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Surve A, Cottam D, Pryor A, Cottam S, Michaelson R, Umbach T, Williams M, Bagshahi H, July L, Bueno R, Chock D, Apel M, Hart C, Johnson W, Curtis B, Rosenbluth A, Spaniolas K, Medlin W, Wright W, Lee C, Lee C, Trujeque R, Rinker D. A Prospective Multicenter Standard of Care Study of Outpatient Laparoscopic Sleeve Gastrectomy. Obes Surg 2024; 34:1122-1130. [PMID: 38366263 PMCID: PMC11026234 DOI: 10.1007/s11695-024-07094-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
A global shift is occurring as hospital procedures move to ambulatory surgical settings. Surgeons have performed outpatient sleeve gastrectomy (SG) in bariatric surgery since 2010. However, prospective trials are needed to ensure its safety before widespread adoption. PURPOSE The study aimed to present a comprehensive report on the prospective data collection of 30-day outcomes of outpatient primary laparoscopic SG (LSG). This trial seeks to assess whether outpatient LSG is non-inferior to hospital-based surgery in selected patients who meet the outpatient surgery criteria set by the American Society for Metabolic and Bariatric Surgery. MATERIALS AND METHODS This study is funded by the Society of American Gastrointestinal and Endoscopic Surgeons and has been approved by the Advarra Institutional Review Board (Pro00055990). Cognizant of the necessity for a prospective approach, data collection commenced after patients underwent primary LSG procedures, spanning from August 2021 to September 2022, at six medical centers across the USA. Data centralization was facilitated through ArborMetrix. Each center has its own enhanced recovery protocols, and no attempt was made to standardize the protocols. RESULTS The analysis included 365 patients with a mean preoperative BMI of 43.7 ± 5.7 kg/m2. Rates for 30-day complications, reoperations, readmissions, emergency department visits, and urgent care visits were low: 1.6%, .5%, .2%, .2%, and 0%, respectively. Two patients (0.5%) experienced grade IIIb complications. There were no mortalities or leaks reported. CONCLUSION The prospective cohort study suggests that same-day discharge following LSG seems safe in highly selected patients at experienced US centers.
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Affiliation(s)
- Amit Surve
- Bariatric Medicine Institute, 1046 E 100 S, Salt Lake City, UT, USA
| | - Daniel Cottam
- Bariatric Medicine Institute, 1046 E 100 S, Salt Lake City, UT, USA.
| | - Aurora Pryor
- Stony Brook University Hospital, 23 South Howell Ave, Centereach, NY, USA
| | - Samuel Cottam
- Bariatric Medicine Institute, 1046 E 100 S, Salt Lake City, UT, USA
| | - Robert Michaelson
- Northwest Weight & Wellness Center, 125 130Th St SE, Everett, WA, USA
| | - Thomas Umbach
- Blossom Bariatrics, 7385 S Pecos Rd #101, Las Vegas, NV, USA
| | - Michael Williams
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | | | - Laura July
- Blossom Bariatrics, 7385 S Pecos Rd #101, Las Vegas, NV, USA
| | - Racquel Bueno
- Blossom Bariatrics, 7385 S Pecos Rd #101, Las Vegas, NV, USA
| | - Devorah Chock
- Northwest Weight & Wellness Center, 125 130Th St SE, Everett, WA, USA
| | - Matthew Apel
- Blossom Bariatrics, 7385 S Pecos Rd #101, Las Vegas, NV, USA
| | - Christopher Hart
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | - William Johnson
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | - Brendon Curtis
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | - Amy Rosenbluth
- Stony Brook University Hospital, 23 South Howell Ave, Centereach, NY, USA
| | | | - Walter Medlin
- Bariatric Medicine Institute, 1046 E 100 S, Salt Lake City, UT, USA
| | - Whitney Wright
- Northwest Weight & Wellness Center, 125 130Th St SE, Everett, WA, USA
| | - Ciara Lee
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | - Christy Lee
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | | | - Deborah Rinker
- Blossom Bariatrics, 7385 S Pecos Rd #101, Las Vegas, NV, USA
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Newbold R, Craven A, Aly A. Efficacy of patient selection criteria for obesity surgery in a non-high-dependency unit/intensive care unit facility. ANZ J Surg 2021; 91:1528-1533. [PMID: 34031972 DOI: 10.1111/ans.16960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUNDS Publicly funded obesity surgery remains underfunded in Australia. One barrier to expansion is the perception that perioperative care requires critical care facilities. This study evaluates the effectiveness of patient selection criteria in avoiding unplanned patient transfer and adverse outcomes in obesity surgery performed at a facility without a high-dependency unit/intensive care unit (HDU/ICU). METHODS Retrospective analysis was performed on patients undergoing obesity surgery between January 2017 and March 2020 in a centre with specific screening criteria. Criteria included: body mass index <48 for males and <52 for females with up to three stable comorbidities from a selected list. Revision sleeve or bypass procedures were contraindicated. Primary outcome was patient transfer to our main campus. Secondary outcomes included return to theatre (RTT), readmission and death. Outcomes were compared to laparoscopic cholecystectomies (LC) performed at the same centre. RESULTS A total of 387 obesity surgery procedures were performed; 372 patients (96%) were discharged without complication. Fifteen (3.9%) were transferred to the main campus, eight were admitted to ICU and two required re-operation. Twelve (3.1%) were readmitted within 30 days of discharge, five required re-operation. Transfer, 30-day readmission and 30-day emergency department presentation rates were similar in comparison to LC. RTT during index admission (0.5% vs. 3.0%; p = 0.006) and during 30-day post-operative period (1.8% vs. 4.4%; p = 0.025) was lower in the obesity surgery group. CONCLUSION Carefully selected screening criteria allow obesity surgery to be performed at a well-supported non-HDU/ICU facility with few complications and acceptable rates of unplanned patient transfer.
