title: Midterm results of primary vs. secondary laparoscopic sleeve gastrectomy (LSG) as an isolated operation.
abstract: BACKGROUND
  We investigated early and midterm results of laparoscopic sleeve gastrectomy (LSG) as an isolated primary and secondary operation after failed gastric banding.
  
  
  METHODS
  Between May 2004 and October 2007, a total of 70 patients (female 77%, mean age 43 (21-65) years, mean initial body mass index (BMI) 46 (35-61) kg/m(2)) were prospectively evaluated and operated by LSG. In 41 patients, LSG was performed as a primary operation (group 1) and in 29 patients as a secondary procedure after failed gastric banding (group 2). The overall average follow-up time after LSG was 24 (12-53) months; follow-up rate 1 year after operation was 100%, after 2 years 98%, and after 3 years 95%.
  
  
  RESULTS
  There were no intraoperative complications, no conversion with shorter operation time in group 1 (91 vs. 132 min, p = 0.001). Early morbidity of LSG was 5% (major) and 7% (minor); mortality was zero. Average excessive BMI loss after 1 year was 65% (9-127%), after 2 years 63% (13-123%), and after 3 years 60% (9-111%). Midterm morbidity was 13%. There was no significant difference between the two groups regarding early and midterm morbidity, reoperation rate for complications (11.4%), or insufficient weight loss (7%).
  
  
  CONCLUSIONS
  LSG is a safe bariatric procedure with good weight loss in the first 3 years postop. It can be used as an isolated initial treatment and as a secondary treatment after failed gastric banding. However, in the absence of long-term results, we suggest LSG to be performed only in controlled trials.
authors.affiliation: Department of Surgery, Claraspital, Kleinriehenstrasse 30, 4016, Basel, Switzerland.
authors.forename: Bettina
authors.initials: B
authors.lastname: Uglioni
authors.forename: Bettina
authors.initials: B
authors.lastname: Wölnerhanssen
authors.forename: Thomas
authors.initials: T
authors.lastname: Peters
authors.forename: Caroline
authors.initials: C
authors.lastname: Christoffel-Courtin
authors.forename: Beatrice
authors.initials: B
authors.lastname: Kern
authors.forename: Ralph
authors.initials: R
authors.lastname: Peterli
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015391:Gastroplasty; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D012086:Reoperation; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult