Safety and effectiveness of reduced-port laparoscopic sleeve gastrectomy in Asian morbidly obese patients.
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SUBMITTER: Park Y
PROVIDER: S-EPMC8648717 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BACKGROUND:Scarce data exists about analgesic requirements in super morbidly obese (SMO) patients who underwent sleeve gastrectomy. We attempted to investigate analgesic requirements for SMO, when compared with morbidly obese (MO) individuals who underwent sleeve gastrectomy and its impact on postoperative outcome. METHODS:We studied 279 consecutive patients (183 MO, 96 SMO) who underwent bariatric surgery. Data analysis included perioperative anaesthetic management, analgesic consumptions, opioids side effects, and ICU admission. RESULTS:The SMO group showed higher patients with asthma, epilepsy, obstructive sleep apnoea (OSA), and ASA III percentages (P?= 0.014, P?= 0.016, P ? 0.001, and P ? 0.001, respectively). There were no significant differences in the total morphine consumption intraoperatively, or after 24 h. However, reduced consumption of intraoperative fentanyl and morphine in SMO when calculated per total body weight (TBW) (P?= 0.004 and P?= 0.001, respectively). At PACU, tramadol consumption per TBW and lean body mass (LBM) were significantly reduced in SMO (P?= 0.001 and P?= 0.025, respectively). Paracetamol consumption was significantly reduced in the SMO group (P?= 0.04). They showed higher comorbidities (P ? 0.001), longer anaesthesia time (P?= 0.033), and greater ICU admissions (P ? 0.001). Vomiting was higher in the MO group (P?= 0.004). Both groups showed comparable pain scores (P?= 0.558) and PACU stay time (P?= 0.060). CONCLUSIONS:Super morbidly obese patients required fewer opioids and analgesics perioperatively. They exhibited higher comorbidities with greater anaesthesia time and ICU admissions. PACU stay time and pain scores were comparable.
| S-EPMC7260144 | biostudies-literature
Project description:BackgroundReduced-port laparoscopic gastrectomy is currently widely performed for patients with gastric cancer. However, its safety in obese patients has not yet been verified. This is the first study on reduced-port laparoscopic distal gastrectomy (RpLDG) in obese patients with gastric cancer. This study aimed to evaluate the short-term surgical outcomes and investigate the feasibility and safety of RpLDG in obese patients with gastric carcinoma.Material and methodsA total of 271 gastric cancer patients who underwent RpLDG at our institution were divided into two groups: non-obese [body mass index (BMI) <30 kg/m2, n = 251; NOG] and obese (BMI ≥30 kg/m2, n = 20; OG). The mean age of the enrolled patients was 64.8 ± 11.4 years, with 72.0% being men and 28.0% women. Operative details and short-term surgical outcomes, including hospital course and postoperative complications, were compared by retrospectively reviewing the medical records.ResultsNo significant difference in operation time was found between the NOG and OG (205.9 ± 40.0 vs. 211.3 ± 37.3 minutes, P = 0.563). Other operative outcomes in the OG, including estimated blood loss (54.1 ± 86.1 vs. 54.0 ± 39.0 mL, P = 0.995) and retrieved lymph nodes (36.2 ± 16.4 vs. 35.5 ± 18.2, P = 0.875), were not inferior to those in the NOG. There were also no statistical differences in short-term surgical outcomes, including the incidence of surgical complications (13.9% vs. 10.0%, P = 1).ConclusionRpLDG can be performed safely in obese gastric cancer patients by an experienced surgeon. It should be considered a feasible alternative to conventional port distal gastrectomy.