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Affiliation(s)
- Ryan Newbold
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Alexander Craven
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Ahmad Aly
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
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Yheulon CG. Comment on: Malabsorption surgery can be safely performed in an ambulatory surgical setting. Surg Obes Relat Dis 2019; 16:e1-e2. [PMID: 31786142 DOI: 10.1016/j.soard.2019.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/22/2019] [Indexed: 11/19/2022]
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Single-anastomosis duodenal ileostomy with sleeve is a safe and effective option for patients in an ambulatory surgical center. Surg Obes Relat Dis 2019; 15:1990-1993. [DOI: 10.1016/j.soard.2019.09.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/23/2019] [Accepted: 09/11/2019] [Indexed: 11/18/2022]
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Billing P, Billing J, Harris E, Kaufman J, Landerholm R, Stewart K. Safety and efficacy of outpatient sleeve gastrectomy: 2534 cases performed in a single free-standing ambulatory surgical center. Surg Obes Relat Dis 2019; 15:832-836. [DOI: 10.1016/j.soard.2019.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/21/2019] [Accepted: 03/01/2019] [Indexed: 12/22/2022]
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Abstract
Obesity is a major public health concern that leads to numerous metabolic, mechanical and psychological complications. Although lifestyle interventions are the cornerstone of obesity management, subsequent physiological neurohormonal adaptations limit weight loss, strongly favour weight regain and counteract sustained weight loss. A range of effective therapies are therefore needed to manage this chronic relapsing disease. Bariatric surgery delivers substantial, durable weight loss but limited access to care, perceived high risks and costs restrict uptake. Medical devices are uniquely positioned to bridge the gap between more conservative lifestyle intervention and weight-loss pharmacotherapy and more disruptive bariatric surgery. In this Review, we examine the range of gastrointestinal medical devices that are available in clinical practice to treat obesity, as well as those that are in advanced stages of development. We focus on the mechanisms of action as well as the efficacy and safety profiles of these devices. Many of these devices are placed endoscopically, which provides gastroenterologists with exciting opportunities for treatment.
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Dupanovic M, Krebill R, Dupanovic I, Nachtigal J, Rockford M, Orr W. Perioperative Factors Affecting Ambulatory Outcomes Following Laparoscopic-Adjustable Gastric Banding. Turk J Anaesthesiol Reanim 2017; 45:282-288. [PMID: 29114413 DOI: 10.5152/tjar.2017.70037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/06/2017] [Indexed: 11/22/2022] Open
Abstract
Objective Morbidly obese patients are traditionally hospitalised following bariatric surgery. However, laparoscopic-adjustable gastric banding (LAGB) is amenable for ambulatory care. We hypothesised that the majority of patients can receive an ambulatory LAGB and that both surgical and anaesthetic perioperative factors will significantly affect non-ambulatory LAGB outcomes. Methods Medical records of 201 consecutive LAGB patients performed at the University of Kansas Medical Centre during a 3-y period were reviewed. Demographic, medical, laboratory, anaesthetic, intraoperative and postoperative data were collected. Factors associated with non-ambulatory outcomes were identified and analysed using logistic regression, and a classification tree analysis was used to rank the descriptive model factor to the non-ambulatory outcome. Results Average patient age was 43.4±11.4 years, and average body mass index was 48.2±10.3 kg m2-1. A total of 155 patients (77.1%; 95% confidence interval, 71%-83%; p<0.0001) were discharged home within 2-3 hours of surgery, whereas 36 stayed for 23 hours and 10 required hospital admission for 1-2 days. Increased surgical port numbers (p=0.007), ≥50% of total intraoperative fentanyl administered in the recovery room (post-anaesthesia care unit) for the treatment of postoperative pain (p=0.007) and a lack of prophylactic beta-blockade (p=0.001) were three factors associated with non-ambulatory outcomes. Obstructive sleep apnoea was not associated with a non-ambulatory outcome (p=0.83). Conclusion The majority of patients received an ambulatory LAGB. Meticulous laparoscopic surgical technique with the least feasible number of access ports and multimodal analgesic technique aimed at reduction of postoperative opioid consumption are the most important factors for a successful ambulatory LAGB outcome.
