Original articlePerioperative outcome of laparoscopic sleeve gastrectomy for high-risk patients
Section snippets
Data collection
Data of “high-risk” patients undergoing primary LSG in a university hospital between January 2008 and December 2014 were recorded in a prospective computer database according to a standardized protocol. Patients were selected, treated, and followed up according to the guidelines of the Swiss Study Group for Morbid Obesity. This study was approved by the University of Bern Institutional Review Board.
Definitions
Patients were classified as “high-risk” if they met 2 of following criteria: definition as ASA
Results
A total of 110 patients met the “high-risk” criteria. Demographic data are shown in Table 2. Thirty-three patients had a BMI>60 kg/m2 (30%). Of 89 patients with T2D (81%), 64 (72%) were insulin-dependent, and 56 (63%) were for>5 years. Patients with neurologic disease had ventriculoperitoneal shunts, epilepsy, or multiple sclerosis. Nine patients (7%) had a history of cancer (thyroid, prostate, colon, astrocytoma), and 4 (4%) had a history of cardiac or renal transplantation. Forty-one patients
Discussion
This study reports the short-term outcome of LSG for patients with the highest perioperative risk. Preoperative stratification of obesity-related, cardiopulmonary, and metabolic risk using well-known grading scores and subsequent uniform treatment leads to a safe and effective approach in this population burdened by significant co-morbidity.
With the increased use of bariatric surgery, patients refused for operation due to massive co-morbidities in earlier times are operated on more and more.
Conclusion
In conclusion, with LSG as part of a specialized treatment pathway for high-risk patients, complication rates stay well below the estimates of the underlying, population-defining risk scores. Still, postoperative morbidity is considerable, reflecting the severity of co-morbidities of “high-risk” patients.
Disclosures
The authors have no commercial associations that might be a conflict of interest in relation to this article.
Acknowledgments
The authors reported that they received no grant support for this study.
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Comment on: Predicting complications following bariatric surgery: the diagnostic accuracy of available tools
2022, Surgery for Obesity and Related DiseasesObesity surgery in patients with end-stage organ failure: Is it worth it?
2022, Surgery for Obesity and Related DiseasesCitation Excerpt :Comparing the present results with other studies in obesity surgery that included patients with a high perioperative risk is somewhat difficult since the present study considers solely ESOF patients, while most other studies include a broader range of potentially high-risk patients. Borbléy et al. examined 110 patients at a single center and reported a major complication rate of 11% and a mortality rate of 1% in the first 30 days after surgery [2]. Patients were considered high risk if they met at least two out of seven criteria, including American Society of Anesthesiologists physical status ≥ 4, Revised Cardiac Risk Index class IV, Obesity Surgery Mortality Risk Score class C, OSA scoring system score ≥ 5, chronic kidney disease stage ≥ 3 (GFR <60 mL/min), liver cirrhosis, and a history of an adverse or life-threatening perioperative event.
Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures – 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists
2020, Surgery for Obesity and Related DiseasesCitation Excerpt :Decisions regarding bariatric procedures should also be based on safety concerns regarding specific organ systems. In general, the greater the inherent risk of a specific bariatric procedure, independent of the risk of not treating obesity and severity of ORC, the less complicated the procedure selected [322]. In addition, preoperative estimation of the likelihood that a patient will experience a cardiac complication at the time of noncardiac surgery can guide procedure selection and prevent postoperative morbidity and mortality.
Electrical stimulation of the lower esophageal sphincter to address gastroesophageal reflux disease after sleeve gastrectomy
2018, Surgery for Obesity and Related DiseasesCitation Excerpt :There is a linear relationship not only between body mass index and GERD, but also between central obesity and GERD [20]. Yet, central obesity complicates bariatric procedures and is one of the main reasons—together with the resulting co-morbidities—for the popularity of LSG [21]. Morbid obesity increases the intraabdominal pressure having an effect on intragastric pressure and the gastroesophageal pressure gradient, and leads further to a higher rate of hiatal hernias and postprandial transient LES relaxations [22].