EARLY EXPERIENCE WITH A NOVEL PROCEDURE FOR OBESITY: LAPAROSCOPIC SLEEVE GASTRECTOMY

1

Department of General Surgery, Singapore General Hospital2

Department of Endocrinology, Singapore

General Hospital, Singapore
Ser Yee Lee1,2,Shanker Pasupathy 1,Kwang Wei

Tham2,Sonali

Ganguly2,Wai Keong Wong 1

BACKGROUND:Bariatric surgery offers the morbidly obese substantial and sustainable weight loss andreduction in obesity- related co-morbidities when other conservative treatments have failed.
Laparoscopic sleeve gastrectomy is a new restrictive procedure in bariatric surgery.
AIMS: To evaluate our experience with laparoscopic sleeve gastrectomy (LSG), a new bariatric surgicalprocedure, with regards to safety and feasibility of the procedure and early weight loss.
METHODS: All patients who underwent LSG were studied in terms of their complications and early clinicalresults.

Patients' clinical data were retrieved from a prospective database.

RESULTS: Twenty-three patients underwent laparoscopic sleeve gastrectomy between the period of December
2008 and June 2010 with a mean age of 38 years (Range: 23 - 64). The mean pre-operative weight was 112kg(range 78-170) and body mass index (BMI) 42.1kg/m2(33 - 60). Diabetes mellitus was present in 39%,
hypertension in 43% and hyperlipidemia in 35% of the patients. Majority of patients had two or moreobesity-related co-morbidities (52%). The stomach was tubularised over a 38French calibration tube using
endoscopic staplers. Mean operative time was 142 mins (80 - 220). There were no conversions. 1 patient
required re-laparoscopy on the 1st post-operative day for bleeding from the gastric staple line. Shesubsequently recovered well but developed a wound infection from one of the laparoscopic port sites.
There were no other morbidities. Median postoperative stay was 3 days (1-9). Mean weight 1, 3 and 6 months
post-operatively was 102, 90 and 79kg, a loss of 9, 20 and 30% respectively.
CONCULSION: Laparoscopic sleeve gastrectomy is a promising procedure for surgical treatment of obesitywith good early weight loss and low morbidity.

Introduction of laparoscopic vertical sleeve gastrectomy into bariatric practice

1John Flynn Private Hospital 2Bond University Medical School

William V. Braun1,Maree Kekeff2,Donna Tanchev2,Candice Silverman1,Laurent Layani1

Aim: LVSG has recently become popular as bariatric procedure, not only as first step in high risk or
superobese patients or in cases of failed restrictive operations, but mainly as a stand alone operationin morbidly obese. Our aim is to investigate safety, efficacy and consistency of LVSG in both weightloss and remission of patients comorbiditiesMethods: Retrospective and prospective analysis of all LVSG
performed at John Flynn private in Gold Coast from January 2008 until August 2010 was performed. Patients
telephone interviews were conducted to establish overall satisfaction with procedure and service Results:
106 LVSG were performed from January 2008 to August 2010. Male to female ratio to 1:1.1. Median age and
BMI were 47 (22 to 70), and 52 (35.5 to 81) respectively. 43 procedures were staged operations following
failed LGB (40) and open stapling gastroplasty (3). Mean operative time was 79 min (38 to 133 min). There
was no mortality. Postoperative complications included gastric leak (1), minor wound infection (4) andprolonged nausea (1). Median LOS was 2 (1 to 61 days). Follow-up was achieved in 97 patients (92%). MeanEWL was 69.1% (23 to 100%) at 6 to 12 months for primary VLSG and 38.5% (16.7 to 76.6) for staged operations.
Major comorbidities subsided. 93 (88%) patients provided their feed back over telephone with overallsatisfaction rate 100%Conclusions: LVSG is safe and efficacious procedure. It achieves excellent resultsin weight loss and sustainable short and midterm improvement of overall patients health. Serious
complications do however occur and pose high demands on care providers as well as patients and theirfamilies

Comparison Between the Results of Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-en-Y Gastric
Bypass for Morbid Versus Super Morbid Obesity

Yotsuya Medical Cube
Hideharu Shimizu, Yosuke Seki, Eri Kikkawa, Kazuko Sonoda, Tetsuya Nakazato, Kazunori Kasama

Background
Data on the effectiveness of laparoscopic sleeve gastrectomy (LSG) for super morbid obesity in patientswith body mass index (BMI) ≧50 are scarce. Whether LSG alone can replace laparoscopic Roux-en-Y Gastric
Bypass (LRYGB) as a standard bariatric procedure is questionable.

