ARTICLES

More Patients Turn to Sleeve Gastrectomy as Revision Procedure to LapBand Surgery

Although LapBand® has become commonplace for the treatment of morbid obesity, it is not unusual for a significant percentage (6-15%) of these patients to undergo "reoperation" for insufficient weight loss and surgical, band-related complications.

San Francisco, CA (PRWEB) January 28, 2007 -- Traditionally, candidates for "reoperation" were left to choose between two surgically demanding, second-stage possibilities: Roux-en-Y gastric bypass or biliopancreatic diversion (BPD), as the only post-LapBand® solutions.

The results of a one-year study published in the medical journal Obesity Surgery indicate that laparoscopic sleeve gastrectomy should be considered as a safe, first-stage alternative in lieu of more complex procedures.

The research conducted involved eight patients - two males and six females - with an average age of 46.6 years and an average BMI of 50.5 kg/m2. Each had undergone LapBand® between two and 13 years prior to the study. Once each individual completed the laparoscopic sleeve gastrectomy procedure, patient results were measured on a monthly basis. Overall, an average excess weight loss of 22% at one month, 47% at six months, and 57% at 12 months was observed in five of the eight patients. Two patients maintained satisfactory results from the LapBand® procedure, and one required second-stage biliopancreatic diversion with duodenal switch (DS).

When asked to comment on the potential for sleeve gastrectomy as a revision procedure after laparoscopic gastric banding, Dr. Paul Cirangle, of Laparoscopic Associates of San Francisco (LAPSF) noted, "This report provides obese patients with data that an alternative exists for effective weight loss. The procedure is not as invasive as Roux-en-Y gastric bypass or duodenal switch - sleeve gastrectomy is a 90-minute procedure that requires an average hospital stay of 1-2 days."

"With obesity rates soaring in the United States, hope for a healthier future lies in the development of weight loss surgery procedures such as sleeve gastrectomy, as well as a patient population educated in living a healthier lifestyle," stated Dr. Cirangle. "I think people are learning and deciding to do something that can help improve their overall health and long-term happiness, with or without bariatric surgery."

Study Shows Vertical Gastrectomy is Safe, Effective Treatment for Different Types of Obesity

San Francisco, CA (PRWEB) May 3, 2007 — A study published in a recent issue of the medical journal Surgical Endoscopy found that vertical sleeve gastrectomy is an effective surgical option in certain medical circumstances when compared to other laparoscopic procedures.

The study, conducted by Dr. Crystine M. Lee, Dr. Paul T. Cirangle, and Dr. Gregg H. Jossart, of the California Pacific Medical Center in San Francisco, follows 216 patients who underwent vertical gastrectomy(also known as the sleeve gastrectomy). The mean patient age is 44.7 years, and 173 patients (80%) were female. The mean body preoperative weight and BMI (body mass index) was 302 lbs, and 49, respectively.

The results of the study indicate that vertical gastrectomy weight loss surgery achieves significant weight loss, comparable to Roux-en-Y gastric bypass and duodenal switch and superior to the LapBand®. The advantage of vertical gastrectomy is that it does not present the technical surgical challenges of the duodenal switch or the significant morbidity rate, which has been reported in duodenal switch to be as high as 23%. Additionally, vertical gastrectomy operations were shorter in duration than the duodenal switch and Roux-en-Y gastric bypass procedures, and vertical gastrectomy patients had, on average, a shorter length of stay (1.9 days) versus the duodenal switch (3.2 days) and Roux-en-Y (2.8 days) patients.

Dr. Gregg Jossart, one of the study’s co-authors and a surgeon at the Laparoscopic Associates of San Francisco, indicated that while more research is needed, the initial findings on vertical gastrectomy are very encouraging. “Vertical gastrectomy is a reasonable solution to the problem of super-obesity. It can usually be done laparoscopically, even in patients weighing over 500 lbs. The gastric restriction can cause these patients to lose more than 200 lbs, allowing significant improvement in health and resolution of associated medical problems such as diabetes and sleep apnea. It is also emerging as an excellent option for lower weight individuals who are considering the LapBand®.”

Sleeve Gastrectomy for Morbid Obesity

Andrew A. Gumbs¹, Michel Gagner^{1, 2} , Gregory Dakin¹ and Alfons Pomp¹

(1)   New York-Presbyterian Hospital, Division of Laparoscopy, and Department of Surgery, Weill-Cornell College of Medicine, New York, NY, USA

(2)   Department of Surgery, Joan and Sanford I, Weill Medical College of Cornell University, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68 Street, PO Box 294, New York, NY 10021, USA

Received: 19 April 2007  Accepted: 11 May 2007  Published online: 6 July 2007

The rising prevalence of morbid obesity and the increased incidence of super-obese patients (BMI >50 kg/m2) seeking surgical treatments has led to the search for surgical techniques that provide adequate EWL with the least possible morbidity. Sleeve gastrectomy (SG) was initially added as a modification to the biliopancreatic diversion (BPD) and then combined with a duodenal switch (DS) in 1988. It was first performed laparoscopically in 1999 as part of a DS and subsequently done alone as a staged procedure in 2000. With the revelation that patients experienced weight loss after SG, interest in using this procedure as a bridge to more definitive surgical treatment has risen. Benefits of SG include the low rate of complications, the avoidance of foreign material, the maintenance of normal gastro-intestinal continuity, the absence of malabsorption and the ability to convert to multiple other operations. Reduction of the ghrelin producing stomach mass may account for its superiority to other gastric restrictive procedures. SG should be in the armamentarium of all bariatric surgeons. Nonetheless, long-term studies are necessary to see if it is a durable procedure in the treatment of morbid obesity.

