Skip to main content
Erschienen in: Obesity Surgery 10/2010

01.10.2010 | Clinical Research

Laparoscopic Sleeve Gastrectomy: An Indian Experience—Surgical Technique and Early Results

verfasst von: P. K. Chowbey, K. Dhawan, R. Khullar, A. Sharma, V. Soni, M. Baijal, T. Mittal

Erschienen in: Obesity Surgery | Ausgabe 10/2010

Einloggen, um Zugang zu erhalten

Abstract

Background

Obesity has been observed to be on the rise in the Indian subcontinent. We report our early experience with the laparoscopic sleeve gastrectomy (LSG) for treating morbid obesity in the Indian population along with description of the surgical technique.

Methods

The data of 75 patients who underwent LSG for the treatment of morbid obesity at the Minimal Access, Metabolic and Bariatric Surgery Centre, Sir Ganga Ram Hospital, Delhi, from November 2006 to February 2009, were retrospectively reviewed from prospective database. The gastric sleeve is created laparoscopically using sequential firings of a linear stapling device applied alongside a 36-Fr calibrating bougie. The data collected included age, gender, initial body mass index (BMI) and excess weight, the co-morbidity status, and preoperative investigations. Perioperative parameters and follow-up details [weight, BMI, excess weight loss (%EWL), resolution of co-morbidities, and postoperative investigations] were noted.

Results

All procedures were completed laparoscopically. There was no major procedure-related morbidity. Hemorrhage requiring blood transfusion was observed in four patients. One patient died at 2 weeks postoperatively due to pulmonary embolism. There was a steady rise in %EWL from 31.2% at 3 months to 52.3% at 6 months, 59.13% at 1 year, and 65% at 2 years. Type II diabetes was resolved in 81.2%, hypertension in 93.75%, and dyslipidemia in 85% at 1 year.

Conclusion

Although long-term results are necessary to determine the benefits of the procedure, early results indicate that LSG may be a safe and feasible option for treating the morbidly obese patients.
Literatur
1.
Zurück zum Zitat Deitel M. Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obes Surg. 2003;13:329–30. (Editorial).CrossRefPubMed Deitel M. Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obes Surg. 2003;13:329–30. (Editorial).CrossRefPubMed
2.
Zurück zum Zitat Professor Phillip James, Chair of London based International Obesity Task Force, Monte Carlo, March 17, 2003. Professor Phillip James, Chair of London based International Obesity Task Force, Monte Carlo, March 17, 2003.
3.
Zurück zum Zitat World Health Organization. Obesity: preventing and managing the global epidemic. Technical report series no. 894, WHO, Geneva 2000. World Health Organization. Obesity: preventing and managing the global epidemic. Technical report series no. 894, WHO, Geneva 2000.
4.
Zurück zum Zitat Misra A, Vikram NK. Insulin resistance syndrome (metabolic syndrome) and obesity in Asian Indians: evidence and implications. Nutrition. 2004;2004(20):482–91.CrossRef Misra A, Vikram NK. Insulin resistance syndrome (metabolic syndrome) and obesity in Asian Indians: evidence and implications. Nutrition. 2004;2004(20):482–91.CrossRef
5.
Zurück zum Zitat Dudeja V, Misra A, Pandey, et al. BMI does not accurately predict overweight in Asian Indians in northern India. Br J Nutr. 2001;86:105–12.CrossRefPubMed Dudeja V, Misra A, Pandey, et al. BMI does not accurately predict overweight in Asian Indians in northern India. Br J Nutr. 2001;86:105–12.CrossRefPubMed
6.
Zurück zum Zitat Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term, mortality, morbidity and health care use in morbidly obese patients. Ann Surg. 2004;240:416–24.CrossRefPubMed Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term, mortality, morbidity and health care use in morbidly obese patients. Ann Surg. 2004;240:416–24.CrossRefPubMed
7.
Zurück zum Zitat Sampalis JS, Liberman M, Auger S, et al. The impact of weight reduction surgery on health-care costs in morbidly obese patients. Obes Surg. 2004;14:939–47.CrossRefPubMed Sampalis JS, Liberman M, Auger S, et al. The impact of weight reduction surgery on health-care costs in morbidly obese patients. Obes Surg. 2004;14:939–47.CrossRefPubMed
8.
Zurück zum Zitat Almogy G, Crookes PF, Anthonr GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obes Surg. 2004;14:492–7.CrossRefPubMed Almogy G, Crookes PF, Anthonr GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obes Surg. 2004;14:492–7.CrossRefPubMed
9.
Zurück zum Zitat Regan JP, Inabnet WB, Gagner M, et al. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super–super obese patient. Obes Surg. 2003;13:861–4.CrossRefPubMed Regan JP, Inabnet WB, Gagner M, et al. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super–super obese patient. Obes Surg. 2003;13:861–4.CrossRefPubMed
10.
Zurück zum Zitat Lee CM, Cirangle PT, Jossart GH. Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc. 2007;21:1810–6.CrossRefPubMed Lee CM, Cirangle PT, Jossart GH. Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc. 2007;21:1810–6.CrossRefPubMed
11.
Zurück zum Zitat Franz X, Felberbauer, et al. Laparoscopic sleeve gastrectomy as an isolated bariatric procedure: intermediate-term results from a large series in three Austrian centers. Obes Surg. 2008;18:814–8.CrossRef Franz X, Felberbauer, et al. Laparoscopic sleeve gastrectomy as an isolated bariatric procedure: intermediate-term results from a large series in three Austrian centers. Obes Surg. 2008;18:814–8.CrossRef
12.
Zurück zum Zitat Wolf AM, Colditz GA. Current estimates of the economic cost of obesity in the United States. Obes Res. 1998;6(2):97–106.PubMed Wolf AM, Colditz GA. Current estimates of the economic cost of obesity in the United States. Obes Res. 1998;6(2):97–106.PubMed
13.
Zurück zum Zitat Gagner M, Patterson E. Laparoscopic biliopancreatic diversion with duodenal switch. Dig Surg. 2000;17:547–66.CrossRef Gagner M, Patterson E. Laparoscopic biliopancreatic diversion with duodenal switch. Dig Surg. 2000;17:547–66.CrossRef
14.
Zurück zum Zitat de Csepel J, Burpee S, Jossart G, et al. Laparoscopic biliopancreatic dicersion with a duodenal switch for morbid obesity. A feasibility study in pigs. J Laparoendosc Adv Surg Tech A. 2001;11:79–83.CrossRefPubMed de Csepel J, Burpee S, Jossart G, et al. Laparoscopic biliopancreatic dicersion with a duodenal switch for morbid obesity. A feasibility study in pigs. J Laparoendosc Adv Surg Tech A. 2001;11:79–83.CrossRefPubMed
15.
Zurück zum Zitat Fazylow RM, Savel RH, Horovitz JH, et al. Association of super-super-obesity and male gender with elevated mortality in patients undergoing the duodenal switch procedure. Obes Surg. 2005;15:618–23.CrossRef Fazylow RM, Savel RH, Horovitz JH, et al. Association of super-super-obesity and male gender with elevated mortality in patients undergoing the duodenal switch procedure. Obes Surg. 2005;15:618–23.CrossRef
16.
Zurück zum Zitat Baltasar A, Serra C, Perez N, et al. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg. 2005;15:1124–8.CrossRefPubMed Baltasar A, Serra C, Perez N, et al. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg. 2005;15:1124–8.CrossRefPubMed
17.
