Is pneumatic balloon dilation safe and effective primary modality of treatment for post-sleeve gastrectomy strictures? A retrospective study.

BACKGROUND: The optimal treatment of sleeve strictures has not been agreed upon at the current time. At our institution, we began using pneumatic balloon dilation to help resolve these obstructions in 2010. Herein we report our experience with pneumatic balloon dilation for the treatment of sleeve strictures. METHODS: From Jan 2010 to Dec 2016 we retrospectively reviewed our prospectively kept database for patients who developed a Laparoscopic Sleeve Gastrectomy (LSG) stricture within 90 days of surgery. If the stricture was found, then we dilated all our patients initially at 30 mm at 10 PSI for 10-20 min (14.5 min average) and increased the balloon size (30-40 mm) and duration (10-30 min) in subsequent sessions if the first session was unsuccessful. RESULTS: The review found that 1756 patients underwent either LSG or the first step of a Laparoscopic Duodenal Switch (LDS) (1409 LSG & 356 LDS). Of the 1756 patient 33 patients (24 underwent LSG, and 9 underwent LDS) developed a stricture as a complication of LSG. The average age of the patients was 46.4 (±9.6) years, and the average BMI was 43.7 (±6.4). The most common location for stricture was mid-body of the sleeve (54.5%). The average time from the primary surgery to diagnosis and first pneumatic dilation was 5.6 months (± 6.8) and 5.9 months (± 6.6) respectively. We successfully used pneumatic dilation in 31 (93.9%) of these patients to relieve the stricture. CONCLUSION: We conclude that pneumatic dilation is an effective procedure in patients with post sleeve gastrectomy stricture.

A matched cohort analysis of single anastomosis loop duodenal switch versus Roux-en-Y gastric bypass with 18-month follow-up.

BACKGROUND: The Roux-en-Y gastric bypass (GBP) has been considered the gold standard for many years. The loop duodenal switch (LDS) is a relatively new procedure that simplifies the complexity of the duodenal switch (BPDDS) by making it a single anastomosis procedure while at the same time giving it more intestinal absorption to reduce the rates of malnutrition associated with traditional BPDDS. This paper seeks to compare the 18-month weight loss outcomes and complications of the more standard GBP with the newer LDS in a single US center. METHODS: A retrospective matched cohort was analyzed on 108 patients who had either GBP (54 patients) or LDS (54 patients). Regression analysis was used to compare weight loss outcomes as measured by BMI and weight loss percentages. Complications gathered included bleeds, reoperations, diagnostic or therapeutic endoscopy (EGD), ulcers and chronic nausea. RESULTS: GBP and LDS have statistically similar weight loss at 18 months (39.6 vs 41 % weight loss, respectively). However, there were significantly more nausea complaints (26 vs 5), diagnostic endoscopies (EGD) (21 vs 3) and ulcers (6 vs 0) with the GBP than the LDS. CONCLUSION: LDS has comparable weight loss results to GBP. However, LDS has fewer 30-day and 18-month complications and patients suffer from less nausea postoperatively.

Bowel Reconstruction to Treat Chronic Diarrhea and Hypoproteinemia Following Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy: a Single-Site Experience.

BACKGROUND: Single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) is a modification of the biliopancreatic diversion with duodenal switch (BPD-DS) surgery. A concern with SADI-S is chronic diarrhea and hypoproteinemia. Common channel lengthening (CCL) is a surgical procedure to increase absorption in the small intestine to decrease diarrhea. OBJECTIVES: The aim of this study was to assess the occurrence and treatment of hypoproteinemia and chronic diarrhea with CCL following SADI-S surgery. SETTING: Private practice in the USA. METHODS: Patients were included if they underwent SADI-S from September 2013 to March 2018 and following surgery underwent CCL. RESULTS: Average operating time for laparoscopic CCL is 56.5 ± 4.6 min. The average bowel movements for the eight patients before laparoscopic CCL were 9.1 ± 4.7 a day. After the surgery, the bowel movements were reduced to 2.6 ± 0.4 a day. This difference was found to be statistically significantly different (p = .002). The two patients experiencing hypoproteinemia improved protein levels following CCL. CONCLUSION: CCL is an effective way to treat symptomatic chronic diarrhea after SADI-S when conservative treatments have failed.

Weight Loss Outcomes of Laparoscopic Adjustable Gastric Band with Plication: a Single Center Experience of 66 Patients with 18-Month Follow-Up.

