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LSG outcomes

LSG effective, but technique needs further exploration

Prevalence of GERD increased from 12.8% to 27.4% at two years

Laparoscopic sleeve gastrectomy (LSG) is a safe and effective procedure but the operative technique needs further exploration to avoid post-procedure issue such as gastroesophageal reflux (GERD). The study, published by BioMed Central, also reported that majority of patients had resolution in several comorbidities following surgery.

“There is currently no clear consensus on how the surgical technique is optimally performed, which makes it even more important to continuously evaluate the results at different centres,” report the study authors from Førde Central Hospital and Fjordane University College, Førde, the University of Bergen and Haukeland University Hospital, Bergen, Norway,

For their study, they collected patient data from May 2007 to December 2011. A total of 117 patients (87 women and 30 men) had an LSG and changes in obesity-related diseases and micronutrients were evaluated after 24 months. The mean weight prior to the operation was 135.6kg± 23.7, the mean BMI 46.6±6.0 and the mean age 40.3±10.7.

Results

The results showed that major complications included bleeding (5.1%, n=6), leak (1.7%, n=2) and abscess without a visible leak (0.9%, n= 1); one patient had both bleeding and leak. There was no conversion of laparoscopic to open surgery and no mortality.

LSG significantly lowered the BMI 30.3±5.9 and 30.6±5.6 at 12 and 24 months respectively. At two years, the remission-rate for T2DM was 80.7%, hypertension 63.9%, hyperlipidemia 75.8%, sleep apnoea 93.0%, musculoskeletal pain 31.4%, snoring 85.4% and urinary leakage 73.3% (Table 1).

Table 1: 90-day morbidity after surgery (n = 117)

However, they reported that the prevalence of GERD increased from 12.8% prior to the operation to 27.4% at two years (p=0.011).

“Our study shows a significant increase in GERD after the operation, even though five of our fifteen patients who were treated for GERD symptoms preoperatively had resolution of their GERD symptoms postoperatively,” they write. “Our advice has been to have smaller meals at increased frequency and consume foods at slower rates with sufficient chewing, which might have some effect in reducing GERD-symptoms.”

Twenty-four months after the procedure, 87% of patients were taking vitamin and/or mineral supplements, although there was no difference in the vitamin or mineral status when comparing patients using supplements (n=83) with patients not using supplements (n=12).  Although they commented that the “findings highlight a need for further exploring the necessity of folic acid, cobalamin, iron and possibly calcium-substitution in LSG patients before making any general recommendations.”

“Long term effects of LSG are, however, still limited in terms of possible weight regain, side effects and persistence of comorbidity resolution,” they conclude. “Further development of the technique should be attempted, particularly to reduce the risk for postoperative GERD.”

To access the article, please click here

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