EXPERT COMMENTARY MAJOR FINDINGS
A major finding from this study is that the LSG has a morbidity profile that is intermediate compared to the LAGB and the laparoscopic RYGB. LSG can now be considered as an option for a wide range of patients who previously may not have been candidates for weight loss surgery due to increased device-related risks from a LAGB or increased intestinal bypass risk from a RYGB. For instance, patients dependent on anti- inflammatory medications might be denied surgery due to the increased incidence of ulcers that may occur with a RYGB or LAGB. LSG is a good alternative
operation for transplant patients who need to take and absorb their transplant medications, which may be difficult to do with an intestinal bypass. Patients with Crohn's disease generally cannot undergo an intestinal bypass procedure but an LSG may be offered.
Patients on anticoagulants are ideal for LSG as the entire stomach can still be viewed endoscopically and the risk of bleeding ulcers is very
low compared to an intestinal bypass procedure. Finally, the LSG procedure is an excellent option for the lower risk, lower BMI patients who would not want to consider the more complex RYGB and may only be considering a LAGB. Now, they can consider a LSG as an alternative to the LAGB.
LIMITATIONS In this study, the number of LSG patients was small compared to the other procedures that were evaluated. This study does not offer information regarding the technical variation or standardization of the LSG procedure. Further, the length of follow up is limited.
WHY IS THIS STUDY IMPORTANT TO THE FIELD?
This is a fantastic study because it shows that we now have LSG as an alternative procedure for patients concerned about a foreign body with the LAGB and the gastrointestinal issues associated with the RYGB.
WHAT SHOULD YOU DO WITH THESE DATA AND THESE FINDINGS?
This study presents further evidence to surgeons that the LSG is a very effective procedure with low morbidity. If they have not done so already, surgeons should consider introducing and offering LSG into their practice. Before performing LSG, however, surgeons should receive proper training to ensure successful patient outcomes.
GREGG H. JOSSART, MD, FACS Director, Minimally Invasive Surgery, California Pacific Medical Center, San Francisco, California
June 2012 • Supplement • Bariatric Times 19S