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Laparoscopic vertical sleeve gastrectomy: A 5-year veterans affairs review.

Abstract The aim of this study was to evaluate the outcomes after laparoscopic sleeve gastrectomy (SG) in a VA population.SG has recently gained popularity as a definitive bariatric surgery procedure. Data are lacking on long-term outcomes, particularly in a Veterans Affairs population.We retrospectively reviewed 223 patients who underwent SG for morbid obesity between January 2009 and June 2014. Data on length of stay, complications, interval weight loss, comorbidities, and number of therapies preoperatively and at long-term follow-up were collected.There were 164 males and 59 females who underwent SG. The mean body mass index was 45.4 kg/m. Mean excess weight loss at 1 year was 62.9%, and 47.0% at 5 years. Weight loss continued until 12 to 18 months, when there was a nadir in weight loss (P < .001). There were 4 deaths and 4 staple-line leaks, with 3 deaths related to late cardiac events. One early death occurred in a very high-risk patient. All staple-line leaks were managed nonoperatively. Of the 223 patients, 193 had hypertension, 137 diabetes, 158 hyperlipidemia, 119 obstructive sleep apnea (OSA), and 125 had gastroesophageal reflux disease. Preoperatively, patients were on a mean of 1.9 antihypertensive and 0.9 hyperlipidemic, anti-reflux and oral hypoglycemic agents. Fifty percent of patients with diabetes were on insulin and 68% with OSA used continuous positive airway pressure/bilevel positive airway pressure (CPAP/BiPAP). We found significant absolute reductions in mean antihypertensive medications (-0.8), hyperlipidemic agents (-0.4), antireflux agents (-0.4), oral hypoglycemics (-0.6), insulin use (-25%), and use of CPAP/BiPAP (-55%) (all P < .001).Laparoscopic sleeve gastrectomy is a safe and effective bariatric surgery procedure, resulting in significant early weight loss up to 18 months and long-term improvement in all major obesity-related comorbid conditions.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28858079
OWN - NLM
STAT- MEDLINE
DA  - 20170831
DCOM- 20170911
LR  - 20170912
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 35
DP  - 2017 Sep
TI  - Laparoscopic vertical sleeve gastrectomy: A 5-year veterans affairs review.
PG  - e7508
LID - 10.1097/MD.0000000000007508 [doi]
AB  - The aim of this study was to evaluate the outcomes after laparoscopic sleeve
      gastrectomy (SG) in a VA population.SG has recently gained popularity as a
      definitive bariatric surgery procedure. Data are lacking on long-term outcomes,
      particularly in a Veterans Affairs population.We retrospectively reviewed 223
      patients who underwent SG for morbid obesity between January 2009 and June 2014. 
      Data on length of stay, complications, interval weight loss, comorbidities, and
      number of therapies preoperatively and at long-term follow-up were
      collected.There were 164 males and 59 females who underwent SG. The mean body
      mass index was 45.4 kg/m. Mean excess weight loss at 1 year was 62.9%, and 47.0% 
      at 5 years. Weight loss continued until 12 to 18 months, when there was a nadir
      in weight loss (P &lt; .001). There were 4 deaths and 4 staple-line leaks, with 3
      deaths related to late cardiac events. One early death occurred in a very
      high-risk patient. All staple-line leaks were managed nonoperatively. Of the 223 
      patients, 193 had hypertension, 137 diabetes, 158 hyperlipidemia, 119 obstructive
      sleep apnea (OSA), and 125 had gastroesophageal reflux disease. Preoperatively,
      patients were on a mean of 1.9 antihypertensive and 0.9 hyperlipidemic,
      anti-reflux and oral hypoglycemic agents. Fifty percent of patients with diabetes
      were on insulin and 68% with OSA used continuous positive airway pressure/bilevel
      positive airway pressure (CPAP/BiPAP). We found significant absolute reductions
      in mean antihypertensive medications (-0.8), hyperlipidemic agents (-0.4),
      antireflux agents (-0.4), oral hypoglycemics (-0.6), insulin use (-25%), and use 
      of CPAP/BiPAP (-55%) (all P &lt; .001).Laparoscopic sleeve gastrectomy is a safe and
      effective bariatric surgery procedure, resulting in significant early weight loss
      up to 18 months and long-term improvement in all major obesity-related comorbid
      conditions.
FAU - Barry, Rahman G
AU  - Barry RG
AD  - aDepartment of Surgery, Marshall University bDepartment of Surgery, Huntington
      Veterans Affairs Medical Center, Huntington, WV.
FAU - Amiri, Farzad A
AU  - Amiri FA
FAU - Gress, Todd W
AU  - Gress TW
FAU - Nease, D Blaine
AU  - Nease DB
FAU - Canterbury, Timothy D
AU  - Canterbury TD
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Female
MH  - Gastrectomy/*methods
MH  - Humans
MH  - Laparoscopy/*methods
MH  - Male
MH  - Middle Aged
MH  - Obesity, Morbid/*surgery
MH  - Postoperative Complications/*epidemiology/etiology
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - United States/epidemiology
MH  - United States Department of Veterans Affairs
MH  - Veterans/*statistics &amp; numerical data
MH  - Weight Loss
PMC - PMC5585473
EDAT- 2017/09/01 06:00
MHDA- 2017/09/12 06:00
CRDT- 2017/09/01 06:00
AID - 10.1097/MD.0000000000007508 [doi]
AID - 00005792-201709010-00003 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Sep;96(35):e7508. doi: 10.1097/MD.0000000000007508.