Zurück zum Zitat Date Y, Kojima M, Hosoda H, et al. Ghrelin, a novel growth hormone-releasing acylated peptide, is synthesized in a distinct endocrine cell type in the gastrointestinal tracts of rats and humans. Endocrinology. 2000;141:4255–61.CrossRefPubMed Date Y, Kojima M, Hosoda H, et al. Ghrelin, a novel growth hormone-releasing acylated peptide, is synthesized in a distinct endocrine cell type in the gastrointestinal tracts of rats and humans. Endocrinology. 2000;141:4255–61.CrossRefPubMed
18.
Zurück zum Zitat Ariyasu H, Takaya K, Tagami T, et al. Stomach is a major source of circulating ghrelin, and feeding state determines plasma ghrelin-like immunoreactivity levels in humans. J Clin Endocrinol Metab. 2001;86:4753–8.CrossRefPubMed Ariyasu H, Takaya K, Tagami T, et al. Stomach is a major source of circulating ghrelin, and feeding state determines plasma ghrelin-like immunoreactivity levels in humans. J Clin Endocrinol Metab. 2001;86:4753–8.CrossRefPubMed
19.
Zurück zum Zitat Neary NM, Small CJ, Wren AM, et al. Ghrelin increases energy intake in cancer patients with impaired appetite; acute randomized, placebo-controlled trial. J Clin Endocrinol Metab. 2004;89:2832–6.CrossRefPubMed Neary NM, Small CJ, Wren AM, et al. Ghrelin increases energy intake in cancer patients with impaired appetite; acute randomized, placebo-controlled trial. J Clin Endocrinol Metab. 2004;89:2832–6.CrossRefPubMed
20.
Zurück zum Zitat Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15:1024–9.CrossRefPubMed Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15:1024–9.CrossRefPubMed
21.
Zurück zum Zitat Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006;16:1450–6.CrossRefPubMed Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006;16:1450–6.CrossRefPubMed
22.
Zurück zum Zitat Iannelli A, Facchiano E, Gugenheim J. Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2006;16:1265–71.CrossRefPubMed Iannelli A, Facchiano E, Gugenheim J. Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2006;16:1265–71.CrossRefPubMed
23.
Zurück zum Zitat Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high risk patients. Obes Surg. 2006;16:1138–44.CrossRefPubMed Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high risk patients. Obes Surg. 2006;16:1138–44.CrossRefPubMed
24.
Zurück zum Zitat Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high risk patients with morbid obesity. Surg Endosc. 2006;20:859–63.CrossRefPubMed Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high risk patients with morbid obesity. Surg Endosc. 2006;20:859–63.CrossRefPubMed
25.
Zurück zum Zitat Iannelli A, Dainese R, Pieche T, et al. Laparoscopic sleeve gastrectomy for morbid obesity. World J Gastroenterol. 2008;14(6):821–7.CrossRefPubMed Iannelli A, Dainese R, Pieche T, et al. Laparoscopic sleeve gastrectomy for morbid obesity. World J Gastroenterol. 2008;14(6):821–7.CrossRefPubMed
26.
Zurück zum Zitat Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg. 2004;199:543–51.CrossRefPubMed Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg. 2004;199:543–51.CrossRefPubMed
27.
Zurück zum Zitat Flum DR, Salem L, Elrod JA, et al. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA. 2005;294:1903–8.CrossRefPubMed Flum DR, Salem L, Elrod JA, et al. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA. 2005;294:1903–8.CrossRefPubMed
28.
Zurück zum Zitat Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after Bariatric surgery. N. Engl J Med. 2004;351:2683–93.CrossRefPubMed Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after Bariatric surgery. N. Engl J Med. 2004;351:2683–93.CrossRefPubMed
29.
Zurück zum Zitat Wilson LJ, Ma W, Hirschowitz BI. Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol. 1999;94:2840–4.CrossRefPubMed Wilson LJ, Ma W, Hirschowitz BI. Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol. 1999;94:2840–4.CrossRefPubMed
30.
Zurück zum Zitat Langer FB, Bohdjalian A, Felberbauer FX, et al. Does gastric dilation limit the success of sleeve gastrectomy as a sole operation for morbid obesity? Obes Surg. 2006;16:1327–30.CrossRef Langer FB, Bohdjalian A, Felberbauer FX, et al. Does gastric dilation limit the success of sleeve gastrectomy as a sole operation for morbid obesity? Obes Surg. 2006;16:1327–30.CrossRef
31.
Zurück zum Zitat Gagner M, Rogula T. Laparoscopic re-operative sleeve gastrectomy for poor weight loss after biliopancreatic diversion with duodenal switch. Obes Surg. 2003;13:649–54.CrossRefPubMed Gagner M, Rogula T. Laparoscopic re-operative sleeve gastrectomy for poor weight loss after biliopancreatic diversion with duodenal switch. Obes Surg. 2003;13:649–54.CrossRefPubMed
32.
Zurück zum Zitat Deitel M. Surgery for morbid obesity. Overview. Eur J Gastroenterol Hepatol. 1999;11:57–61.CrossRefPubMed Deitel M. Surgery for morbid obesity. Overview. Eur J Gastroenterol Hepatol. 1999;11:57–61.CrossRefPubMed
33.
Zurück zum Zitat Misra A, Chowbey P, Makkar BM, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009;57:163–73.PubMed Misra A, Chowbey P, Makkar BM, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009;57:163–73.PubMed
Metadaten
Titel
Laparoscopic Sleeve Gastrectomy: An Indian Experience—Surgical Technique and Early Results
verfasst von
P. K. Chowbey
K. Dhawan
R. Khullar
A. Sharma
V. Soni
M. Baijal
T. Mittal
Publikationsdatum
01.10.2010
Verlag
Springer-Verlag
Erschienen in
Obesity Surgery / Ausgabe 10/2010
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-009-9973-9

Weitere Artikel der Ausgabe 10/2010

Obesity Surgery 10/2010 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.