BACKGROUND: Laparoscopic adjustable gastric band with plication (LAGBP) is a novel bariatric procedure, which combines the adjustability of the laparoscopic adjustable gastric band (LAGB) with the restrictive nature of the vertical sleeve gastrectomy (VSG). The addition of plication of the stomach to LAGB should provide better appetite control, more effective weight loss, and greater weight loss potential. The purpose of the study was to analyze the outcomes of LAGBP at 18 months. METHODS: Data from all patients who underwent a primary LAGBP procedure from December 2011 through June 2016 were retrospectively analyzed. Data collected from each patient included age, gender, weight, body mass index (BMI), and excess weight loss (EWL). RESULTS: Sixty-six patients underwent LAGBP. The mean age and BMI were 44.6 ± 12.7 years and 42.1 ± 5.1 kg/m2, respectively. The patients lost an average of 49% and 46.8% EWL at 12 months (77.2% follow-up) and 18 months (66.1% follow-up), respectively. The mean band adjustments were 2.1 ± 1.7 (range, 0-7) per patient in 1 year. The mean additional adjustment volume (infusion and withdrawal of saline) was 0.6 ± 1 cc. Dysphagia was the most common long-term complication. The band removal rate was 7.5%. The mortality rate was 0%. CONCLUSIONS: LAGBP is a relatively safe and effective bariatric procedure. In light of recent studies demonstrating poor outcomes following LAGB, LAGBP may prove to be the future for patients desiring a bariatric procedure without resection of the stomach.

A Multi-institutional Study on the Mid-Term Outcomes of Single Anastomosis Duodeno-Ileal Bypass as a Surgical Revision Option After Sleeve Gastrectomy.

INTRODUCTION: Recently, a single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has become increasingly popular for patients with BMI > 50 as a primary or staged surgery. Staging allows surgeons to do the sleeve gastrectomy (SG) first with the conversion only happening when a failure or technical challenge is identified. PURPOSE: We present the mid-term outcomes of SADI bypass surgery after SG. METHOD: A retrospective analysis was performed on a prospective database from four institutions. Ninety-six patients were identified from 2013 to 2018. Patients were divided into two groups: one had two-stage SADI because of insufficient weight loss, the second had planned two-stage SADI because of super obesity (BMI > 50 kg/m2). Incidence of complications was divided into < 30 days and > 30 days. RESULT: Of 96 patients, 3 patients were completely lost to follow-up. The mean age was 44.8 ± 11.3 years. There were no deaths or conversion to open surgery. The postoperative early complication and late complication rate was 5.3% and 6.4% respectively. At 24 months, group 2 had higher %weight loss (WL) and change in BMI units compared to group 1 with statistically significant difference. The average WL and change in BMI for entire patient's population at 24 months after 2nd stage SADI was 20.5% and 9.4 units respectively. The remission rate for DM was 93.7% with or without the use of medication. CONCLUSION: The two-stage approach to SADI-S appears technically simpler than a single compromised operation. However, this approach needs more patients to understand its limitations.

The Use of Predictive Markers for the Development of a Model to Predict Weight Loss Following Vertical Sleeve Gastrectomy.

BACKGROUND: Average percent excess weight loss data is commonly discussed preoperatively to guide patient expectations following surgery. However, there is a wide range and variation in weight loss following vertical sleeve gastrectomy (SG). Unfortunately, most surgeons and even fewer patients have heard of using predictive models to help guide their decisions on procedure choice. We have developed a predictive model for SG to help patient choice prior to this major life-changing decision. OBJECTIVE: Predict weight loss results for SG patients at 1 year using preoperative data. SETTING: Private practice. METHODS: Three hundred and seventy-one SG patients met the criteria for our study. These patients underwent surgery between October 2008 and June 2016. Non-linear regressions were performed to interpolate individual patient weights at 1 year. Multivariate analysis was used to find factors that affected weight loss. A model was constructed to predict weight loss performance. RESULTS: Variables that affect weight loss were found to be preoperative body mass index (BMI), age, hypertension, and diabetes. Diabetes and hypertension together were found to significantly affect weight loss. CONCLUSION: Patient weight loss can be accurately predicted by simple preoperative factors. These findings should be used to help patients and surgeons decide if the SG is an appropriate surgery for each patient. Using this model, most patients can avoid failure by choosing an appropriate surgical approach for their personal circumstances.

