scholarly journals Learning curve and global benchmark values of laparoscopic sleeve gastrectomy: results of first 100 cases of a newly trained surgeon in an Italian center of excellence

2021 ◽  
Author(s):  
Antonio Vitiello ◽  
Giovanna Berardi ◽  
Nunzio Velotti ◽  
Vincenzo Schiavone ◽  
Mario Musella
Keyword(s):  
Weight Loss ◽  
Sleeve Gastrectomy ◽  
Learning Curve ◽  
Hospital Stay ◽  
Operative Time ◽  
Perioperative Outcomes ◽  
Short Term ◽  
Cusum Analysis ◽  
Group 1

AbstractTo evaluate whether the learning curve for sleeve gastrectomy could be completed after 50 cases. First 100 patients undergoing LSG under a newly trained laparoscopic surgeon were included in this study and divided into two groups of 50 consecutive patients each. Perioperative outcomes were compared to recently introduced global benchmarks. Short-term weight loss was calculated as Total Weight Loss Percent (%TWL) and complications were classified in accordance with the Clavien–Dindo classification. CUSUM analysis was performed for operative time and hospital stay. Mean preoperative age and BMI were 41.8 ± 10.3 years and 42.9 ± 5.4 kg/m2, respectively. Demographics and rate of patients with previous surgery were comparable preoperatively in the two groups. Mean operative time was 92.1 ± 19.3 min and hospital stay was 3.4 ± 0.6 days as per our standard protocol of discharge. Uneventful postoperative course was recorded in 93% of patients and only one case of staple line leak was registered in the first 50 cases (group 1). No statistical difference in BMI and %TWL was found between the two groups at any time of follow-up. Comparison between two groups showed a significant reduction in hospital stay and operative time after the first 50 LSGs (p < 0.05). LSG can be performed by newly trained surgeons proctored by senior tutors. At least 50 cases are needed to meet global benchmark cut-offs and few more cases may be required to reach the plateau of the learning curve.

scholarly journals Laparoscopic Sleeve Gastrectomy as a Primary Operation for Morbid Obesity: Experience with 200 Patients

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Paolo Gentileschi
Keyword(s):  
Morbid Obesity ◽  
Weight Loss ◽  
Sleeve Gastrectomy ◽  
Hospital Stay ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Excess Weight Loss ◽  
Gastric Stump ◽  
Short Term ◽  
Operative Complications

Introduction. Laparoscopic sleeve gastrectomy (LSG) represents a valid option for morbid obesity, either as a primary or as a staged procedure. The aim of this paper is to report the experience of a single surgeon with LSG as a standalone operation for morbid obesity.Methods. From April 2006 to April 2011, 200 patients underwent LSG for morbid obesity. Each patient record was registered and prospectively collected. In July 2011, a retrospective analysis was conducted.Results. Patients were 128 females and 72 males with a median age of 40.0 years. Median pre-operative BMI was 49.4 kg/m2. Median follow-up was 27.2 months. Median post-operative BMI was 30.4 kg/m2. Median %excess weight loss (%EWL) was 63.6%. Median post-operative hospital stay was 4.0 days in the first 84 cases and 3.0 days in the last 116 cases. Six major post-operative complications occurred (3%): two gastric stump leaks (1%), three major bleedings (1.5%) and 1 (0.5%) bowel obstruction. One case of mortality was registered (0.5%). To date only 4 patients are still in the range of morbid obesity (BMI > 35 kg/m2).Conclusions. Laparoscopic sleeve gastrectomy is a formidable operation in the short-term period. Median %EWL in this series was 63.6% at 27.2 months follow-up.

