Sleeve gastrectomy for morbid obesity. Long-term results, comorbidities and quality of life

  • Soraia Silva Centro Hospitalar e Universitário de Coimbra Clínica Universitária de Cirurgia III da Faculdade de Medicina da Universidade de Coimbra
  • António Milheiro Centro Hospitalar e Universitário de Coimbra Clínica Universitária de Cirurgia III da Faculdade de Medicina da Universidade de Coimbra
  • Luis Ferreira Centro Hospitalar e Universitário de Coimbra Clínica Universitária de Cirurgia III da Faculdade de Medicina da Universidade de Coimbra
  • Manuel Rosete Centro Hospitalar e Universitário de Coimbra Clínica Universitária de Cirurgia III da Faculdade de Medicina da Universidade de Coimbra
  • José Carlos Campos Centro Hospitalar e Universitário de Coimbra Clínica Universitária de Cirurgia III da Faculdade de Medicina da Universidade de Coimbra
  • João Almeida Centro Hospitalar e Universitário de Coimbra Clínica Universitária de Cirurgia III da Faculdade de Medicina da Universidade de Coimbra
  • Mário Sérgio Centro Hospitalar e Universitário de Coimbra Clínica Universitária de Cirurgia III da Faculdade de Medicina da Universidade de Coimbra
  • José-Guilherme Tralhão Centro Hospitalar e Universitário de Coimbra Clínica Universitária de Cirurgia III da Faculdade de Medicina da Universidade de Coimbra
  • Francisco Castro e Sousa Centro Hospitalar e Universitário de Coimbra Clínica Universitária de Cirurgia III da Faculdade de Medicina da Universidade de Coimbra

Abstract

Background and Objectives: Sleeve Gastrectomy (SG) has emerged in the last years as a single procedure for the treatment of morbid obesity. In spite of showing good results in weight loss and comorbidities, improvement on a short- and mid-term follow-up basis, data are still lacking regarding long-term outcomes. We retrospectively reviewed the results of SG in our Institution in terms of complications and therapeutic success (percentage of excess weight loss, percentage of excess body mass index and comorbidities improvement). We measured the quality of life using the quality-of-life assesment (QOL) included in the Bariatric Analysis and Reporting Outcome System (BAROS). Materials and Methods: We reviewed patients’ clinical charts and database of 81 patients (72.84% women) with morbid obesity, submitted to sleeve gastrectomy in our Institution between the 1st January 2005 and 31st October 2011. Twenty three patients had previously been treated with a bariatric procedure (28.39%): nine intragastric balloon and 14 gastric banding. In 79 a laparoscopic approach was used and supraumbilical median laparotomy in two. The mean age was 49 ± 4.24 years and the mean body mass index was 54.8 ± 13.1 Kg/m2. Concerning comorbidities, 18 had diabetes, 50 hypertension, 21 dyslipidemia, 11 obstructive sleep apnea, 22 joint pathology and 23 depression. The measurement of BAROS of 72 patients was completed trough a phone inquiry in February 2012. Results: There was no mortality. One procedure was converted to laparotomy because of adhesions. Early and late complication rate was 11.1% (leak, abscess, bleeding, respiratory insufficiency, wound infection and stricture, gastroesophageal reflux, B12 vitamin deficiency neuropathy and incisional hernia). The mean percentage of excess weight loss or of excess body mass index was 25.69 ± 9.72 in the 1st month, 59.87 ± 25.51 in the 12th month, 61.87 ± 24.93 in the 18th month, 54.08 ± 39.87 in the 24th month, 51.8 ± 44.64 in the 36th month, 55.49 ± 26.45 in the 48th month, 49.34 ± 31.31 in the 60th month and 45.98 ± 30.86 in the 72nd month after surgery. Comorbiditites were resolved and/or improved in 71.7% of the operated patients. The values of BAROS divided the population in five groups: Failure – 4.17% (n=3), Fair – 19.44% (n=14), Good, Very Good and Excellent – 76.39% (n=27, 20 e 8 respectively). Conclusion: Sleeve Gastrectomy is a safe procedure, which gives excellent results in terms of percentage of excess weight loss, comorbidities improvement and quality of life. SG is easier to perform than a Gastric Bypass, and is also safely feasible by the laparoscopic approach, with less morbidity. There seems to be a tendency for weight regain after four years, but more long term studies are needed to confirm this tendency.

