Ohad Guetta1, Amnon Ovnat2, Gad Shaked3, David Czeiger4, Gilbert Sebbag5. 1. Surgery Department B, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 151, Beer Sheva, 84101, Israel. ohadguetta@gmail.com. 2. Surgery Department B, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 151, Beer Sheva, 84101, Israel. amnono@clalit.org.il. 3. Surgery Department B, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 151, Beer Sheva, 84101, Israel. gadish@clalit.org.il. 4. Surgery Department B, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 151, Beer Sheva, 84101, Israel. dudyc@clalit.org.il. 5. Surgery Department B, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 151, Beer Sheva, 84101, Israel. GilbertS@clalit.org.il.
Abstract
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) became a prevalent bariatric procedure in Israel, while laparoscopic adjustable gastric banding (LAGB) was losing ground, due to high failure rates (40 % at 10 years). Many patients after LAGB failure choose LSG as a further bariatric surgery (secondary LSG). However, LAGB often impairs upper stomach anatomy and physiology, which may contribute to complications increased risk after secondary LSG, in comparison to surgery-naive obese patients choosing LSG (primary LSG). METHODS: A retrospective cohort study was conducted on a prospective database, looking at morbidly obese patients for LSG surgery. All procedures were done by a single surgeon at the Soroka Medical Center between January 2008 and March 2013. Data were collected from hospitalization charts on demographics, biometric and bariatric status, medical and bariatric surgical history, post-LSG morbidity, and mortality. RESULTS: Three hundred eight patients underwent LSG during the study period, 181 (58.8 %) had a primary LSG while 127 (41.2 %) had a secondary LSG. No mortality occurred in both groups. Odds ratio for major complication (leak, stenosis) was 3.12 [CI 0.90-10.75] among the secondary LSG group, compared to the primary LSG (p = 0.071). The risk for major complication was doubled (OR = 2, 95 % CI [1.36-3.06]) for each one of previous bariatric procedure underwent (p = 0.001). Significant differences were found between the two groups regarding number and length of readmissions and number of imaging tests (p value = 0.027, 0.022, and 0.049, respectively). CONCLUSIONS: Primary LSG is a safe and efficient bariatric procedure. After failed LAGB, secondary LSG should be carefully considered, because of a potentially higher risk of complications.
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) became a prevalent bariatric procedure in Israel, while laparoscopic adjustable gastric banding (LAGB) was losing ground, due to high failure rates (40 % at 10 years). Many patients after LAGB failure choose LSG as a further bariatric surgery (secondary LSG). However, LAGB often impairs upper stomach anatomy and physiology, which may contribute to complications increased risk after secondary LSG, in comparison to surgery-naive obesepatients choosing LSG (primary LSG). METHODS: A retrospective cohort study was conducted on a prospective database, looking at morbidly obesepatients for LSG surgery. All procedures were done by a single surgeon at the Soroka Medical Center between January 2008 and March 2013. Data were collected from hospitalization charts on demographics, biometric and bariatric status, medical and bariatric surgical history, post-LSG morbidity, and mortality. RESULTS: Three hundred eight patients underwent LSG during the study period, 181 (58.8 %) had a primary LSG while 127 (41.2 %) had a secondary LSG. No mortality occurred in both groups. Odds ratio for major complication (leak, stenosis) was 3.12 [CI 0.90-10.75] among the secondary LSG group, compared to the primary LSG (p = 0.071). The risk for major complication was doubled (OR = 2, 95 % CI [1.36-3.06]) for each one of previous bariatric procedure underwent (p = 0.001). Significant differences were found between the two groups regarding number and length of readmissions and number of imaging tests (p value = 0.027, 0.022, and 0.049, respectively). CONCLUSIONS: Primary LSG is a safe and efficient bariatric procedure. After failed LAGB, secondary LSG should be carefully considered, because of a potentially higher risk of complications.
Authors: Cornelis Adrianus Sebastianus Berende; Jean-Paul de Zoete; Johannes Franciscus Smulders; Simon Willem Nienhuijs Journal: Obes Surg Date: 2012-02 Impact factor: 4.129
Authors: Asad J Choudhry; Nadeem N Haddad; Matthew Martin; Cornelius A Thiels; Elizabeth B Habermann; Martin D Zielinski Journal: J Gastrointest Surg Date: 2016-10-11 Impact factor: 3.452