Short-Term Results of Single-Anastomosis Gastric Bypass After Failed Sleeve Gastrectomy

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Alaa Abbas Sabry ◽  
Karim Sabry Abd-Elsamee ◽  
Mohamed Ibrahim Mohamed ◽  
Mohammed Mohamed Ahmed Abd-Elsalam
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Weight Regain ◽  
Revisional Surgery ◽  
One Anastomosis Gastric Bypass ◽  
Short Term ◽  
Multicenter Studies ◽  
Metabolic Outcomes

Abstract Background It is already known that Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a stand-alone procedure with good short-term results for weight loss. However, in the long-term, weight regain is considered as a complication. Demand for secondary surgery is rising, partly for this reason, but through that study we try to discover the efficacy of conversion of failed sleeve gastrectomy to one anastomosis gastric bypass (OAGB) regarding weight loss and metabolic outcomes. Objective To asses the efficacy and safety of one anastomosis gastric bypass (OAGB) as a conversion surgery post Sleeve Gastrectomy failure as regard weight loss and metabolic outcomes. Patients and Methods This study is a retrospective cohort study which included 20 patients underwent one anastomosis gastric bypass at Ain-Shams University El-Demerdash Hospital, Cairo, Egypt and specialized bariatric center, Cairo, Egypt From February 2019 to July 2019 with 6 months of postoperative follow up till January 2019. Results In this study, we reviewed and analyzed the outcomes from the revision of the SG due to either inadequate weight loss or weight regain to one anastomosis gastric bypass (OAGB) with %EBWL of 6.65% at 1 month, 13.61 % at 3 months and 20.86% at 6 months. Conclusion OAGB appears to be an effective and safe therapeutic technique as a revisional surgery for failed primary SG with good short-term results for treating morbid obesity and its associated comorbidities with a significantly low rate of complications. However the EBWL was less than what is reported after primary OAGB weight. Multicenter studies with larger series of patients and longer term follow up after SG revisions to OAGB are warranted.

scholarly journals Scintigraphic evaluation of gastric emptying after greater curvature plication in comparison with sleeve gastrectomy

2019 ◽  
Author(s):  
Tarek Osama Hegazy ◽  
Ahmed Kandeel ◽  
Mohamed el shawadfy ◽  
Khalid Kassem ◽  
Mohamed Hassan
Keyword(s):  
Weight Loss ◽  
Sleeve Gastrectomy ◽  
Gastric Emptying ◽  
Hospital Stay ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Operative Time ◽  
Gastric Plication ◽  
Term Outcome ◽  
Body Mass Index Loss ◽  
The Mean

Introduction: Laparoscopic gastric plication (LGP) is a relatively new restrictive bariatric procedure that emerged to avoid the problems and to reduce the cost of laparoscopic sleeve gastrectomy. In this study we present the initial short-term outcome of LGP and its effect on gastric emptying and compare it with the results of laparoscopic sleeve gastrectomy (LSG). Methods: From May 2016 to April 2017, a total of 50 patients were allocated to undergo either LGP (n = 25) or LSG (n = 25). Data on the operative time, complications, hospital stay, overall cost of LSG and LGCP, body mass index loss (BMIL), post-operative gastric emptying (the first study to asses gastric emptying after LGP), percentage of excess weight loss (%EWL), and improvement of comorbidities were collected during the follow-up examinations. Results: All procedures were completed laparoscopically. The mean operative time was significantly higher for the LGP group. The mean hospital stay, cost and %EWL were significantly higher in the LSG group. The mean gastric emptying t1/2 was 40 ± 13 minutes for LGP group and 28.3 ± 8.31 minutes for LSG group (P = 0.001). Conclusion: There is significant acceleration of gastric emptying after LSG more than after LGP with significant effect on weight loss.

scholarly journals The Effect of the Resection Distance from the Pylorus on the Short-Term Outcome of Laparoscopic Sleeve Gastrectomy

2020 ◽  
Author(s):  
Ahmed H Hussein ◽  
Islam Khaled ◽  
Mohammed Faisal
Keyword(s):  
Quality Of Life ◽  
Morbid Obesity ◽  
Weight Loss ◽  
Short Term ◽  
Term Outcome ◽  
Short Term Outcome ◽  
Group 2 ◽  
Group 1

