Age is not associated with increased surgical complications in patients after laparoscopic sleeve gastrectomy

The hundred most frequently cited studies on sleeve gastrectomy

INTRODUCTION

Sleeve gastrectomy (SG) is one of the most popular bariatric operations and one of the most frequently studied areas in bariatric surgery.

AIM

To summarise the characteristics of the most frequently cited studies focusing on SG.

MATERIAL AND METHODS

We used the Web of Science database to identify all studies focused on SG published from 2000 to 2018. The term "sleeve gastrectomy" and synonyms were used to reveal the 100 most cited records.

RESULTS

The most frequently cited publication had 493 citations. The highest mean number of citations per year was 73.00. Studies were most frequently published in the years 2010 and 2012. Articles were most commonly published in bariatric surgery-oriented journals.

CONCLUSIONS

Our study indicates an increase in medical researchers' interest in the subject of SG and underlines the need to perform studies with a higher level of evidence to further analyse the outcomes and basic science behind SG.

Outcomes of sleeve gastrectomy in patients older than 60 years: a multicenter matched case-control study

INTRODUCTION

The prevalence of obesity is increasing according to the World Health Organization. Furthermore, global aging is increasing, especially in developed countries in Europe. Whether bariatric surgery should be performed in elderly people is still controversial.

AIM

To determine the clinical outcomes of sleeve gastrectomies (SG) in older central European patients. We compared the safety and efficacy of SG in patients older than 60 years with younger patients.

MATERIAL AND METHODS

Eighty-nine patients older than 60 years, who underwent SG, were included in the study. Eighty-nine younger patients (aged 18-40 years) were matched according to body mass index (BMI) and comorbidities. The analyzed data included age, sex, total body weight, BMI, length of hospital stay, 30-day complications and improvement in comorbidities.

RESULTS

There was no significant difference in the complication rate between the 2 age groups (p = 0.59). An improvement in hypertension was observed in 73.1% of older patients and in 69.2% of younger patients (p = 0.67). There was improvement in diabetes mellitus in 40% of older patients and in 31.1% of younger patients (p = 0.25). The ΔBMI after 12, 24 and 36 months was significantly lower in older patients than in younger patients (p = 0.002, p = 0.001; p = 0.043, respectively). Percent excess BMI loss (%EBMIL) after 12, 24, and 60 months was significantly lower in older than in younger patients (p = 0.001, p = 0.001, p = 0.028, respectively).

CONCLUSIONS

Better weight loss is achieved in younger than in older patients, while maintaining a similar effect on the risk of complications and improvement in comorbidities. Therefore, SG is safe and effective in older people.

Setting realistic expectations for weight loss after laparoscopic sleeve gastrectomy

Introduction

Despite the clinical benefits of bariatric surgery, some patients have experienced disappointment with their weight loss. Setting realistic expectations is the key to success.

Aim

To develop a specific prediction calculator to estimate the expected body mass index (BMI) at 1 year after laparoscopic sleeve gastrectomy (LSG).

Material and methods

A retrospective analysis was performed to study 211 patients after primary LSG. Nine baseline variables were analyzed. Least angle regression (LARS) was employed for variable selection and to build the predictive model. External validation was performed on a dataset of 184 patients. To test the accuracy of the model, a Wilcoxon signed-rank test was performed between BMI estimates and the observed BMI. A linear logistic equation was used to construct the online predictive calculator.

Results

The model included three variables – preoperative BMI (β = 0.023, p < 0.001), age (β = 0.005, p < 0.001), and female gender (β = 0.116, p = 0.001) – and demonstrated good discrimination (R² = 0.672; adjusted R² = 0.664) and good accuracy (root mean squared error of estimate, RMSE = 0.124). The difference between the observed BMI and the estimated BMI was not statistically significant (median = 0.737 (–2.676, 3.254); p = 0.223). External validation confirmed good performance of the model.

Conclusions

The study revealed a useful predictive model for estimating BMI at 1 year after LSG. The model was used for development of the PREDICT BMI calculator. This tool allows one to set realistic expectations of weight loss at one year after LSG.

Postoperative nausea and vomiting in bariatric surgery in comparison to non-bariatric gastric surgery

Introduction

Postoperative nausea and vomiting (PONV) are complications of general anesthesia. Patient-specific factors, type of surgery and a variety of drugs determine the frequency. Clinical experience shows nausea and vomiting to be very frequent in morbidly obese patients undergoing bariatric surgery.

Aim

To detect the onset and extent of nausea and vomiting in the group of morbidly obese patients undergoing laparoscopic bariatric surgery.

Material and methods

We conducted a retrospective data bank analysis (since 2004) of all patients with body mass index > 35 kg/m² undergoing laparoscopic bariatric surgery in comparison to patients with a body mass index < 35 kg/m² undergoing gastric surgery. Propensity score matching was applied to minimize bias effects. The frequency of postoperative nausea was defined as the primary outcome parameter.

Results

One hundred and thirty-eight patients were included. There was a significant difference between the morbidly obese group and the control group concerning the frequency of postoperative nausea (15.9% vs. 55.1%; p < 0.001). In patients receiving volatile anesthetics a significant difference between groups concerning frequency of PONV was not observed. Intravenous anesthetics were suitable to reduce PONV in the control group but not in the morbidly obese group (12.5% vs. 56.8%, p < 0.001). With given prophylaxis PONV events still occurred in 15.6% vs. 48.8% (p = 0.003).

Conclusions

Morbidly obese patients undergoing laparoscopic bariatric surgery are at higher risk of suffering from PONV than non-morbidly obese patients. To reduce the PONV incidence in morbidly obese patients, further research, especially focusing on more efficient use of antiemetic drugs, seems to be necessary.

Comparison of effects of low-flow and normal-flow anesthesia on cerebral oxygenation and bispectral index in morbidly obese patients undergoing laparoscopic sleeve gastrectomy: a prospective, randomized clinical trial

Introduction

The effects of low-flow anesthesia on cerebral oxygenation in high-risk, morbidly obese patients are not well known.

Aim

In this prospective randomized study, we compared the effects of low-flow (0.75 l/min) and normal-flow (1.5 l/min) anesthesia on regional cerebral oxygen saturation (rSO₂) and the bispectral index (BIS) in morbidly obese patients undergoing laparoscopic bariatric surgery.

Material and methods

Fifty-two morbidly obese patients undergoing laparoscopic bariatric surgery (sleeve gastrectomy) were enrolled in this study. Patients were randomly allocated to two study groups: low-flow and normal-flow anesthesia groups. Heart rate, mean arterial pressure, peripheral oxygen saturation, end-tidal carbon dioxide, BIS, left and right rSO₂, and duration of anesthesia and surgery were recorded.

Results

The groups were similar with respect to age, gender, height, weight, body mass index, American Society of Anesthesiology physical status, heart rate, duration of anesthesia, and procedure. Mean arterial pressure and end-tidal carbon dioxide, both before and after insufflation of carbon dioxide and after the reverse Trendelenburg position, were significantly higher in the low-flow group. BIS values and left and right rSO₂ during the preoperative and intraoperative periods were similar. Although the difference in right rSO₂ between the two groups after awakening from anesthesia was statistically significant, the results of both groups remained within the normal range and were not clinically meaningful.

Conclusions

Low-flow anesthesia is safe regarding hemodynamic and respiratory characteristics, depth of anesthesia, and regional cerebral oxygen saturation in morbidly obese patients undergoing laparoscopic bariatric surgery.