Laparoscopic sleeve gastrectomy: long-term weight loss outcomes.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has become an increasingly popular stand-alone weight loss surgery, but there is a paucity of long-term efficacy data. OBJECTIVE: To determine long-term outcomes for patients undergoing LSG. SETTING: Tertiary care university hospital in the United States. METHODS: This study presents a case series of the first 16 patients undergoing LSG at our institution. Inclusion criteria were accepted indications for bariatric surgery, and exclusion criteria were any prior bariatric surgery, gastrectomy, substance abuse, uncontrolled psychiatric illness, end-stage organ disease, or advanced-stage cancer. Patients were followed for 7 years. Outcomes included percent excess weight loss (%EWL), percent weight loss (%WL), resolution of co-morbidities, and major and minor complications. RESULTS: Patients enrolled in this study had a mean body mass index (BMI) of 43.5 kg/m(2) and a mean age of 49, and 14 of 16 patients were women. Fourteen of 16 patients had 7-year follow-ups with a mean %WL of 29.6%±8.95 and a mean %EWL of 59.6%±89.9%. At 7 years, 11 of 14 patients achieved>50% EWL. One-year follow-up data revealed a mean EWL of 72%±20%, which was significantly greater than the %EWL at 7 years (P = .005). Complications included 1 partial obstruction at the gastric incisura angularis and 1 subacute leak; both were managed endoscopically. There were no reoperations and no deaths. Five of 14 patients experienced new-onset gastroesophageal reflux disease. CONCLUSIONS: At 7 years postoperative, the LSG remained a durable and successful operation.

Acid suppression medications are associated with suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass in patients older than 40 years.

BACKGROUND: Bariatric surgery, including laparoscopic Roux-en-Y gastric bypass (LRYGB), achieves the greatest long-term weight loss in severe obesity. Approximately 50%-60% of severely obese patients have gastroesophageal reflux disease, and a substantial proportion is taking a proton pump inhibitor (PPI) or histamine-2 blocker (H2 B) at the time of LRYGB. The objective of this study was to explore the association of PPI/H2 B use before LRYGB with suboptimal percent weight loss (PWL) after LRYGB. METHODS: This was a cohort study of 472 consecutive patients who underwent LRYGB at a single center from 2004-2011. Suboptimal PWL was defined as<14% at 2 months,<25% at 6 months, and<30% at 12 months. Because of effect modification by age, stratified analyses (by median age of 40 yr) were performed. All models were adjusted for appropriate covariates, including obesity-associated co-morbidities. RESULTS: For patients aged ≤40 years, PPI/H2 B use leading up to LRYGB was not associated with suboptimal PWL at 2 months (P = .86), 6 months (P = .47), or 12 months (P = .66). However, for patients aged>40 years, PPI/H2 B use leading up to LRYGB was associated with a nonsignificant increase in suboptimal PWL at 2 months (odds ratio [OR] 2.23; P = .08) and significant increases in suboptimal PWL at 6 months (OR 7.23; P = .002) and 12 months (OR 11.1; P = .02). Results were independent of GERD. CONCLUSIONS: Mechanisms for the poorer weight loss in patients aged>40 years who were using a PPI/H2 B just before LRYGB should be explored.

The effect of Medicaid status on weight loss, hospital length of stay, and 30-day readmission after laparoscopic Roux-en-Y gastric bypass surgery.

BACKGROUND: Patients with Medicaid are much less likely to undergo bariatric surgery compared to those with commercial insurance. The aims of this study were to compare outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB) for patients covered by Medicaid, other (non-Medicaid) government insurance, and commercial insurance. METHODS: This was a retrospective cohort study of all eligible patients who underwent LRYGB between July 2004 and October 2011 at a single university hospital (n = 450). Multivariable regression analysis was used to compare percent weight loss (PWL), absolute weight loss (AWL), hospital length of stay (LOS) ≥3 days, and 30-day readmission rates. Analyses were adjusted for appropriate covariates. RESULTS: There was a nonsignificant increase in PWL in Medicaid patients at 2 months (p = 0.08), 6 months (p = 0.09), and 12 months (p = 0.17) compared to commercial insurance patients. Similarly, there was a nonsignificant increase in AWL in Medicaid patients at 2 months (p = 0.054), 6 months (p = 0.08), and 12 months (p = 0.14) compared to commercial insurance patients. Medicaid patients had similar PWL and AWL compared to those with other government insurance (p ≥ 0.29 at all time points). Medicaid patients were more likely to have a hospital LOS ≥ 3 days (OR 2.03; 95 % confidence interval (CI) 1.09-3.77) and a hospital readmission within 30 days of discharge (odds ratio (OR) 2.84; 95 % CI 1.15-6.96) compared to commercial insurance patients. CONCLUSIONS: These data should be considered as states expand Medicaid and make decisions regarding treatment of severe obesity. Interventions to decrease hospital LOS and the 30-day readmission rate, particularly in Medicaid patients, should be explored.