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Affiliation(s)
- Mirsad Dupanovic
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ron Krebill
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - John Nachtigal
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Melissa Rockford
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Walter Orr
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
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Molina JC, Misariu AM, Nicolau I, Spicer J, Mulder D, Ferri LE, Mueller CL. Same day discharge for benign laparoscopic hiatal surgery: a feasibility analysis. Surg Endosc 2017; 32:937-944. [PMID: 28779258 DOI: 10.1007/s00464-017-5769-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/14/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Advances in minimally invasive surgery and the development of enhanced recovery pathways have favored the spread of day-surgery programs. Despite laparoscopic approaches being accepted as the standard of care for benign hiatal diseases, safety and feasibility of same day discharges for laparoscopic hiatal surgeries other than fundoplication has yet to be established. OBJECTIVE This study aimed to assess the feasibility of same day discharge for primary and revisional laparoscopic hiatal surgeries including paraesophageal hernia repairs (PEHR), fundoplication for reflux, and Heller myotomy (±diverticulectomy). METHODS A retrospective cohort study including all patients undergoing elective laparoscopic hiatal procedures in the division of Thoracic surgery between 2011 and 2016 at McGill University Health Centre was performed. Planned day-surgery (DAYCASE) was compared to planned inpatient (INPATIENT) cohorts with respect to operative and postoperative outcomes, length of stay, readmission, and emergency room visits. RESULTS A total of 261 patients were identified, 161 female (62%); median age 62 (20). The case distribution was: PEHR (123; 47.1%), Heller myotomy (94;36%, 7 diverticulectomy), and fundoplication (44; 16.9%). Twenty patients had revisional procedures (7.7%). Same day discharge was planned in 98 cases (38%) and was successful in 80 (81.6%). Proportion of DAYCASE increased form 12% prior to 2013 to 67% in 2016. INPATIENTs were older (median 66 vs. 60 years), and had a higher proportion of PEHR (55 vs. 34%), p < 0.05. Both cohorts were comparable in gender proportion, ASA classification, and length of surgery. Complications, readmission, and emergency visits did not differ between the two cohorts. On multivariate analysis, female gender (OR 37, 95% CI 1.46-936, p = 0.028), surgery beginning after noon (OR 5.4, 95% CI 1.1-26.9, p = 0.038), intraoperative complications (OR 20.4 95% CI 1.5-286, p = 0.025), and postoperative complications (OR 52.1, 95% CI 4.5-602, p = 0.002) were independently associated with unplanned admission. CONCLUSIONS Day-case surgery for complex laparoscopic hiatal procedures is feasible and can be achieved in a significant number of patients without compromising safety.
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Affiliation(s)
- Juan Carlos Molina
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada.
| | - Ana María Misariu
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada
| | - Ioana Nicolau
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada
| | - Jonathan Spicer
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada
| | - David Mulder
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada
| | - Lorenzo E Ferri
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada
| | - Carmen L Mueller
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada
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Billing P, Billing J, Kaufman J, Stewart K, Harris E, Landerholm R. High acuity sleeve gastrectomy patients in a free-standing ambulatory surgical center. Surg Obes Relat Dis 2017; 13:1117-1121. [DOI: 10.1016/j.soard.2017.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/17/2017] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
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Nightingale CE, Margarson MP, Shearer E, Redman JW, Lucas DN, Cousins JM, Fox WTA, Kennedy NJ, Venn PJ, Skues M, Gabbott D, Misra U, Pandit JJ, Popat MT, Griffiths R. Peri-operative management of the obese surgical patient 2015: Association of Anaesthetists of Great Britain and Ireland Society for Obesity and Bariatric Anaesthesia. Anaesthesia 2015; 70:859-76. [PMID: 25950621 PMCID: PMC5029585 DOI: 10.1111/anae.13101] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 12/13/2022]
Abstract
Guidelines are presented for the organisational and clinical peri-operative management of anaesthesia and surgery for patients who are obese, along with a summary of the problems that obesity may cause peri-operatively. The advice presented is based on previously published advice, clinical studies and expert opinion.