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Author Biographies

Soraia Silva, Centro Hospitalar e Universitário de Coimbra Clínica Universitária de Cirurgia III da Faculdade de Medicina da Universidade de Coimbra
Assistente Hospitalar de Cirurgia Geral do Centro Hospitalar e Universitário de Coimbra (Serviço de Cirurgia A)
António Milheiro, Centro Hospitalar e Universitário de Coimbra Clínica Universitária de Cirurgia III da Faculdade de Medicina da Universidade de Coimbra
Clínica Universitária de Cirurgia III da Faculdade de Medicina da Universidade de Coimbra
Luis Ferreira, Centro Hospitalar e Universitário de Coimbra Clínica Universitária de Cirurgia III da Faculdade de Medicina da Universidade de Coimbra
Interno do Internato Complementar de Cirurgia Geral do CHUC (Cirurgia A)
Manuel Rosete, Centro Hospitalar e Universitário de Coimbra Clínica Universitária de Cirurgia III da Faculdade de Medicina da Universidade de Coimbra
Interno do Internato Complementar de Cirurgia Geral do CHUC (Cirurgia A)
José Carlos Campos, Centro Hospitalar e Universitário de Coimbra Clínica Universitária de Cirurgia III da Faculdade de Medicina da Universidade de Coimbra
Assistente Graduado de Cirurgia Geral do CHUC (Cirurgia A)
João Almeida, Centro Hospitalar e Universitário de Coimbra Clínica Universitária de Cirurgia III da Faculdade de Medicina da Universidade de Coimbra
Assistente Hospitalar de Cirurgia Geral do CHUC (Cirurgia B)
Mário Sérgio, Centro Hospitalar e Universitário de Coimbra Clínica Universitária de Cirurgia III da Faculdade de Medicina da Universidade de Coimbra
Assistente Graduado de Cirurgia Geral do CHUC (Cirurgia B)
José-Guilherme Tralhão, Centro Hospitalar e Universitário de Coimbra Clínica Universitária de Cirurgia III da Faculdade de Medicina da Universidade de Coimbra

Assistente Graduado de Cirurgia Geral do CHUC (Cirurgia A)

Professor Auxiliar com agregação de Cirurgia da Faculdade de Medicina da Universidade de Coimbra (FMUC)

Francisco Castro e Sousa, Centro Hospitalar e Universitário de Coimbra Clínica Universitária de Cirurgia III da Faculdade de Medicina da Universidade de Coimbra

Chefe de Serviço de Cirurgia Geral do CHUC (Cirurgia A)

Professor Catedrático de Cirurgia da FMUC

References

Helmiö M, Victorzon M, Ovaska J, et al. SLEEVEPASS: A randomized prospective multicenter study comparing laparoscopic sleeve gastrectomy and gastric bypass in the treatment of morbid obesity: preliminary results. Surg Endosc. 2012;26(9):2521-2526. doi:10.1007/s00464-012-2225-4.

Nora M, Guimarães M, Almeida R, et al. Excess body mass index loss predicts metabolic syndrome remission after gastric bypass. Diabetol Metab Syndr. 2014;6(1):1-14.

Padwal R, Klarenbach S, Wiebe N, et al. Bariatric surgery: A systematic review of the clinical and economic evidence. J Gen Intern Med. 2011;26(10):1183-1194. doi:10.1007/s11606-011-1721-x.

Nora M, Guimaraes M, Almeida R, et al. Metabolic laparoscopic gastric bypass for obese patients with type 2 diabetes. Obes Surg. 2011;21(11):1643-1649. doi:10.1007/s11695-011-0418-x.

Peterli R, Borbély Y, Kern B, et al. Early results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Ann Surg. 2013;258(5):690-4; discussion 695. doi:10.1097/SLA.0b013e3182a67426.

