Laparoscopic sleeve gastrectomy for morbid obesity: 5 years experience from an Asian center of excellence.

Zachariah, Sanoop Koshy; Chang, Po-Chih; Ooi, Andrea Se En; Hsin, Ming-Che; Kin Wat, Jason Yiu; Huang, Chih Kun

BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is emerging as a popular "stand-alone" bariatric procedure. We report our 5 years experience with LSG as a single-stage bariatric procedure with which to study the technical progress, learning curve, complications, and follow-up results. METHODS Prospectively collected data of 228 patients (145 females and 83 males), who underwent LSG for morbid obesity, from February 2007 to March 2012, was retrospectively analyzed. RESULTS The mean age was 34.68 years (range, 18-62 years) and the mean preoperative body mass index (BMI) was 37.42 ± 4.75 kg/m(2) (range, 32.08-65.69 kg/m(2)). Mean operative time was 60.63 ± 27.37 min. The mean BMI decreased to 26.15 ± 3.71 kg/m(2) at 3 years (p < 0.001) and to 27.94 ± 4.08 kg/m(2) at 5 years (p < 0.001). Mean percentage excess weight loss was 71.96 ± 21.30 % at 3 years and 63.71 ± 20.08 % at 5 years. The 30-day readmission rate was 3.07 %.Overall complication rate was 4.3 %, including strictures, leaks, peritonitis, gastrocutaneous fistula, and one (0.43 %) mortality. One patient with weight regain and another with stricture underwent conversion to Roux-en-Y gastric bypass. Complication rates significantly decreased after the first 50 cases (p = 0.022), suggesting an initial learning curve. Resolution of diabetes, hypertension, and hyperlipidemia was 66.67, 100, and 50 %, respectively, at 5 years. CONCLUSIONS LSG as a single-stage bariatric procedure is safe and durable, achieving weight loss and resolution of comorbidities up to 5 years. Adherence to technical details is pivotal in reducing complications associated with the initial learning phase.