Laparoscopic sleeve gastrectomy--influence of sleeve size and resected gastric volume.

BACKGROUND: Although the efficacy of laparoscopic sleeve gastrectomy (LSG) for morbidly obese patients with a BMI of <50 kg/m2, the incidence of weight gain by change of eating behaviors, and gastric dilatation following LSG have not been investigated thus far, LSG is becoming more common as a single-stage operation for the treatment morbid obesity. METHODS: This is a prospective study of the initial 120 patients who underwent isolated LSG. Initially, the LSG was performed without a calibration tube and resulted in high sleeve volumes (group 1: n=25). In group 2 (n=32), a calibration tube of 44 Fr and in group 3 (n=63) a calibration tube of 32 Fr were used. The study group consists of 101 patients with high BMI who were scheduled for a two-step LBPD-DS, but rejected the second step after 1 year. Study endpoints include estimated sleeve volume, volume of removed stomach, operative time, complication rates, length of hospital stay, changes in co-morbidity, percentage of excess BMI loss (%EBL) and changes in BMI (kg/m2). RESULTS: All 3 groups were comparable regarding age, gender, and co-morbidities. There was no hospital mortality, but there was one case of late mortality (0.8%). 2 early leaks (1.7%) were seen. % excess BMI loss was significantly higher for patients who underwent LSG with tube calibrations. LSG with large sleeve volume showed a slight weight gain during 5 years of observation. A total of 16 patients (13.3%) underwent a second stage procedure within a period of 5 years (2 redo-sleeves, 7 LBPD-DS, 3 LRYGBP). CONCLUSION: Early weight loss results were not different between the groups, but after 2 years the more restrictive LSG (groups 2, 3) results were significantly better than in patients without calibration. A removed gastric volume of <500 cc seems to be a predictor of failure in treatment or early weight regain. A statistically significant improved health status and quality of life were registered for all groups. The general introduction of LSG as a one-stage restrictive procedure in the bariatric field can be considered only if the procedure is standardized and long-term results are available.

The Bariatric Quality of Life index: a measure of well-being in obesity surgery patients.

BACKGROUND: Quality of life (QoL) is considered to be the true measure for the effectiveness of a surgical procedure, but there are only a few validated instruments available for bariatric surgery. Therefore, a new diseasespecific 30-item instrument was created, which was called Bariatric Quality of Life (BQL) questionnaire. METHODS: To validate the BQL, we studied 133 patients after 4 different types of bariatric surgery. Initially, mean body mass index (BMI) was 47.2 +/-7.6 kg/m2 and mean age was 38.8 +/-11.0 years. At baseline, and 1, 6, and 12 months after surgery, patients filled in the BQL, the SF-12 (Short Form of SF-36 Health Survey), the GIQLI (Gastrointestinal Quality of Life Index), and the BAROS (Bariatric Analysis and Reporting Outcome System). RESULTS: Internal consistency of the BQL was found to be good, with Cronbach's alpha ranging between 0.71 and 0.86. Factor analyses suggested that the BQL included a highly consistent set of QoL items and a second part on co-morbidities and gastrointestinal symptoms. At the 12 months follow-up, the BQL was closely correlated to SF 12 (Pearson's r = 0.86), GIQLI (0.68), BAROS (0.71), and excess weight loss (0.55). Standardized effect sizes over time were larger for the BQL (1.39 and 1.58) than for the other instruments. CONCLUSIONS: The BQL questionnaire is a validated instrument ready for clinical use.

New advances in laparoscopic treatment of morbid obesity.

The prevalence of obesity in the United States (U.S.) is increasing to epidemic proportions. Currently, more than 60% of Americans and 51% of Germans are overweight. Whereas a variety of medications are available for treatment of obesity, none results in the long-term loss of more than 10% of body weight. The current standard for treatment of severe obesity, defined as a body mass index (BMI) of greater than 35 kg/m2 with comorbidities and generally greater than 40 kg/m2, is surgical. Several surgical procedures are currently available, including gastric bypass, biliopancreatic diversion (BPD) with duodenal switch, and the adjustable gastric band. These operations may be performed using laparoscopic surgical techniques to minimize perioperative morbidity and postoperative recovery time. To optimize the outcome of this type of procedure, bariatric surgery should be performed on carefully selected patients, in bariatric centers specially equipped to care for the obese, within a broadly based, multidisciplinary setting that provides lifelong postoperative care.