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Issue link: https://bariatrictimes.epubxp.com/i/69304
EXPERT COMMENTARY MAJOR FINDINGS This landmark systemic review of LSG published in 2009 demonstrates for the first time that the LSG can be performed safely all over the world with acceptable morbidity and good weight loss results in highly specialized centers of excellence. This paper has been a primary resource for insurance companies and single-payer countries to adopt this procedure as a standard of care for populations with morbid obesity for which they care. STUDY LIMITATIONS This paper also illustrates the problems with most surgical review papers in that they all rely heavily on case series and not randomized trials. In this case, 33 of the 36 papers reviewed were case series. Case series, while valuable, are an inherently flawed way of projecting systemic effects of a certain procedure. Systematic reviews such as this one can magnify those flaws. REMAINING QUESTIONS TO BE ADDRESSED The overall leak rate was high in both groups when compared to centers of excellence worldwide that perform gastric bypass surgery. The question of why a procedure that is technically simpler to perform and has fewer anastomoses has a higher leak rate is a serious concern for surgeons who do not perform this procedure. The comorbidity resolution of studies included in this paper varied wildly. T2DM was reported to have resolved in 100% in one study and 14% in another. These numbers are too dissimilar to be taken seriously. Before this procedure is accepted as treatment for certain comorbid conditions, these vast differences need to be reconciled. The authors feel that the large variations in weight loss were due to learning curves and procedural techniques (33–85% EWL). This may be true but we need far more evidence to be sure that there is not some other confounding variable. WHY IS THIS STUDY IMPORTANT TO THE FIELD? This paper should be read by any surgeon thinking of doing LSG. The findings should be shared with insurance companies, medical review boards, and primary care physicians to help set expectations for weight loss and complications related to this procedure. The low weight loss numbers reported in many studies should not be used for comparisons to a single surgeon's practice. Rather, the mean scores for all valid parameters viewed in this paper should be used as a benchmark for surgeons starting their sleeve practice. If surgeons are not at or above those benchmarks seen in this paper they should consider further training. DANIEL COTTAM, MD Director, Bariatric Medicine Institute, Salt Lake Regional Medical Center, Salt Lake City, Utah June 2012 • Supplement • Bariatric Times 17S