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Affiliation(s)
| | | | - E Shearer
- Society for Obesity and Bariatric Anaesthesia
| | - J W Redman
- Society for Obesity and Bariatric Anaesthesia
| | - D N Lucas
- Obstetric Anaesthetists' Association
| | - J M Cousins
- Society for Obesity and Bariatric Anaesthesia
| | - W T A Fox
- Society for Obesity and Bariatric Anaesthesia
| | - N J Kennedy
- Society for Obesity and Bariatric Anaesthesia
| | | | - M Skues
- British Association of Day Surgery
| | | | - U Misra
- Obstetric Anaesthetists' Association
| | - J J Pandit
- Association of Anaesthetists of Great Britain & Ireland
| | | | - R Griffiths
- Association of Anaesthetists of Great Britain & Ireland
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Hussain AA, Nicholls J, El-Hasani SS. Laparoscopic adjustable gastric band: how to reduce the early morbidity. JSLS 2014; 18:JSLS-D-13-00241. [PMID: 25392623 PMCID: PMC4154413 DOI: 10.4293/jsls.2014.00241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Laparoscopic adjustable gastric band insertion is a safe weight reduction procedure, but serious complications can develop. The aim of this study was to evaluate our technique in preventing early band complications. METHODS Patients were given the choice of procedure according to body mass index, the presence of diabetes, and preference. Weight loss data were not considered, as our aim was to evaluate the morbidity of band surgery using a specific technique. A pars flaccida approach and plication technique were used for all patients. Postoperative follow-up was provided at 1 month, 2 months, and every 3 months for the first year and then yearly for a further 2 years. Thereafter, general practitioners referred patients if late complications arose. RESULTS From January 2007 to August 2011, 1149 patients (245 men [21.32%], 904 women [78.67%]) underwent laparoscopic adjustable gastric band insertion under the care of a single bariatric surgeon. Patients were hospitalized for 1 night only unless they developed early complications. The primary and secondary outcomes were major and minor band complications, respectively. Patients' age range was 18 to 64 years (mean, 44 years). Body mass index ranged from 33 to 62 kg/m2 (mean, 42 kg/m2). There were 2 band erosions (0.17%), 6 cases of band prolapse (0.52%), 4 port problems (0.34%), 1 band leak (0.08%), 3 tight bands (0.26%), 2 port infections (0.17%), and no deaths. Five procedures (0.43%) were abandoned and excluded from this study, and 1 (0.17%) was converted to minilaparotomy to control abdominal wall bleeding. The duration of follow-up ranged from 16 to 60 months. CONCLUSIONS A combined pars flaccida and plication technique is associated with a low early complication rate.
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Affiliation(s)
- Abdulzahra A Hussain
- Bariatric Unit, General Surgery Department, Princess Royal University Hospital, Orpington, Greater London, United Kingdom
| | - Jacqueline Nicholls
- Bariatric Unit, University College London Hospitals, Greater London, United Kingdom
| | - Shamsi S El-Hasani
- Bariatric Unit, General Surgery Department, Princess Royal University Hospital, Orpington, Greater London, United Kingdom
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Chirurgie bariatrique en ambulatoire : étude observationnelle à propos de 68 sleeve gastrectomies. ACTA ACUST UNITED AC 2014; 33:497-502. [PMID: 25282446 DOI: 10.1016/j.annfar.2014.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 09/25/2013] [Indexed: 01/07/2023]
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Long-term outcomes of laparoscopic adjustable silicone gastric banding (LAGB) in moderately obese patients with and without co-morbidities. Obes Surg 2014; 23:897-902. [PMID: 23529850 DOI: 10.1007/s11695-013-0877-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Overweight and obesity independently increase cardiovascular risk, while even modest weight loss can result in clinically significant improvements in cardiovascular risk and reduce long-term mortality. Lowering the body mass index (BMI) threshold for bariatric surgery to those with moderate obesity might be one way to lower the burden of this disease. The aim of this study was to evaluate the efficacy and safety of laparoscopic adjustable silicone gastric banding (LAGB) in moderately obese subjects with or without obesity-related co-morbidities. METHODS Thirty-four patients with BMI between 30 and 35 kg/m(2) (5 males/29 females, mean age 36 ± 10 years, mean preoperative weight 87.9 ± 7.1 kg, mean BMI 32.6 ± 1.6 kg/m(2) and mean percentage excess weight 48.7 ± 9 %) who underwent LAGB via pars flaccida between June 1, 2002 and August 31, 2010 were included. Good response was defined as BMI <30 kg/m(2) or percentage estimated weight loss (%EWL) >50. Poor response was defined as BMI >30 kg/m(2) or %EWL less than 50 after a minimum of 1 year. RESULTS Mean weight, BMI and %EWL were recorded at 1, 3, 5 and 7 years and were 77.4 ± 7.6, 69.9 ± 10.8, 70.9 ± 9.3 and 73.3 ± 12.0 kg; 28.8 ± 2.9, 26.4 ± 3.2, 26.5 ± 3.4 and 27.4 ± 5.0 kg/m(2); and 36 ± 23, 46.1 ± 33.8, 58.6 ± 31.5 and 45 ± 57, respectively (p < 0.01). Co-morbidities were diagnosed in 17/34 (50 %) patients at baseline and underwent remission or improvement in all cases after 1 year. CONCLUSIONS LAGB in a safe and effective procedure in patients with a BMI <35 kg/m(2).