Banded Sleeve Gastrectomy: Better Long-Term Results? A Long-Term Cohort Study Until 5 Years Follow-Up in Obese and Superobese Patients.

INTRODUCTION: The failure rate of the laparoscopic sleeve gastrectomy (LSG) is increasing. Gastric pouch dilation is frequently suggested to be one of the causes for the failure. The banded laparoscopic sleeve gastrectomy (BLSG) has been proposed to overcome this complication. This is the first study that reports the long-term outcome (> 5 years) of BLSG in obese and superobese patient population. MATERIALS AND METHODS: One hundred and forty-seven patients (n = 51, non-banded LSG (NLSG)/n = 96, BLSG) were followed up for 5 years. Patients were evaluated for % excess weight loss (%EWL), % excess body mass index loss (%EBMIL), weight regain, BMI, and complications. Weight loss analysis was also done between banded and non-banded superobese patient populations. RESULT: There was statistical significant difference between two groups at each given time point in terms of %EWL and %EBMIL. NLSG group had higher weight loss failure rate (35.2%) and weight regain (19.6%) at the 5-year follow-up compared to BLSG group (P < 0.001). There was no statistical significant difference in weight loss between obese and superobese BLSG group. The complication rates were more with BLSG group (14.5%) compared to NLSG group (9.8%); no signs of band slippage, erosion, or migration were seen. There was no mortality seen. CONCLUSION: BLSG surgery was found to be safe and effective in maintaining weight loss on the long term compared to the NLSG group with low incidence of band-related problems. Additionally, the NLSG group had a higher rate of weight loss failure and weight regain at 5 years compared to the BLSG group.

Adjustable gastric banded plication versus sleeve gastrectomy: the role of gastrectomy in weight loss.

BACKGROUND: Laparoscopic adjustable gastric banded plication (LAGBP) is a procedure that has a stomach volume similar to the sleeve gastrectomy (SG). It has shown promising results but has not been adopted widely. OBJECTIVE: To determine the difference gastrectomy has on weight loss and complications. SETTING: Private practice, United States. METHODS: A retrospective, matched-cohort analysis of LAGBP and SG patients was found through matching body mass index and sex for each LAGBP to a SG patient. Body mass index, percentage excess weight loss, and total weight loss percentage were analyzed. Complication data were also collected on a short- (<30 d) and long- (>30 d) term basis. Complication rates were then compared. Data were analyzed through descriptive statistics. RESULTS: Patients who received SG lost more body mass index, percentage excess weight loss, and total weight loss percentage at 1 year and started to gain weight between 1 and 2 years. LAGBP patients weight loss also peaked at 1 year but maintained their weight loss to year 2. SG patients lost more weight at all time points, and the difference was statistically significant (P<.05). LAGBP and SG patients had statistically similar rates of short- and long-term complication rates. In the LAGBP group (57 patients) 5, 9, 13, 14, 14, and 17 patients were lost to follow-up at 3, 6, 9, 12, 18, and 24 months, respectively. In the SG group (57 patients) 11, 10, 11, 13, 20, and 29 patients were lost to follow-up at 3, 6, 9, 12, 18, and 24 months, respectively. CONCLUSION: Both procedures have peak weight loss at 1 year with acceptable complication rates. However, the SG starts to regain weight while the LAGBP shows weight stability. More time is needed to see if the weight loss curves will intersect or if the late band complications will also happen with the LAGBP as they have with band placement without plication.

Does Bismuth Subgallate Affect Smell and Stool Character? A Randomized Double-Blinded Placebo-Controlled Trial of Bismuth Subgallate on Loop Duodenal Switch Patients with Complaints of Smelly Stools and Diarrhea.

BACKGROUND: Loop duodenal switch (LDS) can result in fat and starch malabsorption. In a small percentage of patients, a relevant qualitative and quantitative change in stools happens usually characterized by steatorrhea-like diarrhea. Bismuth subgallate (BS) has been marketed as a way to eliminate the odor associated with flatulence and bowel movements. The objective of this study is to see the efficacy and effect of BS on the quality of life (QOL) in patients undergoing LDS. METHODS: A prospective, randomized, double-blinded, placebo-controlled, crossover study was designed. Thirty-six patients who reported flatus and/or stool odor changes and have completed at least 6 months post-LDS were included. Patients participated in two treatment periods, each lasting for 1 week, separated by 1-week washout. Patients received 200 mg BS, 2 capsules per meal, or placebo for 1 week each. The Gastrointestinal Quality of Life Index (GIQLI) questionnaire was used to compare the QOL before the initiation of the therapy and after each treatment completion. RESULTS: Of 36 patients, 5 patients were lost to follow-up and 2 were withdrawn from the study. And 29 patients were included for final analysis. GIQLI scores obtained with BS treatment completion were significantly higher both overall (P = 0.007) and in the digestive domain (P < 0.001) than those obtained before the treatment. GIQLI scores obtained from the other domains were also higher compared to the pre-treatment as well as placebo treatment but not statistically significant. CONCLUSION: In our double-blinded trial, treatment with BS after LDS statistically improves GIQLI score and steatorrhea-like symptoms.