Methods
For this study, 129 morbidly obese patients who underwent LSG (68 patients) or LRYGB (61 patients) between
2006 and 2009 were retrospectively analyzed. We compared the weight loss effect of LSG to that of LRYGB
according to BMI.

Results
The percentage of excess weight loss (EWL) at the 1-, 3-, 6-, 12-, 24-month follow up points of the patients
who underwent LSG and LRYGB were comparable. According to BMI, The percentage of EWL of the patientswith an initial BMI≦35 in LSG (n=14) and LRYGB (n=11) group at 1-, 3-, 6-, 12-month follow up points
were 36.1 and 31.2, 74.2 and 70.8, 78.8 and 99.0, 92.7 and 89.1%, respectively. As for 35<BMI≦40, thepercentage in LSG (n=20) and LRYGB (n=25) group at the same follow up points were 40.7 and 23.7, 50.0
and 47.2, 64.7 and 69.0, 76.9 and 78.3, 83.6 and 85.6%, respectively.

As for 40<BMI≦50, the percentage

in LSG (n=20) and LRYGB (n=27) at the same follow up points were 22.6 and 20.4, 43.8 and 40.9, 72.5 and59.6, 80.5 and 75.2, 72.0 and 80.7%, respectively. There was no significant difference between bothgroups. However, the percentage of EWL of the patients with 50< initial BMI<60 in LSG (n=7) and LRYGB(n=5) group were 14.7 and 20.9 (P=0.21), 27.9 and 35.3 (P=0.14), 36.3 and 56.1%(P=0.04), 35.5 and 69.7%(P=0.01), 32.5 and 60.9% (P=0.02) at 1-, 3-, 6-, 12-, 24-month after operation. Compared with LSG, LRYGB
obtained better weight loss outcomes for super morbid obesity (50<BMI≦60).

Conclusions
LSG can be a standalone procedure for morbidly obese patients with BMI<50 as well as LRYGB, but LSG is
not expected to be performed as a solo procedure for the patients with BMI over 50.

Early results from a specialized Metabolic and Bariatric Surgery service

1Department of General Surgery, Singapore General Hospital 2Department of Anaesthesia and Surgical

Intensive Care, Singapore General Hospital 3Department of Endocrinology, Singapore General Hospital
Shanker Pasupathy1,Ruban Poopalalingam2,Daniel Wai3,Kwang Wei Tham3

BACKGROUND: Bariatric surgery is one of the most effective weight loss interventions for morbidly obese
individuals. However, surgery in morbidly obese patients involves potentially significant risk and should
be undertaken by specially trained teams.AIMS OF STUDY: The experience of a specialised metabolic andbariatric surgery service is described.METHODS: In 2008, a dedicated metabolic and bariatric surgery
service was set up at the Singapore General Hospital. Patients were managed according to a clinical pathway
which included pre-surgical evaluation, surgical admission and post-surgical follow-up.RESULTS: FromAugust 2008 to November 2010, 47 patients underwent bariatric surgery. The mean pre-operative weightwas 119 kg (range 78- 209) and body mass index (BMI) 44 kg/m2 (32.5-74). 21 patients had impaired glucose
tolerance or type 2 diabetes mellitus. 91% of patients had at least 1 major comorbidity (diabetes mellitus,hypertension, dyslipidaemia, obstructive sleep apnoea) . 37 patients underwent laparoscopic sleeve
gastrectomy, 9 laparoscopic gastric bypass and 1 laparoscopic bilio-pancreatic diversion. 3 patientsrequired re-operation for haemorrhage (two) and anastomotic leak (one) on the 1st post-operative day,and then recovered uneventfully. 1 patient with post-operative haemorrhage was managed conservatively
with blood transfusion only. There were no mortalities. Median length of stay was 4 days (3-14). The
mean absolute weight loss at 6 months was 27% (12-34). CONCLUSION: A multi-disciplinary approach improves
patient selection and optimization, resulting in improved clinical outcomes after bariatric surgery.

Laparoscopic Sleeve Gastrectomy with a BIB in situ for 14 months

1

Al Taie center for laparoscopic and Obesity surgery,Dubai,UAEAbdulsalam S. Al taie1

Introduction: Bioenteric Intragastric Balloon BIB is used to stay in the stomach for approximately 6months.its benefit as a sole procedure is questionable.It could be useful if used in a staged procedure
as a first step followed by a definitive bariatric surgery for high risk patients.patient and method:
In this video am presenting to you a 24 years old

gentleman 210 KG

with a BMI of 72 who had a BIB in

his stomach 14 months prior to our surgery.He had a trial of endoscopic removal of the balloon but

wasunsuccessful as the balloon was digested. We planned to remove the balloon in a novel technique,alongwith laparoscopic sleeve gastrectomy(LSG). we started by dividing the omentum on the greater
curvature,then dividing the stomach 3 cm from the doudenum along 36 Fr. calibration tube. Approaching
the mid stomach

after firing the 3rd 60 mm endo cartridge ,the balloon deflated and pulled into theresected stomach through a gastrostomy

made on that part,

part removed along with the BIB inside.results:

LSG completed as usual. then the resected

the aim is to show a novel technique of removal of BIB

that left for long time and was not possible to be taken out endoscopically.He did excellent

post

operative recovery and was dismissed home on the second post operative day . At the end of year one
following the surgery he lost a bout 75 KGs and his BMi dropped to 46 .conclusion: LSG
performed in patients with failed

can safely be

BIB , especially when they are left for longer than 6 months which

would be difficult to be removed endoscopically, it can be retrieved in such away that the resected stomachwould be used as a retrieval bag for that purpose.

Removal of stomach remnant after laparoscopic sleeve gastrectomy

1

Luton & Dunstable NHS Foundation Trust, Luton, UK

Kirsty R. Cattle1,Periyathambi S. Jambulingam1,Ravindra Date1

Removal of the remnant stomach after laparoscopic sleeve gastrectomy for obesity can be tricky without
enlarging the port site incision.

We therefore present a simple technique to facilitate the removalof the remnant stomach which does not involve additional equipment or expense.

Early Experience with Laparoscopic Roux-en-Y Gastric Bypass for Morbidly Obese patients

1

Department of General Surgery, Singapore General Hospital, Singapore 2Department of Endocrinology,Singapore General Hospital, Singapore
CH Lim1,S Pasupathy1,KW Tham2,S Ganguly2,WK Wong1

Objective: To evaluate the early outcome for laparoscopic Roux-en-Y gastric bypass in a new bariatric
surgical program in SingaporeMethods: A prospective pilot study of 9 patients who underwent laparoscopic
Roux-en-Y gastric bypass for obesity by a single surgeon at Singapore General Hospital between September
2008 to October 2010. The study endpoint included operative time, complications and hospital length ofstay. At one month post surgery, weight loss and HbA1c levels were recorded.

Results: Five males and4 females with median age of 39 years (range 30 to 60) were included in the study. Mean pre-operative
weight was 125.5kg (range 74kg to 170.7kg) with a mean pre-operative BMI of 45.9 (range 35.4 to 70).
All our patients had diabetes. In addition to diabetes, 8 out of 9 patients had at least one othersignificant medical co-morbidity related to obesity. The median operative time was 325 minutes (meanof 438 minutes for first 4 cases and 246 minutes for last 4 cases). There was no conversion. One patient
required a re-operation for anastomotic leak. Median hospital stay was 4 days (range 1 to 13) and theaverage weight loss was 13.3% at one month. The median pre-operative HbA1c was 8.6% (range 6.5 to 12.3)
and at one month, HbA1c levels reduced to 6.1% (range 5.2 to 8).Conclusions: Laparoscopic Roux-en-Y
gastric bypass is a technically challenging procedure that can be safely integrated into a bariatrictreatment program with early weight loss and improved diabetic control. With more experience, operative
time and length of stay decreased.