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Cobourn C, Chapman MA, Ali A, Amrhein J. Five-year weight loss experience of outpatients receiving laparoscopic adjustable gastric band surgery. Obes Surg 2014; 23:903-10. [PMID: 23446665 PMCID: PMC3671103 DOI: 10.1007/s11695-013-0881-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study evaluated the efficacy and safety of laparoscopic adjustable gastric banding (LAGB) in a large cohort of morbidly obese patients followed for up to 5 years. METHODS Morbidly obese patients, ≥ 16 years of age, who underwent LAGB surgery at the Surgical Weight Loss Clinic in Ontario, Canada, between May 2005 and January 2011 were eligible for this retrospective chart review. Electronic files were searched to identify all patients who met the inclusion/exclusion criteria. Demographics, weights at baseline and follow-up visits (up to 60 months following surgery), and post-operative complications were documented. As follow-up visits occurred at unevenly spaced intervals within and across patients, modeling methods were used to more accurately assess mean % weight loss (WL) and % excess weight loss (EWL) over time. RESULTS This study included 2,815 patients (82 % female, mean age 43 years, mean baseline BMI 44.6 kg/m(2)) followed for a mean of 21.8 ± 15.4 months. Complications developed in 238 patients (8.5 %), the most frequent being prolapse/slippage (4.2 %), tubing/access port problems (1.2 %), and explantation (1.2 %). Mean %WL and %EWL progressed continuously over the first 2.5 years post-LAGB, plateauing at 20 and 49 %, respectively, for up to 5 years of follow up. Factors associated with increased weight loss were time since surgery, greater baseline weight (excess weight), older age at time of surgery, and male gender. CONCLUSIONS Weight loss was maintained for up to 5 years in our population of patients who underwent LAGB for the treatment of morbid obesity.
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Affiliation(s)
- Chris Cobourn
- Surgical Weight Loss Centre, 1413 Hurontario St., Mississauga, Ontario, L5G 3H5, Canada.
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Is Ambulatory Laparoscopic Roux-En-Y Gastric Bypass Associated With Higher Adverse Events? Ann Surg 2014; 259:286-92. [DOI: 10.1097/sla.0000000000000227] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zwintscher NP, Azarow KS, Horton JD, Newton CR, Martin MJ. The increasing incidence of adolescent bariatric surgery. J Pediatr Surg 2013; 48:2401-7. [PMID: 24314178 DOI: 10.1016/j.jpedsurg.2013.08.015] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 08/26/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Morbid obesity continues to be a significant problem within the United States, as overweight/obesity rates are nearing 33%. Bariatric surgery has had success in treating obesity in adults and is becoming a viable treatment option for obese adolescents. METHODS We studied 1615 inpatient admissions for children ≤20 years of age undergoing a bariatric procedure for morbid obesity in 2009 using the Kids' Inpatient Database (KID). Patients had a principal diagnosis of obesity and a bariatric procedure listed as one of their first 5 procedures. Procedures (open gastric bypass, laparoscopic gastric bypass, sleeve gastrectomy, laparoscopic gastroplasty, and laparoscopic gastric band) and complications were defined by ICD-9 codes. RESULTS There were 90 open gastric bypasses, 906 laparoscopic gastric bypasses, 150 sleeve gastrectomies, 18 laparoscopic gastroplasties, and 445 laparoscopic gastric bandings. The length of stay for each procedure was 2.44, 2.20, 2.33, 1.10, and 1.02 days, respectively (P<0.001). The complication rates were 3.3%, 3.5%, 0.7%, 0.0%, 0.2%, respectively (P=0.004). CONCLUSIONS Bariatric surgery is an increasingly utilized option for the treatment of morbid obesity among adolescents. The procedures can be performed safely as evidenced by low complication rates. Additional long-term follow-up is necessary.