Stomach Intestinal Pylorus-Sparing Surgery for Morbid Obesity.

BACKGROUND AND OBJECTIVE: The Roux-en-Y duodenal switch (RYDS) is one of the most efficient forms of bariatric surgery. However, diarrhea, malnutrition, ulcers, and internal hernias have hampered its widespread adoption. The stomach intestinal pylorus-sparing (SIPS) procedure was developed to alleviate these sequelae while retaining the same weight loss as the RYDS. In this study, we report our midterm experience with this novel technique. METHODS: Retrospective analysis was performed on data from 225 patients who underwent a primary SIPS procedure by 2 surgeons at a single center from October 2013 through December 2016. RESULTS: Two hundred twenty-five patients were identified for analysis. The mean preoperative body mass index (BMI) was 52.4 ± 9.1 kg/m2. Forty-eight patients were beyond 2 years after surgery, with data available for 30 patients (62.5% follow-up). Three patients were lost to follow-up. At 2 years, the patients had an average change in BMI of 26.6 U (kg/m2) with an average of 88.7% of excess weight loss. Three deaths were related to the surgery. The most common short-term complication was a leak (2.2%), whereas the most common long-term complication was diarrhea (2.2%). CONCLUSION: In conclusion, SIPS surgery is a safe procedure with favorable weight loss outcomes at 2 years.

An Analysis of Mid-Term Complications, Weight Loss, and Type 2 Diabetes Resolution of Stomach Intestinal Pylorus-Sparing Surgery (SIPS) Versus Roux-En-Y Gastric Bypass (RYGB) with Three-Year Follow-Up.

BACKGROUND: For many years, the Roux-en-Y Gastric Bypass (RYGB) was considered a good balance of complications and weight loss. According to several short-term studies, single anastomosis duodenal switch or stomach intestinal pylorus sparing surgery (SIPS) offers similar weight loss to RYGB with fewer complications and better diabetes resolution. No one has substantiated mid-term complication and nutritional differences between these two procedures. This paper seeks to compare complication and nutritional outcomes between RYGB and SIPS. METHODS: A retrospective analysis of 798 patients who either had SIPS or RYGB from 2010 to 2016. Complications were gathered for each patient. Nutritional outcomes were measured for each group at 1, 2, and 3 years. Regression analysis was applied to interpolate each patient's weight at 3, 6, 9, 12, 18, 24, and 36 months. These were then compared with t tests, Fisher's exact tests, and chi-squared tests. RESULTS: RYGB and SIPS have statistically similar weight loss at 3, 6, 9, 12, and 36 months. They statistically differ at 18 and 24 months. At 36 months, there is a trend for weight loss difference. There were only statistical differences in nutritional outcomes between the two procedures with calcium at 1 and 3 years and vitamin D at 1 year. There were statistically significantly more long-term class IIIb-V complications, class I-IIIa complications, reoperations, ulcers, small bowel obstructions, nausea, and vomiting with the RYGB than the SIPS. CONCLUSION: With comparable weight loss and nutritional outcomes, SIPS has fewer short- and long-term complications than RYGB and better type 2 diabetes resolution rates.

Laparoscopic stomach intestinal pylorus-sparing surgery as a revisional option after failed adjustable gastric banding: a report of 27 cases with 36-month follow-up.

