title: Laparoscopic sleeve gastrectomy for high-risk patients: weight loss and comorbidity improvement--short-term results.
abstract: BACKGROUND
  The obesity surgery mortality risk score (OS-MRS) is a five-point scoring system stratifying the risk of post-operative mortality. Patients with a body mass index (BMI) > 60 may also carry an increased risk of peri-operative complications. Laparoscopic sleeve gastrectomy (LSG) as an initial procedure could reduce weight and associated comorbidity allowing a safer, definitive second procedure. We investigated weight loss and risk reduction in patients having LSG as part of a planned two-stage definitive bariatric procedure.
  
  
  METHODS
  Patients with a high OS-MRS (4-5), males with BMI  > 60 or females with BMI  > 65, who underwent LSG were identified from a prospective database. Data were analysed by means of the Mann-Whitney U and Chi-squared test.
  
  
  RESULTS
  Sixty-eight patients underwent LSG. LSG reduced median BMI at 12 months (68 versus 54, P < 0.001) and the OS-MRS (3 versus 2, P = 0.005). An increase in patients considered low risk (OS-MRS, 0-1) was seen following LSG (35% versus 14%, P = 0.006). The proportion of patients with BMI < 50 increased from 0% to 30% (P < 0.001). Improvement or resolution of diabetes and hypertension was seen in 23% and 25% of cases, respectively.
  
  
  CONCLUSIONS
  LSG achieves good weight loss, reduces the OS-MRS and improves obesity-related comorbidity in high-risk surgical patients.
authors.affiliation: Gravitas, P.O. Box 3627, Bourne End SL85GQ, UK.
authors.forename: Conor J
authors.initials: CJ
authors.lastname: Magee
authors.forename: Jonathan
authors.initials: J
authors.lastname: Barry
authors.forename: Mayilone
authors.initials: M
authors.lastname: Arumugasamy
authors.forename: Shafiq
authors.initials: S
authors.lastname: Javed
authors.forename: Robert
authors.initials: R
authors.lastname: Macadam
authors.forename: David D
authors.initials: DD
authors.lastname: Kerrigan
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000601:surgery; D011028:Pneumoperitoneum, Artificial; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult