I may not be the world's most consistent blogger, but I do love to research.  So I thought I'd use my blog space to post the studies I've found that touch on VSG.  Hopefully others can use these to deal with insurance companies.  There are over 20 articles and studies here.   Some are kinda technical, but if you feel swamped in the detail, just skip to the conclusions.

Happy reading!

Laparoscopic Sleeve Gastrectomy as an Alternative to Gastric Bypass in Patients with Multiple Intraabdominal Adhesions.

Quesada BM, Roff HE, Kohan G, Salvador Oría A, Chiappetta Porras LT.

Department of Surgery, “Cosme Argerich” Hospital, Buenos Aires, Argentina, [email protected].

BACKGROUND: Laparoscopic sleeve gastrectomy and its indications are currently being evaluated. The objective of this study was to show the preliminary results obtained with this technique indicated as an alternative to gastric bypass in patients with multiple intraabdominal adhesions, therefore preserving the benefits of the laparoscopic approach. METHODS: An analysis of all patients who underwent a laparoscopic sleeve gastrectomy for the above indication was done. Data included demographics, number of previous surgeries, operative time, morbidity, mortality, and %EWL at 3 and 6 months. RESULTS: Fifteen patients underwent laparoscopic sleeve gastrectomy as an alternative to gastric bypass because of multiple intraabdominal adhesions. No patient required conversion to an open procedure; morbidity was 6% with no mortality. %EWL at 3 months was 41% and at 6 months was 44%. Mean follow-up was 6 months. CONCLUSION: In our initial experience, laparoscopic sleeve gastrectomy proved to be a safe and effective alternative to gastric bypass for patients with multiple intraabdominal adhesions.

2007

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

Weiner RA, Weiner S, Pomhoff I, Jacobi C, Makarewicz W, Weigand G.

Center for Minimal-Invasive Surgery, Department of General and Bariatric Surgery, Krankenhaus Sachsenhausen, Frankfurt am Main, Germany. [email protected]

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 International Consensus Summit for Sleeve(Vertical) Gastrectomy on October 26th, 2007

Vertical Sleeve Gastrectomy update
The International Consensus Summit for Sleeve(Vertical) Gastrectomy on October 26th, 2007 was a meeting attended by surgeons from all over the world. Approximately 15 surgeons from different countries presented their experience. Many surgeons had only been doing the operation for 2-3 years and had less than 200 patients to report. The largest experience was right here in San Francisco at LapSF (Dr. Jossart and Dr. Cirangle) at over 900 patients since 2002. The next largest experience was from Belgium with 450 patients.

It was clear from the various presentations that the technique, pouch size, complications and results were quite different from surgeon to surgeon. Major complications ranged from less than 1% to more than 5%. Most surgeons were making the pouch too large and were offering it to higher weight(high BMI) patients only. Weight loss results were moslty limited to 1 year.

Our experience with over 900 sleeve gastrectomy plus 500 duodenal switch patients over 10 years has produced some very clear data and also the limitations of the procedure. The following points can be made:

1. A pouch less than 2 ounces(32 French bougie) is necessary for optimal weight loss. This has been our routine technique since 2002.
2. Five year weight loss results are still not available because so few patients have achieved that point. Our three year results show that weight loss is similar to the gastric bypass and the duodenal switch for patients with BMI under 55. It is unclear if any procedure is optimal for patients with a BMI over 55.
3. The cure rates for Diabetes, high blood pressure, high cholesterol, sleep apnea and other weight related problems are the same as the gastric bypass and duodenal switch. One only needs to attend one of our support groups or go online to verify all the diabetics that have been cured by this operation. Our diabetic cure rate is over 90%!
4. Insurance companies are still resistant to approving the procedure because of the lack of 5 year results and higher complication rates among less experienced surgeons. Please be sure to follow up and report your annual weight loss result so we can continue to publish our results and convince the insurance companies to approve this procedure!

In summary, the vertical sleeve gastrectomy will become more common as more results are published and the insurance companies update their policies. For additional questions surrounding this procedure please attend one of our support groups or call the office and ask to speak to one of our new patient coordinators or one of the doctors.

Learn more about the Vertical Sleeve Gastrectomy


Sincerely,

Dr. Gregg Jossart ~ Dr. Paul Cirangle
Laparoscopic Associates of San Francisco
2100 Webster Street, Suite 110
San Francisco, CA 94115
(415) 561-1310/(415) 561-1713 fax
www.LapSF.com
[email protected]

Study Suggests Vertical Gastrectomy is the Most Successful Weight-Loss Surgery

Weight-loss surgery study conducted by Dr. Paul Cirangle at Laparoscopic Assoicates of San Francisco compares surgery options for obese patients.

San Francisco, CA (PRWEB) June 4, 2005 - "Vertical Gastrectomy is emerging as the quickest and most successful obesity-related surgery. Despite the risks inherent to all types of surgery, Vertical Gastrectomy is the preferred method” said Dr. Paul Cirangle, surgeon at the San Francisco Bay Area Laparoscopic Associates. Laparoscopic Associates of San Francisco, where Dr. Cirangle works with San Francisco weight loss surgery experts Dr. Gregg Jossart and Dr. John Feng, is the only group in the Western United States to perform all weight-loss surgeries laparoscopically.

 

Dr. Cirangle, who authored this one-year study of 166 patients over 50 years old, compared the results of Vertical Gastrectomy surgery with the results of three other kinds of obesity-related surgeries: LapBand, Roux en Y Gastric Bypass, and the Duodenal Switch. In a statement prepared for delivery to a conference of gastrointestinal and other experts in Chicago, Dr. Cirangle said, “It is important for us to know, especially as these surgeries become more prevalent, which operation is best for each patient."

 

The study found that Vertical Gastrectomy, in which up to 95 percent of the stomach is removed, leaving behind a thin tube-like stomach roughly two ounces (60 milliliters) in volume, was performed in the shortest amount of time, approximately 90 minutes, and had the fewest complications. Patients who underwent this surgery lost an average of 133 pounds (60 kg) after one year, 15 pounds (6.8 kg) more than the next-best surgical method.

 

More than 300 obesity-related surgeries are performed each year by the surgeons at Laparoscopic Associates of San Francisco. Doctors Cirangle, Jossart, and Feng’s bariatric surgeries achieve excellent long-term weight-loss for their morbidly obese patients as well as additional health benefits including:

·          Diabetes cured in 77% of patients and resolved or improved in 86% of patients

·          Hypertension (high blood pressure) cured in 62% of patients and resolved or improved in 78.5%

·          Hyperlipidemia (high cholesterol and high triglycerides) improved in more than 70% of patients

·          Obstructive sleep apnea cured in 86% of patients

·          Improvement is seen in many other conditions, such as: arthritis, fibromyalgia, asthma, acid reflux and heart failure.

 

The study can be downloaded at http://www.lapsf.com/press/lapsf_study_6_2_05.pdf. More information about weight-loss surgery can be found on LAPSF’s Website, http://www.lapsf.com, or by contacting Laparoscopic Associates of San Francisco, 2100 Webster Street, Suite 518, San Francisco, CA 94115, phone: 415-561-1310, fax: 561-1713, email: e-mail protected from spam bots

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."

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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.)