BACKGROUND: Inadequate weight loss, weight recidivism, and device-related complications after an adjustable gastric banding (AGB) can be treated by a laparoscopic conversion to stomach intestinal pylorus-sparing surgery (SIPS). OBJECTIVE: The aim of the study was to analyze the midterm outcomes of revision SIPS surgery after failed AGB. SETTING: Private practice, United States. METHODS: This is a retrospective review of our prospectively collected data of patients who underwent laparoscopic conversion from AGB to SIPS surgery from June 2013 and February 2017 by a single surgeon in a single institution. RESULTS: Twenty-seven patients (1 stage: 22 and 2 stage: 5) underwent a laparoscopic revision of AGB to SIPS surgery. The mean ± standard deviation preoperative body mass index (BMI) before AGB was 47.5 ± 6.8 kg/m2, while the mean nadir BMI after AGB was 36 ± 7.7 kg/m2. The overall time to reoperation was 9.3 ± 8.7 and 5.6 ± 2.5 years in 1- and 2-stage conversion patients, respectively. The mean preoperative BMI before revision SIPS surgery was 46.7 ± 7 kg/m2. At 36 months, the patients had an average change in BMI of 20.9 units with 90% excess weight loss. A major complication occurred in 4 patients. Postoperatively, the fasting blood glucose, insulin, low-density lipoprotein, triglyceride, and most of the co-morbidities were resolved or improved. CONCLUSION: This study demonstrates that conversion of failed AGB to SIPS surgery is an effective approach to AGB failure.

Mid-term 4-Year Outcomes with Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy Surgery at a Single US Center.

BACKGROUND: Single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) is a modification of Roux-en-Y duodenal switch (RYDS). Long-term data on this operation is lacking in the literature. We reviewed our mid-term data of this RYDS modification. PURPOSE: To analyze the outcomes with SADI-S at 4 years. METHODS: Data from patients who underwent a primary SADI-S procedure performed by three surgeons at a single institution from June 2013 through February 2018 were retrospectively reviewed. All revision bariatric surgeries were excluded. Regression analyses were performed for all follow-up weight loss data. RESULTS: There were 437 patients in our database. The pre-operative mean body mass index (BMI) was 49.8 ± 8.8 kg/m2. The 30-day complication rate was 7.7%. The 30-day readmission, reoperation, and mortality rates were 1.8, 1.3, and 0.2%, respectively. The long-term complication rate was 10.9%. Seventy-nine patients were 4 years post SADI-S surgery and follow-up was possible for 44 patients (55.7%). At 4 years, patients had an average change in BMI of 18.1 ± 6 units with an excess weight loss (EWL) of 85.7 ± 27.3%. At 4 years, 97.6% patients were able to maintain HbA1c < 6% with or without the use of diabetic medication. There was a statistically significant difference between most of the pre-operative and post-operative nutritional data. CONCLUSIONS: SADI-S is a safe and effective procedure in both short- and mid-term data points. Diabetes resolution and weight loss appear similar to traditional RYDS and better than RYGB.

The incidence of complications associated with loop duodeno-ileostomy after single-anastomosis duodenal switch procedures among 1328 patients: a multicenter experience.

BACKGROUND: The single-anastomosis duodenal switch procedure is a type of duodenal switch that involves a loop anastomosis rather than traditional Roux-en-Y reconstruction. To date, there have been no multicenter studies looking at the complications associated with post-pyloric loop reconstruction. OBJECTIVES: The aim of the study was to report the incidence of complications associated with loop duodeno-ileostomy (DI) following single-anastomosis duodenal switch (SADS) procedures. SETTING: Mixed of private and teaching facilities. METHODS: The medical records of 1328 patients who underwent primary SADS procedure (single-anastomosis duodeno-ileal bypass with sleeve gastrectomy or stomach intestinal pylorus-sparing surgery) by 17 surgeons from 3 countries (United States, Spain, and Australia) at 9 centers over a 6-year period were retrospectively reviewed, and their results were compared with articles in the literature. RESULTS: Mean preoperative body mass index was 51.6 kg/m2. Of 1328 patients, 123 patients received a linear stapled duodeno-ileostomy (DI) and 1205 patients a hand-sewn DI. In the overall series, the anastomotic leak, ulcer, and bile reflux occurred in .6% (9/1328), .1% (2/1328), and .1% (2/1328), respectively. None of our patients experienced volvulus at the DI or an internal hernia. Overall, 5 patients (.3%) (3/123 [2.4%] with linear stapled DI versus 2/1205 [.1%] with hand-sewn DI [P<.05]) experienced stricture at the DI in this series. CONCLUSIONS: The overall incidence of complications associated with loop DI was lower than the reported incidence of anastomotic complications after Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch. SADS procedures may cause much fewer anastomotic complications compared with Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch.

