Laparoscopic bariatric surgery: a five-year review.

OBJECTIVE: To review our results of laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, and laparoscopic gastric bypass for the treatment of morbid obesity. DESIGN: Prospective cohort study. SETTING: Bariatric Surgery Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. PATIENTS: All patients consisted of those referred to our Combined Obesity Clinic (to provide multidisciplinary weight management for severely obese patients) during the period July 2002 to December 2007. For patients who received bariatric surgeries as treatment of morbid obesity, peri-operative data, postoperative weight change, and co-morbidity improvements were collected and prospectively reviewed. RESULTS: During the study period, 531 patients attended our Clinic for treatment of obesity. Their mean (standard deviation) body weight was 96 (22) kg, mean body mass index was 36 (6) kg/m(2), mean age was 40 (10) years, and 64% were female. Of these patients, 94 (18%) underwent bariatric surgery, which included: laparoscopic adjustable gastric banding (n=57), laparoscopic sleeve gastrectomy (n=30), and laparoscopic gastric bypass (n=7). Adverse events occurred in 11 (12%) of these 94 patients, but there was no operative mortality. At 2 years, the mean percentage weight loss for patients having laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, and laparoscopic gastric bypass were 34%, 51% and 61%, respectively. After operative treatment, obesity-related co-morbidities including metabolic syndrome, type 2 diabetes, hypertension, and sleep apnoea had also improved significantly. CONCLUSION: Through a multidisciplinary weight management programme and various bariatric procedures, favourable results can be achieved in Chinese patients with severe obesity.

Development of bariatric surgery: the effectiveness of a multi-disciplinary weight management programme in Hong Kong.

INTRODUCTION: In Hong Kong, obesity and its associated co-morbidities are increasingly becoming a health and societal burden. Conservative weight management therapy is ineffective in maintaining substantial weight loss in severely obese patients and more invasive interventions are required to achieve sustainable weight loss. MATERIALS AND METHODS: Invasive bariatric procedures were introduced to Hong Kong in 2002. Severely obese patients will be seen in a combined obesity clinic where multi-disciplinary assessment was carried out before interventional therapy. Patients will be allocated to various bariatric surgeries such as laparoscopic adjustable gastric banding (LAGB), laparoscopic sleeve gastrectomy (LSG) or laparoscopic gastric bypass (LGB) when operative criteria were met. For selected patients who were not suitable or refused surgical treatment, endoscopic placement of intragastric balloon (IGB) will be used as an alternative weight control option. Multi-disciplinary approach was also applied during perioperative period to accomplish different clinical needs for the individual patient. RESULTS: Over 500 patients were seen in our unit seeking advice on severe obesity. Two hundred and twenty-five patients received interventional therapy which included LAGB (n = 57), LSG (n = 71), LGB (n = 7) and IGB programme (n = 120). Thirty patients (25%) received second bariatric surgery after IGB removal. Adverse events occurred in 20 patients (7.8%) and there was no operative mortality. At 2 years, the mean percentage of excessive weight loss (%EWL) for LAGB, LSG and LGB are 34%, 51% and 61%, respectively. In those patients who received IGB alone, the mean %EWL at removal and 6 months after removal were 44% and 34%, respectively. CONCLUSIONS: Through a multi-disciplinary weight management programme with different specialties and various bariatric procedures, favourable results can be achieved in patients with severe obesity.