Long-Term Outcomes of the Laparoscopic Sleeve

Gastrectomy as a Definitive Bariatric Procedure

Abeezar Sarela, Ashok Menon, Mary O’Kane, Simon Dexter, Michael McMahonThe General Infirmary at Leeds & The Leeds Nuffield Hospital

Sleeve GastrectomyCurrent Status

Updated Position Statement on Sleeve Gastrectomy as a Bariatric Procedure

– Clinical Issues Committee of the ASMBS.

SOARD 2010 In press.

•Systematic review of sleeve gastrectomy as staging and primary bariatric procedure.

– Brethauer, Hammel, Shauer. SOARD 2009;5:469-475

Sleeve GastrectomyAvailable Long-Term Follow-Up Data

• 36 studies-2570 patients

• BMI 37-69 (51.2)

• % EWL 33-85 (55)

• 12 studies >100 patients

• FU>36 months –3 studies

• FU>60 months –1 studySOARD 2009;5:469-475

Follow-up Intervals

•3 y 123 patients

•4 y 26 patients

•5 y 8 patients

SOARD 2010. In press

Aim

To examine weight-loss outcomes from

laparoscopic sleeve gastrectomy as a

definitive bariatric procedure at prolonged

follow-up

Study Design

• Period: 2000-2007

• Hospitals–The General Infirmary at Leeds–The Leeds Nuffield Hospital

• 3 consultant surgeons

• ExclusionInitial explicit intent as a staging procedure and subsequent completion of duodenal switch

Patient Characteristics

• 77 patients• Men: 27%• Median Age:

46 y (19-71)• 26% aged ≥50 y• Previous gastric band

– 4 patients

• Median Weight: 144 kg (89-283)

• BMI ≥50 kg/m2: 57%

Median BMI

53 kg/m2 (29-83)

Technique

• Calibration with 32F bougie

• Preservation of 5-7 cm of antrum

• Staple line reinforcement with Peristrips™ or SeamGuard™

Post-operative Complications

• Staple line leakage 5 patients (6%)

• No mortality

2nd Stage Procedure(Intent not explicitly stated initially)

•Median interval: 30 months (18-96)

•9 patients (12%)

• Roux-en-Y gastric bypass 7• Initial BMI≥50 kg/m2 5 patients

• Duodenal Switch 2 • Initial BMI≥50 kg/m2 1 patient

Weight Loss after Sleeve Gastrectomyas a Primary Procedure

55

70 74 76 74

6169 66

51 25 20 15 9 8 8 5

Number of patients

BMI<50kg/m2 vs. Super-Obese1 year after Sleeve Gastrectomy

77

49

P=0.02

22 29Number of patients

BMI<50kg/m2 vs. Super-Obese3 years after Sleeve Gastrectomy

74 74

P=0.7

10 10Number of patients

Conclusion

• Sleeve gastrectomy, as a stand-alone

procedure, provided median EWL >60%

for up to 8 years

• Super-obese patients had significantly less

excess weight loss at one year (49% vs.

77% for BMI <50 kg/m2) but no apparent

difference at three years