Does the future of laparoscopic sleeve gastrectomy lie in the outpatient surgery center? A retrospective study of the safety of 3162 outpatient sleeve gastrectomies.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is a safe and effective procedure that can be performed as an outpatient procedure. OBJECTIVES: The aim of the study was to determine whether same-day discharge LSG is safe when performed in an outpatient surgery center. SETTING: Outpatient surgery centers. METHODS: The medical records of 3162 patients who underwent primary LSG procedure by 21 surgeons at 9 outpatient surgery centers from January 2010 through February 2018 were retrospectively reviewed. RESULTS: Three thousand one hundred sixty-two patients were managed with enhanced recovery after surgery protocol and were included in this analysis. The mean age and preoperative body mass index were 43.1 ± 10.8 years and 42.1 ± 7.1 kg/m2, respectively. Sleep apnea, type 2 diabetes, gastroesophageal reflux disease, hypertension, and hyperlipidemia were seen in 14.4%, 13.5%, 24.7%, 30.4%, and 17.6% patients, respectively. The mean total operative time was 56.4 ± 16.9 minutes (skin to skin). One intraoperative complication (.03%) occurred. The hospital transfer rate was .2%. The 30-day follow-up rate was 85%. The postoperative outcomes were analyzed based on the available data. The 30-day readmission, reoperation, reintervention, and emergency room visit rates were .6%, .6%, .2%, and .1%, respectively. The 30-day mortality rate was 0%. The total short-term complication rate was 2.5%. CONCLUSIONS: Same-day discharge seems to be safe when performed in an outpatient surgery center in selected patients. It would appear that outpatient surgery centers are a viable option for patients with minimal surgical risks.

A retrospective comparison of biliopancreatic diversion with duodenal switch with single anastomosis duodenal switch (SIPS-stomach intestinal pylorus sparing surgery) at a single institution with two year follow-up.

BACKGROUND: The traditional duodenal switch is performed using a Roux-en-Y configuration. This procedure has proven to be the most effective procedure for long-term weight loss and co-morbidity reduction. Recently, stomach intestinal pylorus sparing surgery (SIPS) has been introduced as a simpler and potentially safer variation of the duodenal switch (DS). It is a single anastomosis end-to-side proximal duodeno-ileal bypass with a sleeve gastrectomy. In this study, we compare our outcomes between biliopancreatic diversion with duodenal switch (BPD-DS) and SIPS at 2 years. SETTING: This is a retrospective analysis from a single surgeon at a single private institution. METHODS: We analyzed data from 182 patients retrospectively, 62 patients underwent BPD-DS while 120 other patients underwent SIPS between September 2011 and March 2015. A subset analysis was performed comparing data from both procedures to evaluate weight loss and complications. RESULTS: Of 182 patients, 156 patients were beyond 1 year postoperative mark and 99 patients were beyond 2 year postoperative mark. Five patients were lost to follow-up. None of our patients had complications resulting in death. BPD-DS and SIPS had statistically similar weight loss at 3 months but percent excess weight loss (%EWL) was more with BPD-DS than SIPS at 6, 9, 12, 18, and 24 months. Patient lost a mean body mass index (BMI) of 23.3 (follow-up: 69%) and 20.3 kg/m2 (follow-up: 71%) at 2 years from the BPD-DS and SIPS surgery, respectively. However, patients who had undergone SIPS procedure had significantly shorter operative time, shorter length of stay, fewer perioperative and postoperative complications than BPD-DS (P<.001). Interestingly, even though BPD-DS patients lost slightly more weight, the actual final BMI for SIPS group was lower than BPD-DS group (25.6 versus 26.9) (P<.05). There was no statistical difference between 2 groups for postoperative nutritional data such as vitamins D, B1, B12, serum calcium, fasting blood glucose, glycosylated hemoglobin (HbA1C), insulin, serum albumin, serum total protein, and lipid panel. CONCLUSION: The SIPS is a simplified DS procedure. The SIPS eliminates one anastomosis and compared with BPD-DS has fewer perioperative and postoperative complications, shorter operative time and length of stay, and similar nutritional results at 2 years. However, weight loss was more with BPD-DS. A fair criticism is that the vast majority of BPD-DS cases were done before the SIPS cases. As a result, experience and learning curve cannot be completely dismissed when viewing postoperative complications.

Laparoscopic adjustable gastric banding versus laparoscopic adjustable gastric banding with gastric plication: midterm outcomes in terms of weight loss and short term complications.

