacientes), uno presentó una oclusión por bridas y otro fuga en la anastomosis. No hubo mortalidad. Conclusiones El abordaje monopuerto es una técnica reproducible y segura, manteniendo criterios oncológicos, en cirujanos habituados a la cirugía colorrectal por vía laparoscópica convencional. Sería necesario un mayor número de casos para la estandarización de la técnica (AU)

Introduction The aim of this study is to evaluate the single port access technique in colorectal disease, as regards its suitability to oncological criteria, reliability, safety and reproducibility of the technique. A descriptive and prospective case study is performed describing the preliminary results of our series. Material and methods We present a series of 24 patients with colorectal disease who underwent single port access surgery using a Gel point ® device between June and December 2010. The operations performed were, 9 right hemicolectomies, 9 sigmoid resections, 4 high anterior resections, 1 left hemicolectomy due to a tumour of the splenic flexure, and 1 sub-total colectomy. Results The mean surgical time for the right colon was 82.8minutes (range 40-170), 122.1minutes (range 75-200) for the left colon and rectum, and 270minutes for the sub-total colectomy. The median number of ganglia resected was 22 (range: 3-27) for the right colon and 21 (range: 11-28) left colon/rectum. The mean length of the surgical specimen was 20.37cm (range: 16.2 – 27.5) for the right colon, and 24.92cm (range: 14.5 – 31) for the left colon/rectum. The median overall hospital stay was 6 days (range: 5-13). Morbidity was 8.3% (2 patients); one with an occlusion due to adhesions, and another with a leak in the anastomosis. There were no deaths. Conclusions The single port access technique is safe and reproducible, maintaining oncological criteria, for surgeons accustomed to colorectal surgery by conventional laparoscopy. A larger number of cases would be required to standardise the technique(AU)

[Single port access surgery in colorectal disease: preliminary results]. / Cirugía Monopuerto en patología colorrectal: resultados preliminares.

INTRODUCTION: The aim of this study is to evaluate the single port access technique in colorectal disease, as regards its suitability to oncological criteria, reliability, safety and reproducibility of the technique. A descriptive and prospective case study is performed describing the preliminary results of our series. MATERIAL AND METHODS: We present a series of 24 patients with colorectal disease who underwent single port access surgery using a Gel point® device between June and December 2010. The operations performed were, 9 right hemicolectomies, 9 sigmoid resections, 4 high anterior resections, 1 left hemicolectomy due to a tumour of the splenic flexure, and 1 sub-total colectomy. RESULTS: The mean surgical time for the right colon was 82.8 minutes (range 40-170), 122.1 minutes (range 75-200) for the left colon and rectum, and 270 minutes for the sub-total colectomy. The median number of ganglia resected was 22 (range: 3-27) for the right colon and 21 (range: 11-28) left colon/rectum. The mean length of the surgical specimen was 20.37 cm (range: 16.2 - 27.5) for the right colon, and 24.92 cm (range: 14.5 - 31) for the left colon/rectum. The median overall hospital stay was 6 days (range: 5-13). Morbidity was 8.3% (2 patients); one with an occlusion due to adhesions, and another with a leak in the anastomosis. There were no deaths. CONCLUSIONS: The single port access technique is safe and reproducible, maintaining oncological criteria, for surgeons accustomed to colorectal surgery by conventional laparoscopy. A larger number of cases would be required to standardise the technique.

Short- and mid-term outcomes of sleeve gastrectomy for morbid obesity: the experience of the Spanish National Registry.

BACKGROUND: Reports on laparoscopic sleeve gastrectomy (LSG) communicate very good short-term results on very high-risk morbid obese patients. However, mid- and long-term results are still unknown. A National Registry has been created in Spain to achieve information on the outcomes of this bariatric procedure. METHODS: Data were obtained from 17 centers and collected in a database. Technical issues, preoperative comorbid conditions, hospital stay, early and late complications, and short- and mid-term weight loss were analyzed. RESULTS: Five hundred forty patients were included; 76% were women. Mean BMI was 48.1 +/- 10. Mean age was 44.1 +/- 11.8. Morbidity rate was 5.2% and mortality rate 0.36%. Complications presented more frequently in superobese patients (OR, 2.8 (1.18-6.65)), male (OR, 2.98 (1.26-7.0)), and patients >55 years old (OR, 2.8 (1.14-6.8)). Staple-line reinforcement was related to a lower complication rate (3.7 vs 8.8%; p = 0.039). Mean hospital stay was 4.8 +/- 8.2 days. Mean follow-up was 16.5 +/- 10.6 months (1-73). Mean percent excess BMI loss (EBL) at 3 months was 38.8 +/- 22, 55.6 +/- 8 at 6 months, 68.1 +/- 28 at 12 months, and 72.4 +/- 31 at 24 months. %EBL was superior in patients with lower initial BMI and lower age. Bougie caliber was an inverse predictive factor of %EBL at 12 and 24 months (RR, 23.3 (11.4-35.2)). DM is remitted in 81% of the patients and HTA improved in 63.2% of them. A second-stage surgery was performed in 18 patients (3.2%). CONCLUSIONS: LSG provides good short- and mid-term results with a low morbid-mortality rate. Better results are obtained in younger patients with lowest BMI. Staple-line reinforcement and a thinner bougie are recommended to improve outcome.