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.

[Factors associated with morbidity and mortality after gastric bypass. Alternatives for risk reduction: sleeve gastrectomy]. / Factores asociados a morbimortalidad tras el bypass gástrico. Alternativas para disminuir riesgos: gastroplastia tubular.

INTRODUCTION: The aim of this study was to analyze factors related to morbidity and mortality after gastric bypass and to evaluate lower-risk alternatives in selected patients. PATIENTS AND METHODS: A prospective cohort of 761 patients who underwent gastric bypass was included. Prognostic factors were studied using a logistic regression model with SPSS 11.0. Independent variables were age, sex, body mass index (BMI), comorbidities, and the laparoscopic approach. Dependent variables consisted of medical complications, surgical complications, and mortality. We performed a preliminary descriptive study of morbidity and weight loss at 3 months after sleeve gastrectomy. RESULTS: In the postoperative period, 2.8% of patients presented medical complications and 5.4% presented surgical complications. Mortality was 0.52%. Surgical complications were significantly associated with age > 45 years (P = .04; OR = 2.00 [1.03-3.8]) and male sex (P = .041; OR = 2.40 [1.12-5.14]). Medical complications were significantly associated with a BMI of > 50 kg/m2 (P = .012; OR = 3.32 [1.23-8.98]), and mortality was significantly associated with a BMI of > 50 kg/m2 (P = .006) and male sex (P = .006). Sleeve gastrectomy was performed in eight patients with a BMI of > 60 kg/m2, in three patients with a BMI of > 50 kg/m2, cardiopulmonary disease and android fat distribution, and in four patients with a BMI of between 35 and 40 kg/m2 and major comorbidity. Morbidity consisted of self-limited febrile syndrome in one patient. There was no mortality. Weight loss at 3 months was 39.8 +/- 5.36% of excess BMI in superobese patients (n = 4) and was 50.2 +/- 11.05% of excess BMI in morbidly obese patients (n = 4). CONCLUSIONS: Postoperative morbidity and mortality was significantly higher in male patients, in patients aged more than 45 years, and in those with a BMI of > 50 kg/m2. Sleeve gastrectomy in selected patients could be a lower-risk alternative.

Factores asociados a morbimortalidad tras el bypass gástrico. Alternativas para disminuir riesgos: gastroplastia tubular / Factors associated with morbidity and mortality after gastric bypass. Alternatives for risk reduction: sleeve gastrectomy

Introducción. El objetivo fue estudio ha sido evaluar factores relacionados con la morbimortalidad tras el bypass gástrico y considerar alternativas de menor riesgo en pacientes seleccionados. Pacientes y métodos. Se incluye una cohorte prospectiva de 761 pacientes a los que se realizó bypass gástrico. Se realiza un estudio de factores pronósticos mediante el modelo de regresión logística con SPSS 11.0. Las variables independientes fueron edad, sexo, índice de masa corporal (IMC), comorbilidades, abordaje laparoscópico; las variables dependientes fueron complicaciones médicas, complicaciones quirúrgicas y mortalidad. Es un estudio preliminar descriptivo de morbilidad y resultados ponderales a 3 meses con gastroplastia tubular. Resultados. En el postoperatorio el 2,8% de los pacientes presentó complicaciones médicas y el 5,4%, complicaciones quirúrgicas. La mortalidad fue del 0,52%. Las variables que han presentado relación estadísticamente significativa con las complicaciones quirúrgicas fueron la edad > 45 años (p = 0,04; odds ratio [OR] = 2,00; intervalo de confianza [IC] del 95%, 1,03-3,8) y el sexo masculino (p = 0,041; OR = 2,40; IC del 95%, 1,12-5,14). Las variables presentaron relación estadísticamente significativa con las con las complicaciones médicas fueron: IMC > 50 kg/m2 (p = 0,012; OR = 3,32; IC del 95%, 1,23-8,98); con la mortalidad: IMC > 50 kg/m2 (p = 0,006), el sexo masculino (p = 0,006). Se ha realizado gastroplastia tubular en pacientes con IMC > 60 kg/m2 (8 casos); IMC > 50 kg/m2 con afección cardiopulmonar y morfología androide (3 casos); IMC entre 35 y 40 kg/m2 y comorbilidad mayor (4 casos); con la morbilidad: síndrome febril autolimitado. No hubo mortalidad. En superobesos el descenso del 39,8 ± 5,36% del exceso de IMC en 3 meses (n = 4); en obesos mórbidos un descenso del 50,2 ± 11,05% del exceso del IMC en 3 meses (n = 4). Conclusiones. La morbimortalidad postoperatoria fue significativamente mayor en los varones, mayores de 45 años y con IMC > 50 kg/m2.La gastroplastia tubular en pacientes seleccionados podría ser una alternativa de menor riesgo (AU)