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is a safe procedure with variable outcomes and large standard deviations. LAGB with gastric plication (LAGBP) is a new restrictive procedure that combines the lap band with gastric plication. This procedure, with its mechanism being below the band anatomically, should augment the weaknesses of the lap band: slips and inadequate weight loss. OBJECTIVE: Compare the weight loss results and complication rates between the LAGB and LAGBP. SETTING: Private practice. METHODS: Data was analyzed data from 120 patients retrospectively from 2 surgeons at a single private institution. Seventy-six patients underwent LAGB, and 44 other patients underwent LAGBP between February 2011 and July 2013. All 120 patients are beyond the 1-year postoperative mark and 110 patients are beyond the 2-year postoperative mark. A subset analysis was performed comparing data from both procedures to evaluate weight loss and complications. RESULTS: There were no significant differences between preoperative age, weight, and body mass index between the patients who underwent either procedure. We had 47.4% and 52.3% follow-up at 1 year for LAGB and LAGBP, respectively, with 91.5% and 92.3% follow-up at 2 year for LAGB and LAGBP, respectively. Complications were low with LAGBP; however, it was not statistically significant (P = .54). The LAGBP had a greater percent excess weight loss, percent total weight loss, and percent excess body mass index lost compared with the LAGB at 3, 6, 9, 12, and 24 months, and these differences were statistically significant. Mean percent excess weight loss for LAGB and LAGBP was 28.3% and 34.5% (P<.05) at 1 year and 32.1% and 39.2% (P<.05) at 2 years, respectively. CONCLUSION: LAGBP is a safe, feasible, and reproducible bariatric procedure. The LAGBP performs significantly better than the LAGB for weight loss. The complication and revision rates were slightly higher with LAGB than LAGBP. However, it was not statistically significant.

Long-term success and failure with SG is predictable by 3 months: a multivariate model using simple office markers.

INTRODUCTION: Despite being the most common surgery in the United States, little is known about predicting weight loss success and failure with sleeve gastrectomy (SG). Papers that have been published are inconclusive. We decided to use multivariate analysis from 2 practices to design a model to predict weight loss outcomes using data widely available to any surgical practice at 3 months to determine weight loss outcomes at 1 year. SETTING: Two private practices in the United States. METHODS: A retrospective review of 613 patients from 2 bariatric institutions were included in this study. Co-morbidities and other preoperative characteristics were gathered, and %EWL was calculated for 1, 3, and 12 months. Excess weight loss (%EWL)<55% at 1 year was defined as weight loss failure. Multiple variate analysis was used to find factors that affect %EWL at 12 months. RESULTS: Preoperative sleep apnea, preoperative diabetes, %EWL at 1 month, and %EWL at 3 months all affect %EWL at 1 year. The positive predictive value and negative predictive value of our model was 72% and 91%, respectively. Sensitivity and specificity were 71% and 91%, respectively. CONCLUSION: One-year results of the SG can be predicted by diabetes, sleep apnea, and weight loss velocity at 3 months postoperatively. This can help surgeons direct surgical or medical interventions for patients at 3 months rather than at 1 year or beyond.

A Matched Cohort Analysis of Stomach Intestinal Pylorus Saving (SIPS) Surgery Versus Biliopancreatic Diversion with Duodenal Switch with Two-Year Follow-up.

BACKGROUND: In bariatric surgery, the procedure with the highest average weight loss is the biliopancreatic diversion with duodenal switch (BPDDS). A new simplified duodenal switch called the stomach intestinal pylorus sparing (SIPS) surgery with less malabsorption and one fewer anastomosis claims to have similar outcomes when compared to the BPDDS. METHODS: A retrospective matched cohort analysis of SIPS versus BPDDS patients in a single private practice was obtained by matching every BPDDS to a SIPS patient of the same gender and BMI. Excess weight loss percentage (EWL), BMI, and percentage total weight loss (%TWL) were compared. Additionally, comorbidity resolution, nutritional data, and complications were also compared. Data was analyzed using both descriptive and comparative statistics. RESULTS: Over 2 years, there was no statistical difference in weight loss between BPDDS and SIPS. There also was no difference in nutritional data between the two procedures pre- and post-op. Complication rates were lower in SIPS however, due to the small sample sizes this is not statistically significant. CONCLUSION: Weight loss and nutritional results between SIPS and BPDDS are similar at 2 years. However, there are fewer complications with SIPS.