Abstract Background: Laparoscopic sleeve gastrectomy (LSG) was recently described as an effective approach for the operative treatment of obesity, but the ideal procedure remains controversial. One of the most debated issues is the resection distance from the pylorus (DP). We conducted this study to elucidate any potential difference in the short-term outcome between 2 cm and 6 cm DP in LSG.Methods: This was an interventional, prospective, randomized study aimed at assessing the effect of the resection DP on the weight loss outcome as expressed by the excess weight loss percentage (%EWL) after LSG carried out from January 2018 to March 2020 in 96 patients with morbid obesity who had LSG performed at the Surgical Department, Suez Canal University. The patients were randomly separated into two equal groups; Group 1 (48 patients) underwent LSG with a 2 cm DP resection distance and Group 2 (48 patients) underwent LSG with a 6 cm DP resection distance. Body weight, body mass index, bariatric quality of life, lipid profile, and comorbidities were evaluated pre- and postoperatively for a duration of 12 months.Results: Statistically, there was no significant difference between the two study groups regarding the %EWL, comorbidity resolution throughout the postoperative follow-up, enhancement of the quality of life score throughout the postoperative follow-up, or incidence of complications (25% in Group 1 vs. 25% in Group 2, p > 0.05).Conclusion: LSG was an effective and safe management for morbid obesity and obesity-related comorbidities with significant short-term weight loss; it also improved weight-related quality of life and had an acceptable complication rate. The DP resection distance did not affect the short-term effects of LSG with regard to %EWL, resolution of comorbidities, change in quality of life, and occurrence of complications.

802 PERIOPERATIVE AND SHORT-TERM OUTCOMES FOR PRIMARY ANTIREFLUX SURGERY: FUNDOPLICATION VS. RNY RECONSTRUCTION

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Deepika Razia ◽  
Deepika Razia ◽  
Sumeet K Mittal
Keyword(s):  
Postoperative Complications ◽  
Hospital Stay ◽  
Antireflux Surgery ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Perioperative Outcomes ◽  
Short Term ◽  
Perioperative Morbidity ◽  
Conversion To Open Surgery ◽  
Time Length

Abstract   Laparoscopic fundoplication is the gold standard for treatment of gastroesophageal reflux disease (GERD); however, RNY reconstruction may be an alternative option in patients with complex pathophysiology and other risk factors. This study aimed to compare perioperative and short-term outcomes between primary fundoplication and RNY reconstruction. Methods After IRB approval, a prospectively maintained esophageal surgery database was retrospectively reviewed to identify patients who underwent primary fundoplication or RNY reconstruction from September 2016 to July 2020. We retrieved perioperative outcomes (operative time, length of hospital stay, intraoperative and postoperative complications) along with GERD-Health-Related Quality of Life (HRQL) scores at annual follow-up. Results During the study period, 226 patients underwent surgery (fundoplication: 210; RNY: 16). The most common indication for RNY was severe esophageal dysmotility or morbid obesity. There was only one conversion to open surgery due to adhesions (fundoplication group). The operative time, length of hospital stay, and ICU stay were significantly lower in the fundoplication group. Rates of intraoperative (fundoplication: 3% vs RNY: 0) and postoperative complications (Clavien-Dindo ≥II) (fundoplication: 3% vs RNY: 6%) were not significantly different between groups. Both groups had a significant and similar improvement of GERD-HRQL scores 1 year after surgery (Table 1). Conclusion Primary antireflux surgery is associated with low perioperative morbidity and excellent short-term outcomes. RNY reconstruction and fundoplication have similar outcomes. More liberal use of RNY reconstruction as the primary antireflux surgery in patients at high risk of failure with fundoplication should be explored.

Two lessons from a 5-year follow-up study of laparoscopic sleeve gastrectomy: Persistent, relevant weight loss and a short surgical learning curve

Surgery ◽  
2014 ◽  
Vol 155 (2) ◽  
pp. 292-299 ◽  
Author(s):  
Flavien Prevot ◽  
Pierre Verhaeghe ◽  
Aurélien Pequignot ◽  
Lionel Rebibo ◽  
Cyril Cosse ◽  
...  
Keyword(s):  
Weight Loss ◽  
Sleeve Gastrectomy ◽  
Learning Curve ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Follow Up Study ◽  
Surgical Learning

scholarly journals Comparison of Laparoscopic and Conventional Cystotomy/Partial Cystectomy in Treatment of Liver Hydatidosis

