title: Improved obesity reduction and co-morbidity resolution in patients treated with 40-French bougie versus 50-French bougie four years after laparoscopic sleeve gastrectomy. Analysis of 294 patients.
abstract: BACKGROUND
  We compared percent excess body mass index loss (%EBMIL) and resolution of dyslipidaemia, hypertension, and type 2 diabetes mellitus in the 4 years following laparoscopic sleeve gastrectomy (LSG) between patients calibrated with a 40-French (40F) or a 50-French (50F) bougie.
  
  
  METHODS
  We conducted a longitudinal retrospective descriptive study of routinely collected pre- and post-surgical data from 294 patients who underwent LSG at a single surgical centre (50F--n = 106, 40F--n = 185). Obesity measurements were taken prior to surgery and at regular intervals until 48 months post-surgery. Co-morbidity resolution was also assessed across the 48-month observation period. Multivariate regression modelling was used to control analyses for baseline obesity and sociodemographic variables.
  
  
  RESULTS
  At 48 months post-surgery mean (±SD) %EBMIL was 60.2 ± 27.6% and 45.4 ± 38.4% for those treated with the 40F and 50F bougie, respectively. After controlling for sociodemographic variables and baseline excess weight, mean %EBMIL was 15.5% greater with a 40F bougie compared with a 50F bougie at the end of follow-up. The likelihood of dyslipidaemia resolution within 48 months post-LSG was 19.0 times greater (p = 0.006), hypertension resolution 3.6 times greater (p = 0.005) and type 2 diabetes mellitus resolution 5.2 times greater (p = 0.034) by 4 years post-surgery in patients treated with the 40F bougie compared with a 50F bougie.
  
  
  CONCLUSIONS
  Improved obesity reduction and resolution of dyslipidaemia, hypertension and type 2 diabetes mellitus is experienced during the 4 years following surgery by patients treated with a 40F bougie compared with the 50F. These findings remain when controlling for potential confounding clinical and sociodemographic factors.
authors.affiliation: Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, Australia. eatkins@meddent.uwa.edu.au
authors.forename: Emily R
authors.initials: ER
authors.lastname: Atkins
authors.forename: David B
authors.initials: DB
authors.lastname: Preen
authors.forename: Catherine
authors.initials: C
authors.lastname: Jarman
authors.forename: Leon D
authors.initials: LD
authors.lastname: Cohen
mesh_terms: D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000295:instrumentation*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000601:surgery; D010535:Laparoscopy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000601:surgery; D012189:Retrospective Studies; D013523:Surgical Equipment; D016896:Treatment Outcome; D015431:Weight Loss