Complications of Laparoscopic Sleeve Gastrectomy
In one of the reviewed series (n= 707), there are 17 major complications with an incidence of 2.4 percent. One should consider the heterogeneity of the patient's population where those with high risk and multiple severe comorbidities are included. One death due to gastric leakage reported with 11 gastric leakage, 4 renal failures, and 1 stenosis. GERD occurs in too many cases but most of the patients improve gradually on conservative management. Bleeding from the suture line reported rarely and could be managed conservatively in most of the cases.
LSG as Initial Step for Super Obese and High-risk Patients
In two studies, LSG was used as a planned initial step and entertained over other major final technique due to super obesity with the poor general condition in an attempt to minimize the risk in this subgroup of patients. During the post-LSG follow-up, the authors found the second stage operation is only needed by 5 percent in one study and 39 percent in the others.
Main complications of LSG in the reviewed published series
LSG in Morbidly Obese Children
Till et al. carried-out LSG in four morbidly obese pediatric patients with multiple comorbidities. Marked improvements in their comorbidities and 23 percent weight loss had been achieved after 12 months follow-up.
Conclusion
As the prevalence of morbid obesity continues to escalate, the incidence of progressively complicated patients will rise. Clearly, a valid and effective strategy, beyond the current comprehensive evaluation measures, is needed for the optimal management of these patients. Bariatric surgery is the most effective treatment for severe obesity, producing durable weight loss, improvement of comorbid conditions, and longer life. Patient selection algorithms should favor individual risk-benefit considerations over traditional anthropometric and demographic limits. Bariatric care should be delivered within credentialed multidisciplinary systems. Roux-en-Y gastric bypass (RGB), adjustable gastric banding (AGB), and biliopancreatic diversion with duodenal switch (BPDDS) are validated procedures that may be performed laparoscopically.
Laparoscopic sleeve gastrectomy (LSG) also is a promising procedure. Comparative data find that procedures with more dramatic clinical benefits carry greater risks, and those offering greater safety and flexibility are associated with less reliable efficacy. Sleeve gastrectomy has been introduced and well-accepted recently into the armamentarium of bariatric procedures. It was initially intended as a first step for poor-risk patients deemed too ill to undergo biliopancreatic diversion with duodenal switch or Roux-en-Y gastric bypass. Some of the patients lost significant weight and declined the proposed second stage, becoming the first stage with sleeve gastrectomy as a sole procedure. Sleeve gastrectomy has gained popularity with both bariatric surgeons and patients, mainly because of its relative operative simplicity and lower risk profile.
In one of the reviewed series (n= 707), there are 17 major complications with an incidence of 2.4 percent. One should consider the heterogeneity of the patient's population where those with high risk and multiple severe comorbidities are included. One death due to gastric leakage reported with 11 gastric leakage, 4 renal failures, and 1 stenosis. GERD occurs in too many cases but most of the patients improve gradually on conservative management. Bleeding from the suture line reported rarely and could be managed conservatively in most of the cases.
LSG as Initial Step for Super Obese and High-risk Patients
In two studies, LSG was used as a planned initial step and entertained over other major final technique due to super obesity with the poor general condition in an attempt to minimize the risk in this subgroup of patients. During the post-LSG follow-up, the authors found the second stage operation is only needed by 5 percent in one study and 39 percent in the others.
Main complications of LSG in the reviewed published series
LSG in Morbidly Obese Children
Till et al. carried-out LSG in four morbidly obese pediatric patients with multiple comorbidities. Marked improvements in their comorbidities and 23 percent weight loss had been achieved after 12 months follow-up.
Conclusion
As the prevalence of morbid obesity continues to escalate, the incidence of progressively complicated patients will rise. Clearly, a valid and effective strategy, beyond the current comprehensive evaluation measures, is needed for the optimal management of these patients. Bariatric surgery is the most effective treatment for severe obesity, producing durable weight loss, improvement of comorbid conditions, and longer life. Patient selection algorithms should favor individual risk-benefit considerations over traditional anthropometric and demographic limits. Bariatric care should be delivered within credentialed multidisciplinary systems. Roux-en-Y gastric bypass (RGB), adjustable gastric banding (AGB), and biliopancreatic diversion with duodenal switch (BPDDS) are validated procedures that may be performed laparoscopically.
Laparoscopic sleeve gastrectomy (LSG) also is a promising procedure. Comparative data find that procedures with more dramatic clinical benefits carry greater risks, and those offering greater safety and flexibility are associated with less reliable efficacy. Sleeve gastrectomy has been introduced and well-accepted recently into the armamentarium of bariatric procedures. It was initially intended as a first step for poor-risk patients deemed too ill to undergo biliopancreatic diversion with duodenal switch or Roux-en-Y gastric bypass. Some of the patients lost significant weight and declined the proposed second stage, becoming the first stage with sleeve gastrectomy as a sole procedure. Sleeve gastrectomy has gained popularity with both bariatric surgeons and patients, mainly because of its relative operative simplicity and lower risk profile.