Caiazzo R, Pattou F. Adjustable gastric banding, sleeve gastrectomy or gastric bypass. Can evidence-based medicine help us to choose? J Visc Surg. 2013;150(2):85-95. doi:10.1016/j.jviscsurg.2013.03.011.

Jurowich C, Thalheimer A, Seyfried F, et al. Gastric leakage after sleeve gastrectomy-clinical presentation and therapeutic options. Langenbeck’s Arch Surg. 2011;396(7):981-987. doi:10.1007/s00423-011-0800-0.

Boza C, Salinas J, Salgado N, et al. Laparoscopic sleeve gastrectomy as a stand-alone procedure for morbid obesity: report of 1,000 cases and 3-year follow-up. Obes Surg. 2012;22(6):866-71. doi:10.1007/s11695-012-0591-6.

D'Hondt M, Vanneste S, Pottel H, Devriendt D, Van Rooy F, Vansteenkiste F. Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss. Surg Endosc Other Interv Tech. 2011;25(8):2498-2504. doi:10.1007/s00464 011-1572-x.

Nguyen NT, Nguyen B, Gebhart A, Hohmann S. Changes in the makeup of bariatric surgery: A national increase in use of laparoscopic sleeve gastrectomy. J Am Coll Surg. 2013;216(2):252-257. doi:10.1016/j.jamcollsurg.2012.10.003.

Clinical A, Committee I. Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2012;8(3):e21 6. doi:10.1016/j.soard.2012.02.001.

Behrens C, Tang BQ, Amson BJ. Early results of a Canadian laparoscopic sleeve gastrectomy experience. Can J Surg. 2011;54(2):138 143. doi:10.1603/CJS.041209.

Weight IB, Index BM. Recommendations for Reporting Weight Loss. 2003:159-160.

Moorehead K, Oria E. Bariatric Analysis System ( BAROS ) and Reporting. 1998:487-499.

Bobowicz M, Lehmann A, Orlowski M, Lech P, Michalik M. Preliminary outcomes 1 year after laparoscopic sleeve gastrectomy based on Bariatric Analysis and Reporting Outcome System (BAROS). Obes Surg. 2011;21(12):1843-8. doi:10.1007/s11695-011-0403-4.

Péquignot a, Dhahri a, Verhaeghe P, Desailloud R, Lalau J-D, Regimbeau J-M. Efficiency of laparoscopic sleeve gastrectomy on metabolic syndrome disorders: two years results. J Visc Surg. 2012;149(5):e350-5. doi:10.1016/j.jviscsurg.2012.06.005.

Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc Other Interv Tech. 2006;20(6):859-863. doi:10.1007/s00464-005-0134-5.

Bellanger DE, Greenway FL. Laparoscopic sleeve gastrectomy, 529 cases without a leak: short-term results and technical considerations. Obes Surg. 2011;21(2):146-50. doi:10.1007/s11695-010-0320-y.

Gagner M, Deitel M, Erickson AL, Crosby RD. Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy. Obes Surg. 2013;23(12):2013-7. doi:10.1007/s11695 013 1040-x.

De Aretxabala X, Leon J, Wiedmaier G, et al. Gastric leak after sleeve gastrectomy: analysis of its management. Obes Surg. 2011;21(8):1232-7. doi:10.1007/s11695-011-0382-5.

Kleidi E, Theodorou D, Albanopoulos K, et al. The effect of laparoscopic sleeve gastrectomy on the antireflux mechanism: can it be minimized? Surg Endosc. 2013;27(12):4625-30. doi:10.1007/s00464-013-3083-4.
Published
2017-03-30
How to Cite
SILVA, Soraia et al. Sleeve gastrectomy for morbid obesity. Long-term results, comorbidities and quality of life. Revista Portuguesa de Cirurgia, [S.l.], n. 40, p. 11-20, mar. 2017. ISSN 2183-1165. Available at: <https://revista.spcir.com/index.php/spcir/article/view/472>. Date accessed: 23 sep. 2017.
Section
Original Papers