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Elli EF, Masrur MA, El Zaeedi M, Galvani CA, Bozorgui N, Giulianotti PC. Four-year experience with outpatient laparoscopic adjustable gastric banding. Surg Obes Relat Dis 2013; 9:693-5. [DOI: 10.1016/j.soard.2012.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 06/21/2012] [Accepted: 08/28/2012] [Indexed: 11/17/2022]
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Rodarte-Shade M, Barrera GT, Arredondo JFH, Diaz RR. Hybrid technique for removal of eroded adjustable gastric band. JSLS 2013; 17:338-41. [PMID: 23925033 PMCID: PMC3771806 DOI: 10.4293/108680813x13654754534279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A hybrid technique of laparoscopy and endoscopy can be successful in removal of eroded gastric bands. Background: Intragastric migration is a late and rare postsurgical complication in patients with gastric band placement. Gastric band erosion rate has previously been described to be 1.46%. In this report, we present the case of a 43-y-old male with gastric band erosion undergoing a laparoendoscopic retrieval of the gastric band, due to intragastric migration. Method: A hybrid procedure was performed to retrieve the gastric band. A laparoscopic approach was initially used to extract the connecting tube. Endoscopy was then performed to cut the gastric band with a specific cutter system and was subsequently extracted transorally. Results: The postoperative course was uneventful. Clear liquids were started on day 1, and the patient was discharged on day 2. Discussion: The purpose of this study was to describe a hybrid technique for the removal of an eroded gastric band, as a safe and feasible option in patients with band erosions. Conclusion: The laparoscopic approach enables safe extraction of the connecting tube, while endoscopy allows extraction of the band without creating a large incision in the stomach.
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Affiliation(s)
- Mario Rodarte-Shade
- Department of Surgery, Instituto Tecnologico y de Estudios Superiores de Monterrey, Mexico.
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Outpatient laparoscopic sleeve gastrectomy in a free-standing ambulatory surgery center: first 250 cases. Surg Obes Relat Dis 2013; 10:101-5. [PMID: 24094869 DOI: 10.1016/j.soard.2013.07.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 06/13/2013] [Accepted: 07/10/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND A growing body of evidence supports the laparoscopic sleeve gastrectomy (LSG) as a safe and effective procedure for sustained weight loss and amelioration of weight-related co-morbidities. Procedures performed in ambulatory surgery centers (ASC) can provide several advantages over hospital-based surgery. We present our results of 250 consecutive patients undergoing LSG in an ASC. The objective of this study was to assess the safety and efficacy of outpatient LSG in a freestanding ASC. METHODS Data was collected prospectively from 250 consecutive patients who underwent LSG at a freestanding ASC. Patients were excluded from the ASC if they weighed>450 pounds, if anticipated operative time was>2 hours, if the patient had impaired mobility limiting early ambulation, or if there were medical problems requiring postoperative monitoring beyond 23 hours. Revisions were not included in this study. RESULTS Mean age was 47 years (range, 23-74 yr). Mean preoperative body mass index (BMI) was 43 kg/m² (29-71 kg/m²). Mean operative time was 60 minutes (31-161 min). Mean recovery room time was 131 minutes (30-385 min). Mean percent excess weight loss (%EWL) was 60% at 1 year and 63% at 2 years. Nine patients (3.6%) were readmitted within 30 days. Two patients (.8%) were transferred from the ASC to a hospital. There was 1 staple line leak (.4%). There were no open conversions and no deaths. CONCLUSIONS LSG can be performed safely in a freestanding ASC in select patients with outcomes comparable to the inpatient standard. Additional studies are needed to formulate selection criteria and guidelines to maximize patient safety and outcomes.