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Huseyin Kazim Bektasoglu ◽  
Mustafa Hasbahceci ◽  
Yunus Tasci ◽  
Ibrahim Aydogdu ◽  
Fatma Umit Malya ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Partial Cystectomy ◽  
Complication Rates ◽  
First Choice ◽  
Group 2 ◽  
Liver Hydatidosis ◽  
Group 1

Introduction. Hydatidosis is a zoonotic infection and treatment is mandatory to avoid complications. Surgery remains the first choice in the treatment especially for CE2-CE3b cysts. Open or laparoscopic approaches are available. However, comparative studies are limited. Materials and Methods. Data of patients who underwent cystotomy/partial cystectomy for liver hydatidosis between January 2012 and September 2016 (n=77) were evaluated retrospectively. Recurrent cases and the patients with previous hepatobiliary surgery were excluded. 23 patients were operated upon laparoscopically and named as Group 1. 48 patients operated conventionally named as Group 2. Demographics, cyst characteristics, operative time, length of hospital stay, recurrences, and surgery related complications were evaluated. Results. Groups were similar in terms of demographics, cyst characteristics, and operative time. The length of hospital stay was 3.4 days in Group 1 and 4.7 days in Group 2 (p=0,007). The mean follow-up period was 17.8 months and 21.7 months, respectively (p=0.170). Overall complication rates were similar in two groups (p=0.764). Three conversion cases occurred (13%). One mortality was seen in Group 2. Four recurrences occurred in each group (17% versus 8.3%, respectively) (p=0.258). Conclusions. Laparoscopy is a safe and feasible approach for surgical treatment of liver hydatidosis. Recurrence may be prevented by selection of appropriate cases in which exposure of cysts does not pose an intraoperative difficulty.

scholarly journals Omentopexy with Glubran®2 for reducing complications after laparoscopic sleeve gastrectomy: results of a randomized controlled study

BMC Surgery ◽  
2019 ◽  
Vol 19 (S1) ◽  
Author(s):  
Vincenzo Pilone ◽  
Salvatore Tramontano ◽  
Michele Renzulli ◽  
Mafalda Romano ◽  
Angela Monda ◽  
...  
Keyword(s):  
Weight Loss ◽  
Sleeve Gastrectomy ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Operative Time ◽  
Controlled Study ◽  
Control Group ◽  
Group A ◽  
Group B ◽  
High Level

Abstract Background Gastric fistulas, bleeding, and strictures are commonly reported after laparoscopic sleeve gastrectomy (LSG), that increase morbidity and hospital stay and may put the patient’s life at risk. We report our prospective evaluation of application of synthetic sealant, a modified cyanoacrylate (Glubran®2), on suture rime, associated with omentopexy, to identify results on LSG-related complications. Methods Patients were enrolled for LSG by two Bariatric Centers, with high-level activity volume. Intraoperative recorded parameters were: operative time, estimated intraoperative bleeding, conversion rate. We prospectively evaluated the presence of early complications after LSG during the follow up period. Overall complications were analyzed. Perioperative data and weight loss were also evaluated. A control group was identified for the study. Results Group A (treated with omentopexy with Glubran®2) included 96 cases. Control group included 90 consecutive patients. There were no differences among group in terms of age, sex and Body Mass Index (BMI). No patient was lost to follow-up for both groups. Overall complication rate was significantly reduced in Group A. Mean operative time and estimated bleeding did not differ from control group. We observed three postoperative leaks in Group B, while no case in Group A (not statistical significancy). We did not observe any mortality, neither reoperation. Weight loss of the cohort was similar among groups. In our series, no leaks occurred applying omentopexy with Glubran®2. Conclusion Our experience of omentopexy with a modified cyanoacrylate sealant may lead to a standardized and reproducible approach that can be safeguard for long LSG-suture rime. Trial registration Retrospective registration on clinicaltrials.gov PRS, with TRN NCT03833232 (14/02/2019).

