Page 31 - WJOLS - Surgery Journal

Emmanuel E Akpo
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(range, 30-550) for LSG. This report was similar to that of Effect of Surgical Procedure on Weight, BMI,
Turker et al whose mean operating time was 60 minutes (58- Diabetes and Quality of Life
190) in a retrospective study of 148 post LSG patients in the The study of Nocca et al on LSG showed a percentage of
United States between 2004 and 2007 with the view to finding excessive body weight loss of 59.45% at 1 year and 61.52% at 2
out if LSG could be a one-stage primary restrictive procedure. 12 years. No statistical difference was noticed in weight loss
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The only LASGB study that gave details of operative time between obese and extreme obese patients in this study. In a
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was that of Zinzindohoue et al that reported a mean operative related retrospective study of 130 patients between 2003 and
time of 105 minutes in 500 patients who underwent 2004, Han et al reported a median weight loss of 24.6 ±10.0 kg
laparoscopic surgery for morbid obesity between 1997 and and 83.3 ±28.3% while decrease in BMI was 9.2 ±3.7 kg/m . A
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2001 with application of an adjustable gastric band in order to reduction of BMI from 44.3 to 34.2, 32.8 and 31.9 at 1, 2 and
evaluate the early and late morbidity of laparoscopic adjustable 3 years with a mean percent excess weight loss (%EWL) of
gastric banding for morbid obesity and to assess the efficacy 42.8%, 52% and 54.8% respectively were similarly reported
of this procedure. 21 by Zinzindohoue et al in the LASGB study group. Similar
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Four of the articles studied documented the duration of
hospital stay postsurgery. The average hospital stay for patients results were reported by Singhal et al in 2008 in a study
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population of 1,140 who had gone through LASGB. This study
who underwent LSG was 2.7 (2-25) days but one patient who showed an excess percent BMI loss at 1, 2 and years of 38.3%,
had gastric fistula stayed for 47 days. 12,23 The mean stay for 43.7%, and 58.9%. Excess percent BMI loss was persistent
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LASGB patients was 2.7 (0-30) days. 13,21 Five of the articles for 8 years in the only study where patients were followed up
reviewed reported on mortalities in their studies. The overall for this duration of time. The BMI dropped from 46.8 to 32.3
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mortality rate following LSG was 0-0.8% 12,19,20,22 while that of kg/m over the 8 years period. The observations in loss of weight
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LASGB was 0%. 21 and BMI were similar in the LSG group. A drop in the BMI after
1 year of 65% (9-127%), after 2 years 63% (13-123%), and after 3
Blood loss, Complications, Conversion to Open years 60% (9-111%) was observed by Uglioni et al. Similarly,
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Surgery and Reoperation Han reported that at 12 months after LSG, the BMI decrease
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The overall complication rate in this review varied was 9.2 ±3.7 kg/m , and median weight loss was 24.6 ±10.0 kg. 26
from 1.7-11.80% 12,19,22 for LSG and 0.2-24% for Metabolic changes where also observed. Han et al reported
LAGB. 12,17,19,20,22,24,25 The highest reported complication rate that dyslipidemia resolved in 75% of their patients within
following LASGB was due to slippage of the adjustable band 12 months, diabetes resolved in 100% of patients within 6 months
while the highest rate following LSG was secondary to of operation, and hypertension resolved in 92.9% and improved
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esophageal reflux symptoms. 22,24 The other complications in 100% of the patients. Joint pain resolved in 100% within 12
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reported in the LSG studies include early leak (1.7%), gastric months. Weight loss plateaued at 12 months in the majority of
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fistula (1.7-5.1%). 13,14,19,26 Gastric prolapse (20%), incisional patients. Comparative results were reported by Dixon and
hernia (0.6%), reconnection of catheter (0.6%) and wound O’Brien who studied the health outcomes of severely obese
infection (4%) were also reported as complications resulting Type 2 diabetic subjects 1 year after laparoscopic adjustable
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from LASGB. 21,25 Other life-threatening complications reported gastric banding in 50 patients prospectively. In their report,
by Chevallier et al and accounting for 1.2% of their study there was significant improvement in all measures of glucose
population of 1,000 LASGB patients include gastric perforation metabolism. Remission of diabetes occurred in 64% of the
patients, and major improvement of glucose control occurred in
(0.4%), acute respiratory distress (0.2%), pulmonary embolism 26% of them; glucose metabolism was unchanged in 10%. HbA
1c
(0.2%), migration (0.3%), and gastric necrosis (0.1%). 24 was 7.8 ± 3.2% preoperatively and 6.2 ± 2.7% at 1 year
Chevallier et al in this 7-year study, had 11.1% of their patients (P < 0.001). Remission of diabetes was predicted by greater
undergoing an abdominal reoperation for perforation (0.2%), weight loss and a shorter history of diabetes (pseudo r = 0.44,
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band slippage (0.78%), migration (0.3%), gastric necrosis P < 0.001). Improvement in diabetes was related to increased
(0.1%), esophageal dilatation (0.2%), incisional hernias (0.4%) insulin sensitivity and β-cell function. Weight loss was
and port problems (0.21%). Similar conversion and reoperation associated with significant improvements in fasting triglyceride
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rates were reported by Zinzindohoue et al. In their study, level, HDL cholesterol level, hypertension, sleep, depression,
twelve patients (2.4%) were converted to open surgery and a appearance evaluation, and health-related quality of life. 25
patient reoperation rate of 10.4% was reported as a result of Additionally, statistically significant improved health status
abdominal complications. There were no reports of and quality of life were registered for all groups studied under
conversions in the LSG group but reoperation rates ranged LSG by Weiner et al. In a separate 8 years review of 984
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from 4.9-11.4%. 12,19 Tucker et al reported a mean blood loss of LASGB patients, Weiner et al found 82% improvement in the
60 ml (range, 0-300 ml) for LSG. 12 quality of life. This was similar to the findings of Zinzindohoue
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