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Elliott JA, Patel VM, Kirresh A, Ashrafian H, Le Roux CW, Olbers T, Athanasiou T, Zacharakis E. Fast-track laparoscopic bariatric surgery: a systematic review. Updates Surg 2013; 65:85-94. [PMID: 23371325 DOI: 10.1007/s13304-012-0195-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 12/18/2012] [Indexed: 02/06/2023]
Abstract
This study aimed to systematically evaluate the evidence-based literature on fast-track laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB) to determine the feasibility and safety of fast-track laparoscopic bariatric surgery. A literature search of PubMed, EMBASE and Cochrane Library using the MeSH terms "bariatric surgery", "ambulatory surgical procedures" and related terms as keywords was performed. The study included articles that reported on intended next-day discharge for LRYGB and same-day discharge for LAGB. Data were extracted on study design and size, patient demographics, patient-selection criteria, patient preparation, perioperative management, operative details, clinical outcomes, and follow-up. The review included 13 studies classified as level 3b or 4 evidence. There were seven studies that investigated LAGB, five studies investigated LRYGB and one study detailed outcomes from both LRYGB and LAGB. Next-day discharge rate ranged from 81 to 100 % for LRYGB. Same-day discharge rate ranged from 76 to 98 % for LAGB. In LRYGB and LAGB complication, re-admission and mortality rates (≤10.5, ≤7.5, ≤0.1 %, respectively) were comparable with the conventional perioperative care. From our results, the fast-track management of patients undergoing LRYGB and LAGB is feasible. With careful patient selection and preparation within high-volume centres, and application of care pathways including close outpatient follow-up, outcomes for fast-track bariatric procedures can compare favourably with those reported in the literature for standard management, but with decreased cost. However, further studies from independent researchers are required to determine the safety of a generalised adoption of this approach outside of dedicated bariatric units, and to formally demonstrate the cost-benefit of fast-track bariatric surgery.
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High Risks for Adverse Outcomes After Gastric Bypass Surgery Following Failed Gastric Banding. Ann Surg 2013; 257:279-86. [DOI: 10.1097/sla.0b013e3182683037] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Dixon JB, Straznicky NE, Lambert EA, Schlaich MP, Lambert GW. Laparoscopic Adjustable Gastric Banding and Other Devices for the Management of Obesity. Circulation 2012; 126:774-85. [DOI: 10.1161/circulationaha.111.040139] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- John B. Dixon
- From the Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Nora E. Straznicky
- From the Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | | | - Markus P. Schlaich
- From the Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Gavin W. Lambert
- From the Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
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Terranova L, Busetto L, Vestri A, Zappa MA. Bariatric surgery: cost-effectiveness and budget impact. Obes Surg 2012; 22:646-53. [PMID: 22290621 DOI: 10.1007/s11695-012-0608-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Bariatric surgery is to date the most effective treatment for morbid obesity and it has been proven to reduce obesity-related comorbidities and total mortality. As any medical treatment, bariatric surgery is costly and doubts about its affordability have been raised. On the other hand, bariatric surgery may reduce the direct and indirect costs of obesity and related comorbidities. The appreciation of the final balance between financial investments and savings is critical from a health economic perspective. In this paper, we try to provide a brief updated review of the most recent studies on the cost-efficacy of bariatric surgery, with particular emphasis on budget analysis. A brief overview of the economic costs of obesity will also be provided. The epidemic of obesity may cause a significant reduction in life expectancy and overwhelming direct and indirect costs for citizens and societies. Cost-efficacy analyses included in this review consistently demonstrated that the additional years of lives gained through bariatric surgery may be obtained at a reasonable and affordable cost. In groups of patients with very high obesity-related health costs, like patients with type 2 diabetes, the use of bariatric surgery required an initial economic investment, but may save money in a relatively short period of time.
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Affiliation(s)
- Lorenzo Terranova
- Federazione Italiana Aziende Sanitarie e Ospedaliere, Scuola di Specializzazione in Statistica Sanitaria, Università di Roma La Sapienza, Rome, Italy
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Single-incision and dual-incision laparoscopic adjustable gastric band: evaluation of initial experience. Surg Obes Relat Dis 2012; 8:194-200. [DOI: 10.1016/j.soard.2010.09.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 08/19/2010] [Accepted: 09/25/2010] [Indexed: 01/23/2023]
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De Waele B, Lauwers MH, Massaad D, De Vogelaere K, Delvaux G. Outpatient gastroplasty for morbid obesity: our first hundred cases. Obes Surg 2011; 20:1215-8. [PMID: 20405235 DOI: 10.1007/s11695-010-0157-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB) is a safe and effective treatment for morbid obesity. The aim of the present study was to identify factors actually contributing to the feasibility or to the failure of performing this procedure in an outpatient setting. METHODS In this prospective study, 100 ambulatory LAGB procedures were compared with 100 procedures performed in patients with an overnight stay. The recorded variables in both groups were first compared by univariate analysis. Logistic regressions were then calculated to analyse which of the variables were independently predictive. RESULTS The mean time lapse between the end of surgery and discharge from hospital was 8.33 h in the outpatient group and no patient required readmission. Independent risk factors affecting same-day discharge were increasing age of the patient, higher BMI and diabetes. Other variables such as patient's gender, duration of surgery, distance home-hospital, number of previous abdominal procedures and other comorbidities did not demonstrate statistical differences between the two study groups. CONCLUSION Gastric banding for the treatment of obesity can be safely performed in an outpatient setting. Advanced age, higher BMI and diabetes adversely affect same-day discharge and should be taken into consideration when planning an ambulatory LAGB.
