The efficacy of laparoscopic sleeve gastrectomy in treating adolescent obesity.

BACKGROUND: Laparoscopic sleeve gastrectomy (SG) is becoming a popular and preferred primary bariatric intervention; however, its applicability in the adolescent age group remains controversial. The aim of this study is to evaluate the efficacy of SG in treating obesity and its co-morbidities among adolescents. METHODS: A retrospective study was conducted of patients aged 12-21 who underwent SG from 2008 to 2012 at Amiri Hospital, Kuwait. The major outcome measures were percent excess weight loss (%EWL) over a 2-year follow-up period, resolution of co-morbidities, and occurrence of complications. RESULTS: A total of 135 adolescent patients underwent the procedure, of which, 97 (71.9 %) were females. The patients had a median age of 19 years (range 12-21), mean body mass index of 48.5 kg/m(2), and mean follow-up period of 20 ± 11.4 months. The %EWL at 2 years for males and females was 84 and 77 %, respectively. All of the patients with type 2 diabetes mellitus and 75 % of those with hypertension showed complete resolution of the disease at 2 years. CONCLUSION: SG seems to be an effective and safe bariatric procedure in obese adolescents, as it can significantly decrease excess body weight and reduce co-morbidities in a relatively short period of time.

The impact of Helicobacter pylori on the complications of laparoscopic sleeve gastrectomy.

Helicobacter pylori (H. pylori) is a very common bacterium present in the gastric tissue of up to 50 % of people, and the mucosal damage it causes can predispose to multiple comorbid conditions. This study aims to observe the prevalence of H. pylori infection in patients undergoing laparoscopic sleeve gastrectomy (LSG) and its correlation with postoperative complications. A retrospective study was done on the gastric pathology specimen results of 682 patients who underwent LSG at Amiri Hospital from 2008 to 2012. Symptomatic patients had preoperative upper gastrointestinal endoscopies (UGIEs) based on the decision of the treating surgeon, along with campylobacter-like organism test (CLO test) for H. pylori detection. The intraoperatively excised gastric specimen was sent for histopathological assessment of H. pylori, and the patients were followed up for complications. Of the 682 patients, 629 (92.2 %) were found to be H. pylori negative intraoperatively, while 53 (7.8 %) were positive. A total of 32 (4.7 %) patients were found to have postoperative complications, of which 2 (6.3 %) had H. pylori intraoperatively. No statistical significance (p = 0.71), however, was seen between the overall complication rate and H. pylori. Specifically, there were five (0.7 %) cases of leak and eight (1.2 %) cases of neuropathy, both of which were not significantly associated with H. pylori (p = 0.33 and p = 0.12, respectively). All the other complications had no evidence of H. pylori. There appears to be no association between H. pylori infection and post-LSG complications.

Gastric histopathologies in patients undergoing laparoscopic sleeve gastrectomies.

BACKGROUND: With 80 % of its population overweight, 47.5 % obese, and having the eighth fattest population worldwide, Kuwait has a serious obesity problem. This has led to widespread practice of bariatric surgery, with little or no studies regarding operative findings and patient follow-up. This study aims to identify the prevalent gastric histopathologies of the patients who have undergone laparoscopic sleeve gastrectomy (LSG) at Amiri Hospital, Kuwait. METHODS: A retrospective study was done of the gastric pathology specimen results of 656 patients who underwent LSG at Amiri Hospital from 2008 to 2012. RESULTS: Of the 656 patients, the average age was 33 years, and 480 (73.2 %) were female while 176 (26.8 %) were male. The histopathology results identified 488 (74.4 %) cases with chronic gastritis, 63 (9.6 %) with follicular gastritis, and 12 (1.8 %) with atrophic gastritis. A total of 12 (1.8 %) cases showed findings other than gastritis, including four (0.6 %) cases of gastric polyps, three (0.5 %) cases of granulomatous disease, and one (0.2 %) case each of the following: gastro-intestinal stromal tumor, gastro-intestinal autonomic nerve tumor, intestinal metaplasia, collagenous gastritis, and crypt cell apoptosis. Helicobacter pylori was discovered in 48 (7.3 %) of the patients. CONCLUSIONS: The majority of gastric histopathology results after LSG in this study had an element of chronic gastritis (74.4 %), which is in keeping with previous studies showing its high prevalence among the obese population. However, a few cases had clinically significant pathologies, and this may alter post-operative management. In view of these results, routine histological examination of the gastric specimens is highly recommended.