Introduction. The aim of this study was to analyze factors related to morbidity and mortality after gastric bypass and to evaluate lower-risk alternatives in selected patients. Patients and methods. A prospective cohort of 761 patients who underwent gastric bypass was included. Prognostic factors were studied using a logistic regression model with SPSS 11.0. Independent variables were age, sex, body mass index (BMI), comorbidities, and the laparoscopic approach. Dependent variables consisted of medical complications, surgical complications, and mortality. We performed a preliminary descriptive study of morbidity and weight loss at 3 months after sleeve gastrectomy. Results. In the postoperative period, 2.8% of patients presented medical complications and 5.4% presented surgical complications. Mortality was 0.52%. Surgical complications were significantly associated with age > 45 years (P=.04; OR = 2.00 [1.03-3.8]) and male sex (P=.041; OR = 2.40 [1.12-5.14]). Medical complications were significantly associated with a BMI of > 50 kg/m2 (P=.012; OR = 3.32 [1.23-8.98]), and mortality was significantly associated with a BMI of > 50 kg/m2 (P=.006) and male sex (P=.006). Sleeve gastrectomy was performed in eight patients with a BMI of > 60 kg/m2, in three patients with a BMI of > 50 kg/m2, cardiopulmonary disease and android fat distribution, and in four patients with a BMI of between 35 and 40 kg/m2 and major comorbidity. Morbidity consisted of self-limited febrile syndrome in one patient. There was no mortality. Weight loss at 3 months was 39.8 ± 5.36% of excess BMI in superobese patients (n = 4) and was 50.2 ± 11.05% of excess BMI in morbidly obese patients (n = 4). Conclusions. Postoperative morbidity and mortality was significantly higher in male patients, in patients aged more than 45 years, and in those with a BMI of > 50 kg/m2. Sleeve gastrectomy in selected patients could be a lower-risk alternative (AU)

Long-term health-related quality of life following gastric bypass: influence of depression.

BACKGROUND: Severe obesity has been associated with impaired quality of life (QoL). We evaluated the long-term health-related quality of life (HRQoL) after gastric bypass. METHODS: A cross-sectional study was conducted on 50 morbidly obese patients >5 years after gastric bypass and on a control group of 78 non-operated morbidly obese patients. Both groups were evaluated for the EuroQol 5D measure and the Goldberg General Health Questionnaire. In addition, the Bariatric Analysis of Reporting Outcome System (BAROS) was applied to the surgical group. Depression and severe life events were included in the analysis. Logistic Regression Model was used, and age was included in the analysis. RESULTS: Groups were similar except for mean age (lower in the surgical group: 40.5+/-9.0 vs 46.1+/-8.8 years, P=0.026). 86.5% of patients had >50% Excess Weight Loss. 85.7% showed an improvement in co-morbid conditions. BAROS Global score: 22% excellent, 56% very good, 18% good, 2% fair and 2% failure. After surgery, significant improvements were reported in self-esteem (94%), work conditions (72.6%), physical activity (66.7%), and sexual interest/activity (50.9%). The control group showed poorer results for the EuroQol 5D in mobility (55% vs 21.6%, P=0.005), difficulty with daily activity (55% vs 13.7%, P=0.005) and self-evaluation of well-being (59.2% vs 78.1%, P=0.005). Patients with depression or insufficient weight loss following surgery presented poorer global evaluation in HRQoL. CONCLUSION: Gastric bypass resulted in significant long-term improvements in co-morbidities, sustained weight loss and increased HRQoL. Depression and insufficient weight loss were associated with poorer HRQoL in surgical patients.

Is Roux-en-Y gastric bypass adequate in the super-obese?

BACKGROUND: The outcome after Roux-en-Y gastric bypass (RYGBP) in morbidly obese (MO) (body mass index [BMI] 40-50) was compared with super-obese (SO) (BMI >50) and super-super-obese (SSO) (BMI >60) patients. METHODS: A prospective study was conducted in 738 consecutive patients who underwent RYGBP. 483 MO were compared with 184 SO and 70 SSO. Study endpoints included: effect on co-morbid conditions, postoperative morbidity and mortality, and long-term results. Statistical analysis utilized SPSS 11.0. RESULTS: Percentage of males was significantly greater in the SO groups (16.5% vs 13%, P=0.01). Obesity-related conditions were significantly more frequent in the SO groups: sleep apnea (38% vs 17%, P<0.0005), gallstones (23% vs 14%, P=0.013); diabetes (29% vs 17%, P=0.002). Hospital stay was longer in the SO groups (5.7+/-6.1 days vs 4.6+/-2.6 days, P=0.024). Wound infection was more frequent in the SO groups (4.7% vs 1.4%, P=0.019). Postoperative mortality was greater in the SSO and SO groups (1.6% and 1.4%) than MO (0%) (P=0.019). Incisional hernia was more frequent in the SO groups (14.1% vs 8.6%; P=0.041). There was no significant difference in percent of excess weight loss (%EWL) between the three groups. EWL >50% at 5 years was: MO 81.5%, SO 87.5%, SSO 80%. The surgery was effective in treating the co-morbid conditions. CONCLUSION: RYGBP achieved significant durable weight loss and effectively treated co-morbid conditions in SO and SSO patients with acceptable postoperative morbidity and slightly greater mortality than in MO patients.