Laparoscopic sleeve gastrectomy compared with other bariatric surgical procedures: a systematic review of randomized trials.

BACKGROUND: The evidence regarding the effectiveness and safety of laparoscopic sleeve gastrectomy (LSG) has been mostly based on the data derived from nonrandomized studies. The objective of this study was to evaluate the outcomes of LSG and to present an up-to-date review of the available evidence based on the recent publications of new randomized, controlled trials (RCTs). METHODS: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched until November 2012 for RCTs on LSG. RESULTS: Fifteen RCTs, comprising a total of 1191 patients, of whom 795 had undergone LSG, were included. No patient required conversion to open surgery for LSG, laparoscopic gastric bypass (LGB), or laparoscopic adjustable gastric banding (LAGB) procedures. There were no deaths, and the complication rate was 12.1% (range 10%-13.2%) in the LSG group versus 20.9% (range 10%-26.4%) in the LGB group, and 0% in the LAGB group (only 1 RCT). The complications included leakage, bleeding, stricture, and reoperation that occurred with rates of .9%, 3.3%, 0%, and 2.1%, respectively, in the LSG group and rates of 0%, 5%, 0%, and 4%, respectively, in the LGB group. The average operating time in the LSG group was 106.5 minutes versus 132.3 minutes in the LGB group. The percentage of excess weight loss (%EWL) ranged from 49% to 81% in the LSG group, from 62.1% to 94.4% in the LGB group, and from 28.7% to 48% in the LAGB group, with a follow-up ranging from 6 months to 3 years. The type 2 diabetes mellitus (T2DM) remission rate ranged from 26.5% to 75% in the LSG group and from 42% to 93% in the LGB group. CONCLUSIONS: LSG is a well-tolerated, feasible procedure with a relatively short operating time. Its effectiveness in terms of weight loss is confirmed for short-term follow-up (≤ 3 years). The role of LSG in the treatment of T2DM requires further investigation.

Effects of laparoscopic sleeve gastrectomy in patients with morbid obesity and metabolic disorders.

PURPOSES: Obesity and its correlation with other pathological conditions determine the onset of the metabolic syndrome, which exposes the patient to a higher risk of major cardiovascular complications. Laparoscopic sleeve gastrectomy (LSG) is a bariatric surgical procedure that appears to influence both the reduction of fat mass and the action of some gastrointestinal hormones. PATIENTS AND METHODS: Between January 2011 and July 2013, 23 patients with morbid obesity underwent LSG and follow-up. In the evaluation of patients, the criteria for metabolic syndrome given by the International Diabetes Federation were followed. A multidisciplinary team of experts evaluated patients before surgery and in subsequent scheduled postoperative visits at 7, 30, 60, and 90 days and 4, 5, 6, 9, and 12 months. Anthropometric and metabolic parameters were analyzed. RESULTS: The mean excess weight loss was 8.57±3.02%, 17.65±6.40%, 25.47±7.90%, 33.76±9.27%, 41.83±10.71%, 46.02±13.90%, 52.60±14.05%, 58.48±16.07%, and 62.59±21.29% at 7, 30, 60, and 90 days and 4, 5, 6, 9, and 12 months, respectively. In the same observational period there was an excellent improvement of metabolic indices. None of the patients previously taking prescribed hypoglycemic drugs restarted therapy. Mean fasting plasma glucose significantly decreased compared with the preoperative values. Blood pressure had a statistically significant improvement. Modification in the lipid profile was more variable. During the period of observation 22 of 23 patients reported in this study did not fit the criteria for metabolic syndrome. CONCLUSIONS: Morbid obesity and related diseases may benefit from a surgical approach in selected patients. Randomized controlled trials are needed to evaluate the role of LSG.

Laparoscopic sleeve gastrectomy and medical management for the treatment of type 2 diabetes mellitus in non-morbidly obese patients: a single-center experience.