| S-EPMC8341504 | biostudies-literature
Project description:IntroductionStaple-line bleeding (SLB) is a common issue during laparoscopic sleeve gastrectomy (SG). Identifying a method or technique intraoperatively to manage or reduce the prevalence of SLB is crucial.Materials and methodsPatients' data who had undergone primary laparoscopic SG from January 2018 to December 2019 at our hospital were retrospectively analysed. The patients in this study received peripheral gastric vessel coagulation intervention in addition to the standard SG procedure. Preoperative parameters included age, gender, body mass index (BMI), the prevalence of diabetes and hypertension. Intra- and postoperative parameters were prevalence of SLB, operative time, total postoperative stay, the prevalence of leakage and bleeding. Intraoperative SLB was identified and analysed through video recordings.Results217 cases of laparoscopic SG were included in the study. The mean preoperative assessments were as follows: age, 34.2 ± 10.7 years; male/female, 98/119; BMI, 39.9 ± 7.6 kg/m2; prevalence of diabetes, 52 (24.0%) and hypertension, 90 (41.5%). Of 217 patients, 35 (16%) were found to have SLB following the new interventional procedure. The mean operative time was 93.2 ± 13.6 min. The mean total postoperative stay was 3.3 ± 1.3 days. The postoperative prevalence of leakage and bleeding were 0% and 0%, respectively.ConclusionThe technique of coagulating the peripheral gastric vessels to prevent SLB is safe and appears promising. A prospective study comparing with and without peripheral gastric vessel coagulation will be needed in the future.
| S-EPMC8973477 | biostudies-literature
Project description:PURPOSE:Laparoscopic gastrectomy in obese patients has been investigated in several studies, but its feasibility has rarely been examined in morbidly obese patients, such as in those with a body mass index (BMI) of ?30 kg/m(2). The present study aimed to evaluate the technical feasibility and safety of laparoscopic gastrectomy in morbidly obese patients with gastric cancer. MATERIALS AND METHODS:A total of 1,512 gastric cancer patients who underwent laparoscopic distal gastrectomy (LDG) were divided into three groups: normal (BMI<25 kg/m(2), n=996), obese (BMI 25~30 kg/m(2), n=471), and morbidly obese (BMI?30 kg/m(2), n=45). Short-term surgical outcomes, including the course of hospitalization and postoperative complications, were compared between the three groups. RESULTS:The morbidly obese group had a significantly longer operating time (240 minutes vs. 204 minutes, P=0.010) than the normal group, but no significant differences were found between the groups with respect to intraoperative blood loss or other complications. In the morbidly obese group, the postoperative morbidity and mortality rates were 13.3% and 0%, respectively, and the mean length of hospital stay was 8.2 days, which were not significantly different from those in the normal group. Subgroup analysis showed that postoperative complication rates were not high in morbidly obese patients, independent of the type of anastomosis technique used and level of lymph node dissection. CONCLUSIONS:LDG is technically feasible and safe in morbidly obese patients with a BMI of ?30 kg/m(2) and early gastric carcinoma. Except for a longer operating time, LDG might represent a reasonable treatment option in these patients.
| S-EPMC4199886 | biostudies-literature
Project description:ObjectivesPatients with end-stage heart failure (ESHF) treated with ventricular assist devices (VADs) tend to gain weight after implantation, which is associated with higher complication rates and is a contraindication for heart transplantation (HT). The objective was to analyze the outcomes of obese patients with ESHF and VADs who underwent laparoscopic sleeve gastrectomy (LSG) at Ochsner Medical Center in New Orleans, which is the only program performing VADs and HT in the State of Louisiana, and also one of the largest VAD centers in the USA.Data descriptionThis dataset contains detailed baseline, perioperative, and long-term data of patients with VADs undergoing LSG. These variables were collected retrospectively from electronic medical records. Patients who achieved ≥ 50% excess BMI loss, BMI ≤ 35 kg/m2, listing for HT, HT, or myocardial recovery were identified and the timing to each of these milestones was documented. These data can be used alone or in combination with other datasets to achieve a larger sample size with more power for further analysis of these variables, which include the most important, standard, and objective bariatric and ESHF outcomes of patients with VADs undergoing LSG. Elaboration of composite outcomes is feasible.