scholarly journals Laparoscopic Pectopexy—CUSUM Learning Curve and Perioperative Complications Analysis

2021 ◽  
Vol 10 (5) ◽  
pp. 1052
Author(s):  
Paulina Szymczak ◽  
Magdalena Emilia Grzybowska ◽  
Sambor Sawicki ◽  
Dariusz Grzegorz Wydra
Keyword(s):  
Learning Curve ◽  
Hospital Stay ◽  
Operative Time ◽  
Perioperative Complications ◽  
Kpss Test ◽  
Estimated Blood Loss ◽  
Cusum Analysis ◽  
Grade Ii ◽  
Complications Rate ◽  
Prolonged Hospital

The study aimed to examine the learning curve and perioperative complications for laparoscopic pectopexy (LP). A total of 60 women with stage II–IV apical prolapse who underwent LP were dichotomized into groups: LSH(+) with concomitant laparoscopic supracervical hysterectomy (LSH), LSH(−) after previous supracervical/total hysterectomy. Operative time, estimated blood loss and hospitalization length were evaluated with cumulative sum (CUSUM) analysis and the Kwiatkowski–Phillips–Schmidt–Shin (KPSS) test, separately for two surgeons (A and B). Intraoperative and perioperative complications according to the Clavien–Dindo (C–D) classification were analyzed. Mean operative time, change in hemoglobin level, and postoperative hospital stay were 143.5 ± 23.1 min—1.5 ± 0.5g/dL and 2.5 ± 0.9 days, respectively. LSH during pectopexy was associated with longer operative time (p = 0.01) but not with higher intraoperative bleeding or prolonged hospital stay. Severe complications rate was low (1.7%) with one bowel injury in LSH(−) (C–D grade IIIb). No C–D grade II, IV and V complications were found. Conversion to open pectopexy, return to the operating room or blood transfusion were not required. The KPSS test showed that a steady operative time for Surgeon A was achieved after 28 procedures. A proficiency for laparoscopic pectopexy based on CUSUM analysis was observed after 38–40 procedures.

scholarly journals Efficacy and Drawbacks of Single-Anastomosis Duodeno-Ileal Bypass After Sleeve Gastrectomy in a Tertiary Referral Bariatric Center

2021 ◽  
Author(s):  
Arnaud Liagre ◽  
Francesco Martini ◽  
Yves Anduze ◽  
Hubert Boudrie ◽  
Olivier Van Haverbeke ◽  
...  
Keyword(s):  
Weight Loss ◽  
Sleeve Gastrectomy ◽  
Weight Regain ◽  
Postoperative Mortality ◽  
Short Term ◽  
Postoperative Complication Rate ◽  
Single Anastomosis ◽  
Biochemical Assessment ◽  
Ileal Bypass

Abstract Background The need for revisional procedures after sleeve gastrectomy (SG) for insufficient weight loss or weight regain, gastroesophageal reflux, or other complications is reported to be 18–36% in studies with 10-year follow-up. Single-anastomosis duodeno-ileal bypass (SADI) may be performed as a revisional procedure after SG. This study aims to evaluate the short- and mid-term outcomes of SADI after SG in a referral center for bariatric surgery. Materials and Methods Data of patients who underwent SADI between March 2015 and March 2020 were collected prospectively and analyzed retrospectively. Follow-up comprised clinical and biochemical assessment at 1, 3, 6, 12, 18, and 24 months postoperatively, and once a year thereafter. Results Overall, 106 patients underwent SADI after a previous SG. The timeframe between SG and SADI was 50 ± 31.3 months. Postoperative mortality was observed in two cases (1.8%) and morbidity in 15.1% of patients. At 24 months, %total weight loss was 37.6 ± 12.3 and %excess weight loss 76.9 ± 25.2 (64 patients). Three patients were treated for malnutrition during follow-up, two with medical treatment and one with SADI reversal. Conclusion SADI after SG provides effective weight loss results in the short-term, even if in the present series the postoperative complication rate was non-negligible. Further trials are needed to establish the more advantageous revisional bariatric procedure after failed SG.

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