title: Laparoscopic reinforced sleeve gastrectomy: early results and complications.
abstract: BACKGROUND
  Sleeve gastrectomy (SG) was pioneered as a two-stage intervention for super and super-super obesity to minimize morbidity and mortality; it is employed increasingly as a primary procedure. Early outcomes and integrity of laparoscopic SG (LSG) against leak using a technique incorporating gastric transection-line reinforcement were studied.
  
  
  METHODS
  Between 2003 and 2009, 121 patients underwent LSG (16, two-stage; 105, primary). Of the patients, 66% were women, mean age 38.8 ± 10.9 (15.0-64.0), and body mass index (BMI, kg/m(2)) 48.7 ± 9.3 (33.7-74.8). Bovine pericardium (Peri-Strips Dry [PSD]) was used to reinforce the staple line. Parametric and nonparametric tests were used, as appropriate. The paired t test was used to assess change from baseline; bivariate analyses and logistic regression were used to identify preoperative patient characteristics predictive of suboptimal weight loss.
  
  
  RESULTS
  Mean operative time was 105 min (95-180), and mean hospitalization was 5.6 days (1-14). There was no mortality. There were 6 (5.0%) complications: 1 intraoperative leak, 1 stricture, 1 trocar-site bleed, 1 renal failure, and 2 wound infections. There were no postoperative staple-line leaks. Following 15 concomitant hiatal hernia operations, 3 (20%) recurred: 1 revised to RYGB and 2 in standby. Two post-LSG hiatal hernias of the two-stage series required revisions because of symptoms. BMI decreased 24.7% at 6 months (n = 55) to 37.5 ± 9.3 (22.2-58.1); %EWL was 48.1 ± 19.3 (15.5-98.9). Twelve-month BMI (n = 41) was 38.4 ± 10.5 (19.3-62.3); %EWL was 51.7 ± 25.0 (8.9-123.3). Forty-eight-month BMI (n = 13) was 35.6 ± 6.8 (24.9-47.5); %EWL was 61.1 ± 12.2 (43.9-82.1) (p < 0.001). Preoperative BMI was predictive of >70% of patients who experienced <50% EWL at 6 months. At 2 weeks, 100% of type 2 diabetes patients (n = 23) were off medication (mean HbA(1C), 5.9 ± 0.5%; glycemia, 90.0 ± 19.9 mg/dL (p < 0.01) at 3 months).
  
  
  CONCLUSIONS
  Laparoscopic PSD-reinforced LSG as a staged or definitive procedure is safe and effective in the short term and provides rapid type 2 diabetes mellitus reduction with a very low rate of complications.
authors.affiliation: General and Laparoscopic Surgery Unit, San Giovanni Bosco Hospital, Naples, Italy. luigiangrisani@chirurgiaobesita.it
authors.forename: Luigi
authors.initials: L
authors.lastname: Angrisani
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Cutolo
authors.forename: Jane N
authors.initials: JN
authors.lastname: Buchwald
authors.forename: Tim W
authors.initials: TW
authors.lastname: McGlennon
authors.forename: Gabriella
authors.initials: G
authors.lastname: Nosso
authors.forename: Francesco
authors.initials: F
authors.lastname: Persico
authors.forename: Brunella
authors.initials: B
authors.lastname: Capaldo
authors.forename: Silvia
authors.initials: S
authors.lastname: Savastano
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult