Article 7
SYSTEMATIC REVIEW OF SLEEVE GASTRECTOMY AS STAGING AND PRIMARY BARIATRIC PROCEDURE
CITATION
Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5:469–475.
PURPOSE OF THE STUDY
The purpose of this review is to evaluate the efficacy of a sleeve gastrectomy (LSG) regarding weight loss, complication rates, postoperative mortality, and comorbidity improvement.
METHODS
A review of articles on LSG was performed using PubMed. Of the 3,098 citations identified, 2,968 citations did not meet inclusion criteria and were rejected. One- hundred and thirty studies were retrieved, but 92 were rejected due to the wrong population (children), duplicate patient groups, or wrong interventions. The remaining 38 studies were reviewed and included 2 Magenstrasse and Mill studies (uncontrolled) and 36 LSG studies (2 randomized, controlled, 1 nonrandomized, matched cohort analysis, and 33 uncontrolled case series).
The results of the 2 Magenstrasse and Mill procedures were not
RESULTS
• The LSG cases are separated into two groups: high-risk patients (13 studies, 821 patients) and primary procedure (24 cases, 1,749 patients) (Table 1).
• 24 studies reported an estimated weight loss of 33–85% with a mean of 55.4%.
• 26 studies reported mean postoperative BMI that decreased from a mean of 51.2kg/m2 37.1kg/m2
to .
• 10 studies with 1–5 years follow- up provided postoperative comorbidity data: 70% of patients had improvement or remission in type 2 diabetes mellitus (T2DM); and significant improvements
TABLE 1. Reproduced with permission. Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. SurgObes Relat Dis. 2009;5:469–475.
included in the LSG analysis; however, given the similarities between the two procedures, the results are included separately.
were seen in hypertension, hyperlipidemia, sleep apnea, and joint pain.
• The major postoperative complication rate ranged from 0–23.8%. For studies with n>100, the complication rate ranged from 0–15.3%. Thirty-three studies provided the following complication data: 53 leaks (2.2%); 28 bleeding episodes (1.2%); and 15 postoperative strictures (0.6%)
• 5 mortalities overall (0.19%) CONCLUSION
Based on the data reviewed from published articles, LSG is a safe and effective first-stage or primary procedure for weight loss. The procedure has sufficiently low complication and mortality rates and produces excellent results in weight loss and comorbidity reduction.
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Bariatric Times • June 2012 • Supplement