Short-term Effects of Sleeve Gastrectomy on Type 2 Diabetes Mellitus in Severely Obese Subjects

J. Vidal^{1, 2} , A. Ibarzabal¹, J. Nicolau¹, M. Vidov¹, S. Delgado¹, G. Martinez¹, J. Balust¹, R. Morinigo¹ and A. Lacy¹

(1)   Obesity Unit, Hospital Clinic Universitari, Barcelona,

(2)   Obesity Unit, Hospital Clínic Universitari, Villarroel 170, 08036 Barcelona,

Received: 15 April 2007  Accepted: 6 May 2007  Published online: 27 July 2007

Background  Data on the effectiveness of sleeve gastrectomy (SG) in improving or resolving type 2 diabetes mellitus (T2DM) are scarce.

Methods  A 4-month prospective study was conducted on the changes in glucose homeostasis in 35 severely obese T2DM subjects undergoing laparoscopic SG (LSG) and 50 subjects undergoing laparoscopic Roux-en-Y gastric bypass (LRYGBP), matched for DM duration, type of DM treatment, and glycemic control.

Results  At 4-months after surgery, LSG and LRYGBP operated subjects lost a similar amount of weight (respectively, 20.6 ± 0.7% and 21.0 ± 0.6%). T2DM had resolved respectively in 51.4% and 62.0% of the LSG and LRYGBP operated subjects (P = 0.332). A shorter preoperative DM duration (P < 0.05), a preoperative DM treatment not including pharmacological agents, and a better pre-surgical fasting plasma glucose (P < 0.01) or HbA1c (P < 0.01), were significantly associated with a better type 2 DM outcome in both surgical groups.

Conclusions  Our data show that LSG and LRYGBP result in a similar rate of type 2 DM resolution at 4-months after surgery. Moreover, our data suggest that mechanisms beyond weight loss may be implicated in DM resolution following LSG and LRYGBP.

Laparoscopic Vertical Sleeve Gastrectomy for Morbid Obesity. The Future Procedure of Choice?

Eldo E. Frezza¹ 

(1)   Department of Surgery, Division of General Surgery, Texas Tech University Health Sciences Center, 3502 9th Street, Suite 380, Lubbock, TX 79415, USA

Received: 24 July 2006  Accepted: 12 October 2006  Published online: 26 March 2007

Abstract  

I report the general experience of performing sleeve gastrectomy defined as “a partial gastrectomy that results in removal of most of the stomach,” as a first-stage procedure for morbidly and super-obese people. I also explore its potential as a single procedure evaluating its advantages and disadvantages. This procedure is designed to reduce the size of the stomach and its distention, whereby the patient feels full sooner and their appetite is decreased. Some posit-increased satiety results from the decreased ghrelin, secreted by the fundus, which is resected during this procedure. The advantages of sleeve gastrectomy are as follows: the stomach is reduced without loss of function, pyloric preservation prevents dumping, it requires only 1 day in the hospital, it provides an effective first-stage procedure for super-obese patients, it is useful in patients with disorders such as anemia or Crohn's disease, which preclude intestinal bypass, it can be performed laparoscopically, even in patients who weigh over 500 lbs, no band adjustment is required, it does not result in malabsorption, and it provides a good educational teaching base for doctors lacking experience in the treatment of gastric ulcers. The disadvantages include the risk of stapling complications and its irreversibility.

Laparoscopic Sleeve Gastrectomy: an Alternative for Recurrent Paraesophageal Hernias in Obese Patients

Authors: Cuenca-Abente, Federico¹; Parra, Juan D.¹; Oelschlager, Brant K.¹

Source: JSLS, Journal of the Society of Laparoendoscopic Surgeons, Volume 10, Number 1, January - March 2006 , pp. 86-89(4)

Publisher: Society of Laparoendoscopic Surgeons

Abstract:

Background: Recurrent paraesophageal hernias in obese patients are technically challenging and have a high recurrence rate. We sought to develop an alternative to the traditional approaches for this problem. This article describes the use of a sleeve gastrectomy in an obese patient with a large recurrent paraesophageal hernia.

Case Report: A morbidly obese 70-year-old woman presented with a 1-year history of chest pain, cough, dysphagia, and dyspnea. She had undergone an open paraesophageal hernia repair 8 years earlier. Diagnostic workup revealed a recurrent large paraesophageal hernia. Laparoscopically, we took down all adhesions, excised the hernia sac, reduced the stomach and distal esophagus into the abdomen, and closed the hiatus. We then resected the greater curvature and fundus of the stomach, leaving the lesser curve in a sleeve configuration. Eighteen months after the operation, the patient's chest pain, cough, dyspnea, and dysphagia were resolved. In addition, she has lost 57 pounds (255 to 198).

Conclusion: A sleeve gastrectomy is a potentially useful alternative to fundoplication or gastropexy, or both of these, in the treatment of obese patients with complex paraesophageal hernias.

(I tossed this one in because I have a small hiatal hernia.)