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Affiliation(s)
- Boudewijn De Waele
- Department of Surgery, UZB University Hospital, Laarbeeklaan 101, 1090, Brussels, Belgium.
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Adjustable gastric banding outcomes with and without gastrogastric imbrication sutures: a randomized controlled trial. Surg Obes Relat Dis 2011; 7:23-31. [DOI: 10.1016/j.soard.2010.09.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Revised: 07/29/2010] [Accepted: 09/25/2010] [Indexed: 02/05/2023]
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Band slippage and erosion after laparoscopic gastric banding: a meta-analysis. Surg Endosc 2010; 24:2980-6. [DOI: 10.1007/s00464-010-1250-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 07/08/2010] [Indexed: 01/25/2023]
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Laparoscopic Gastric Banding Is Safe in Outpatient Surgical Centers. Obes Surg 2010; 20:415-22. [DOI: 10.1007/s11695-009-0065-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 12/15/2009] [Indexed: 10/20/2022]
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Favretti F, Ashton D, Busetto L, Segato G, De Luca M. The gastric band: first-choice procedure for obesity surgery. World J Surg 2009; 33:2039-48. [PMID: 19551427 DOI: 10.1007/s00268-009-0091-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The advent of laparoscopic adjustable gastric banding (LAGB) during the latter part of the 20th century represents a watershed in the management of chronic obesity. In this paper we provide an overview of LAGB with respect to its development, clinical outcomes, and future role. We also address current controversies, including a comparison of LAGB with Roux-en-Y gastric bypass (RYGBP). At present LAGB seems to be increasing in popularity in the United States, whereas in Europe there seems to be a trend away from gastric banding toward RYGBP. Optimal outcomes after LAGB are a function of correct laparoscopic technique, an experienced surgical team, a well-engineered device, and intensive long-term follow-up. The majority of studies show that LAGB is an extremely safe and effective procedure, with an operative mortality of 0-0.1% and excess weight loss (%EWL) of 50-60%. Commensurate with this degree of weight loss, almost all studies show substantial improvements in obesity-related co-morbidities, such as hypertension, type II diabetes, and dyslipidemia. In addition, LAGB has been shown to be both safe and effective in the super-obese, in adolescents, and in older patients and can be delivered as an ambulatory procedure. Operative mortality and early complication rates are significantly higher for RYGBP and, whilst gastric bypass results in greater weight loss than LAGB in the first 2 years, at 3 years and beyond the difference appears to be less marked. Overall, LAGB provides a safe, effective intervention for obese patients and remains our first-choice procedure for bariatric surgery.
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Affiliation(s)
- Franco Favretti
- Department of Surgery and Obesity Center, Regional Hospital, 36100, Vicenza, Italy
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Bewsher SM, Azzi A, Wright T. Use of standard hypodermic needles for accessing laparoscopic adjustable gastric band ports. Obes Surg 2009; 20:761-7. [PMID: 19730961 DOI: 10.1007/s11695-009-9945-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 08/10/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding is a common and successful method of surgically treating morbid obesity. A recipient will have to attend their surgeon's rooms a number of times to optimally adjust the amount of fluid in the band and hence the amount of restriction. Manufacturers suggest that the ports should be accessed with special non-coring needles that may not always be available in regional or remote centers, and this could create a safety risk in cases where urgent band deflation is required. METHODS Ports of two different brands were repeatedly accessed over 100 times in the same location while containing fluid under pressure, using a standard beveled 21 g hypodermic needle (SN) and a 20 g Huber tipped non-coring needle (NCN). The path the needles types took through the port septum was also examined. RESULTS There was no leakage of fluid from any of the ports tested. Neither SN nor NCN passed through the port septum down their axis, but rather in a direction closer to that of their beveled surface. CONCLUSIONS There is no more risk of "coring" the septum with a SN than with a NCN. SN can be used safely and routinely to access laparoscopic adjustable gastric band ports.
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