| S-EPMC7496210 | biostudies-literature
Project description:IntroductionLaparoscopic sleeve gastrectomy (LSG) has rapidly become popular with excellent results. However, LSG may exacerbate or increase the risk of "de novo" gastroesophageal reflux disease (GERD). Adding a fundoplication has been proposed to increase the lower esophageal sphincter competency. The aim of this study was to examine the current evidence and outcomes of sleeve-fundoplication (Sleeve-F).Materials and methodsSystematic review and meta-analysis. Web of Science, PubMed, and Embase data sets were consulted.ResultsSix studies (485 patients) met the inclusion criteria. The age of the patient population ranged from 17 to 72 years old and 82% were females. All patients underwent sleeve-fundoplication. Rossetti, Collis-Nissen, and Nissen were the most commonly performed fundoplications. The estimated pooled prevalence of postoperative leak, gastric perforation, and overall complications were 1.0% (95% CI = 0.0-2.0%), 2.9% (95% CI = 0.0-8.3%), and 9.8% (95% CI = 6.7-13.4%), respectively. The pooled reoperation rate was 4.1% (95% CI = 1.3-10%). There was no mortality. At 12-month follow-up, the estimated pooled BMI and %EWL were 29.9 kg/m2 (95% CI = 28.5-31.2) and 66.2% (95% CI = 59.3-71.1), respectively, while esophagitis, PPI consumption, and GERD rates were 8.0% (95% CI 3-21%), 7.8% (95% CI 5-13%), and 11% (95% CI 4-26%).ConclusionsThis systematic review and meta-analysis shows that current evidence for Sleeve-F is limited with high postoperative gastric perforation and overall complication rates. Weight loss and GERD resolution seem promising in the short term; however, further studies are warranted to explore long-term effects with instrumental investigations. Sleeve-F should be considered cautiously while future well-structured randomized trials are warranted.
| S-EPMC8012327 | biostudies-literature
Project description:BACKGROUND:Laparoscopic sleeve gastrectomy (LSG) modifies the upper gastrointestinal tract motility. Controversial data currently exist. The aim of the study was to evaluate esophageal motility before and after LSG. PATIENTS AND METHODS:Morbid obese patients scheduled for LSG underwent reflux symptoms evaluation and manometry preoperatively and postoperatively. The preoperative and postoperative results were compared and analyzed. RESULTS:Eighteen patients were enrolled. Heartburn and regurgitation improved in 38.9% and 11.1% of the patients, but deteriorated in 11.1% and 27.8% of the patients, respectively. Lower esophageal sphincter (LES) total length decreased postoperatively (p=0.002). Resting and residual pressures tended to decrease postoperatively (mean difference [95% confidence interval]: -4 [-8.3/0.2] mmHg, p=0.060; -1.4 [-3/0.1] mmHg, p=0.071, respectively). Amplitude pressure decreased from 95.7±37.3 to 69.8±26.3 mmHg at the upper border of LES (p=0.014), and tended to decrease at the distal esophagus from 128.5±30.1 to 112.1±35.4 mmHg (p=0.06) and mid-esophagus from 72.7±34.5 to 49.4±16.7 mmHg (p=0.006). Peristaltic normal swallow percentage increased from 47.2±36.8 to 82.8±28% (p=0.003). Postoperative regurgitation was strongly negatively correlated with LES total length (Spearman's r=-0.670). When groups were compared according to heartburn status, statistical significance was observed between the groups of improvement and deterioration regarding postoperative residual pressure and postoperative relaxation (p<0.002, p<0.002, respectively). With regard to regurgitation status, there was statistically significant difference between groups regarding preoperative amplitude pressure at the upper border of LES (p<0.056). CONCLUSION:Patients developed decreased LES length and weakened LES pressure after LSG. Esophageal body peristalsis was also affected in terms of decreased amplitude pressure, especially at the upper border of LES. Nevertheless, body peristalsis was normalized postoperatively. LSG might not deteriorate heartburn. Regurgitation might increase following LSG due to shortening of LES length, particularly in patients with range of preoperative amplitude pressure at the upper border of LES of 38.9-92.6 mmHg.