BACKGROUND: Type 2 diabetes mellitus (T2DM) and obesity are often associated in the same metabolic pathology and represent a significant public health problem. Although laparoscopic sleeve gastrectomy (LSG) is a relatively recent technique of bariatric surgery, it has shown to be efficient and safe and has obtained much support from physicians and patients. Several studies have highlighted the effects in terms of resolution and improvement of diabetes. SUBJECTS AND METHODS: From January 2009 to November 2012, 15 patients in Obesity Class II (body mass index [BMI], 37.9 ± 1.5 kg/m(2); baseline weight, 102.7 ± 11.6 kg) with uncontrolled T2DM despite taking a glucose-lowering drug therapy (glycated hemoglobin [HbA1c], 8.1 ± 0.6%) underwent LSG and advanced practice medical management in accordance with the American Diabetes Association guidelines. All patients were subjected to follow-up controls with anthropometric and metabolic indices at 5, 15, 30, and 60 days, and at 6 and 12 months after surgery, remission of diabetes was also evaluated. RESULTS: At 1 year after surgery, the mean excess weight loss percentage (EWL%) was 58.4%, and the mean BMI had decreased from the preoperative value of 37.9 kg/m(2) to 30.4 kg/m(2). The average reduction in HbA1c was 2.5 (30.9%). The mean homeostatic model assessment of insulin resistance decreased from 13.3 to 4.9. Overall, during the period of observation, four patients (26.7%) had started drug therapy again, six patients had complete remission (40%), and five patients had partial remission (33.3%). CONCLUSIONS: LSG not only makes it possible to attain a significant EWL% in obese patients, but also a remission or improvement of diabetes. Further studies are required to determine the duration of the effect and the role of different factors involved.

[Acute abdomen: experience with 196 consecutive cases]. / L'addome acuto: esperienza su 196 casi consecutivi.

The authors studied 196 consecutive emergency admissions to their unit with a diagnosis of non-traumatic acute abdomen. The data were analysed in order to evaluate the demographic data, the diagnostic procedures performed and treatments administered, and the reliability of the admission diagnosis in comparison with the final diagnosis. During the study period acute abdomen emergencies amounted to 7% of the total admissions to the unit. Laboratory tests and abdominal ultrasonography were the most frequently used diagnostic tools, followed by plain film of the abdomen and CT scans, the latter being used in a distinctly lower number of cases. Seventy patients out of 196 (35.7%) underwent an emergency surgical procedure. The most frequently reported disease was acute appendicitis. Sixty-one of the subjects (31.1%) with acute abdomen were successfully treated conservatively while 65 (33.2%) were diagnosed as being affected by non-splanchnic-diseases, and thus categorised as cases of false acute abdomen The Authors conclude that the diagnostic work-up for acute abdomen always needs a precise clinical history and a complete physical examination, but in some instances the support of widely available facilities, such as plain x-rays, ultrasonography, or CT scans can help to avoid useless surgical procedures or, conversely, potentially dangerous delays in administering treatment.

[Technical and organisational considerations regarding surgical debulking]. / Alcune considerazioni tecniche e organizzative sull'oncocitoriduzione chirurgica.

The Authors report on their experience with debulking surgery, based on 46 patients affected by advanced cancers and treated between January 2001 and May 2003 to reduce the tumour mass. Thirty-eight out of 46 (82%) were women. The Authors performed 23 pelvic peritonectomies, 16 multicompartmental peritonectomies according to the Sugarbaker technique, 8 hysterectomies with bilateral ovariectomy, 4 ureteral resections with end-to-end reconstruction, 4 pelvic lymphectomies and 2 resections of the bladder. No perioperative mortality is reported, and major morbidity amounted to less than 5%. The Authors stress the problems encountered while performing debulking surgery and are of the opinion that the majority of the problems could be overcome by precise organization in dedicated surgical centres specifically or mainly devoted to surgical debulking.

[Medullary cancer arised in cervical accessory thyroid. Case report]. / Carcinoma midollare insorto su tiroide accessoria cervicale. Considerazioni su un caso clinico.

The Authors present a recent case of a medullary thyroid cancer arised in an ectopic accessory gland, whose definitive diagnosis was only set after the pathologist observation of the resected specimen. The Authors then review the causes of the anomaly and the literature classification of thyroid ectopies together with the commonest clinical, laboratory and imaging diagnostic features. In conclusion Authors indicate the importance of thinking about the possible ectopic thyroidal nature of an undiagnosed cervical mass, in order to recognize an unusual disease thus avoiding a delayed therapy.