| S-EPMC5529110 | biostudies-literature
Project description:Laparoscopic loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG) has theoretical advantages compared with laparoscopic Roux-en-Y gastric bypass. We performed 7 cases of LDJB-SG from May 2019 to September 2019. All procedures were successfully completed by laparoscopy. The mean operative time was 282.9 (210~335) minutes and the mean estimated blood loss was 82.9 (20~150) ml. There was no intraoperative complications, however, there was 1 case of postoperative anastomotic leakage. The average length of postoperative hospital stay was 5.3 (3~12) days. The mean body weight at baseline was 117.1 (88.4~151.1) kg, and was decreased to 90.4 (69.4~130.9) kg at postoperative 3 month. The mean of HbA1c at baseline was 7.6 (5.5~9.4) %, and was decreased to 5.3 (4.8~5.6) % at postoperative 3 month. Although LDJB-SG is a technically demanding procedure, it can be a feasible and safe procedure if the learning curve can be overcame.
| S-EPMC9012210 | biostudies-literature
Project description:BackgroundLaparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) are common weight loss procedures. Our meta-analysis compared these procedures for the treatment of morbid obesity and related diseases.MethodsWe systematically searched the PubMed, Embase, and the Cochrane Library through January 2018. The percentage of excess weight loss (%EWL), improvement or remission of type 2 diabetes mellitus (T2DM) and hypertension were analyzed and compared.ResultsThirty-three studies with 4109 patients were included. Greater decreases in excess weight were found in patients who received LSG at 6 months (weighted mean difference (WMD) -9.29, 95% confidence interval (CI): -15.19 to -3.40, P?=?.002), 12 months (WMD -16.67 95% CI: -24.30 to -9.05, P?<?.0001), 24 months (WMD -19.63, 95% CI: -29.00 to -10.26, P?<?.0001), and 36 months (WMD -19.28, 95% CI: -27.09 to -11.47, P?<?.0001) than in patients who received LAGB. However, there were no significant differences in the 3-month outcomes between the 2 groups (WMD -1.61, 95% CI: -9.96 to 6.73, P?=?.70). T2DM patients after LSG experience more significant improvement or remission of diabetes (odds ratio (OR): 0.22, 95% CI: 0.06-0.87, P?=?.03). The 2 groups did not significantly differ regarding improvement or remission of hypertension (OR 0.80, 95% CI: 0.46-1.38, P?=?.42).ConclusionLSG is a more effective procedure than LAGB for morbidly obese patients, contributing to a higher %EWL and greater improvement in T2DM.
| S-EPMC6831371 | biostudies-literature
Project description:BackgroundThis study aims to summarize and analyze the clinical characteristics and outcomes of severely obese patients who underwent laparoscopic sleeve gastrectomy (LSG) under general anesthesia with multidisciplinary collaboration.MethodsA retrospective analysis was performed for 100 severely obese patients who were hospitalized in Zhongshan Hospital, Fudan University from January 2017 to December 2019, and included preoperative general information, laboratory examinations, anesthesia and outcomes.ResultsA total of 100 patients (46 males, 54 females) were admitted to the department of endocrinology: 100 had hepatic steatosis (100%), 43 had sleep apnea hypopnea syndrome (43%), 25 had hypertension (25%), 11 had type 2 diabetes (11%) and 8 had polycystic ovary syndrome (14% of women). The mean age and BMI were 31.52 ± 10.53 years and 43.31 ± 6.80 kg/m2, respectively. Visual laryngoscope intubation was successfully performed with routine intravenous induction in the optimum sniffing position at one time. The surgeries were successfully performed under general anesthesia, without conversion, and the operation time was 140.92 ± 31.23 min. The follow-up data for 41 patients were obtained. The postoperative BMI showed a downward trend. The BMI at 1 month and 3 months after surgery were 38.40 ± 6.77 kg/m2and 35.52 ± 7.94 kg/m2, respectively.ConclusionsMultidisciplinary collaboration may contribute to better management and recovery during the perioperative period. Visual laryngoscope intubation with intravenous induction was performed successfully in the optimum sniffing position at one time.
| S-EPMC7866898 | biostudies-literature