title: Laparoscopic sleeve gastrectomy without over-sewing of the staple line is effective and safe.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) is a bariatric procedure with very good long-term weight-reducing and metabolic effects.
  
  
  OBJECTIVE
  Here we report 6 years' experience with LSG performed in morbidly obese patients by one surgical team focusing on the impact of the degree of sleeve restriction and safety of the procedure without over-sewing the staple line.
  
  
  METHODS
  From 2006 to 2012, 207 morbid obese patients with average age of 43.4 years and average body mass index 44.9 kg/m(2) underwent LSG without over-sewing the staple line. The complete 5- and 3-year follow-up is recorded in 59 and 117 patients with prospective data collection at 3, 6, 9, 12, 18, 24, 36, 42 and 60 months after LSG. Group 1 patients operated in 2006-2008 had smaller sleeve restriction. Group 2 patients operated in 2009-2012 had major sleeve restriction. All procedures were performed without over-sewing of the staple line.
  
  
  RESULTS
  The average %EBMIL (excess body mass index loss) in group 1 patients with minor sleeve restriction reached 54.1% and average %EWL (excess weight loss) was 50.8% while in group 2 with major sleeve restriction the average %EBMIL reached 69.7% and average %EWL was 66.8%. Final weight reduction was significantly higher in group 2 patients compared to group 1 patients with smaller sleeve restriction. Out of 49 patients with preoperatively diagnosed T2DM (type 2 diabetes mellitus) was completely resolved in 70.8%. Pre-operatively diagnosed hypertension normalized in 64.2%, improved in 23.2%, and remained unchanged in 12.6% of patients.
  
  
  CONCLUSIONS
  Carefully performed LSG without over-sewing the staple line is feasible and safe. A better weight-reducing effect was present in patients with major sleeve restriction.
authors.affiliation: 2 Medical Faculty of Charles University and Central Military Hospital, Prague, Czech Republic ; Faculty of Health Care and Social Work, Trnava University, Trnava, Slovak Republic.
authors.forename: Mojmir
authors.initials: M
authors.lastname: Kasalicky
authors.affiliation: 2 Medical Faculty of Charles University and Central Military Hospital, Prague, Czech Republic.
authors.forename: Radek
authors.initials: R
authors.lastname: Dolezel
authors.affiliation: 2 Medical Faculty of Charles University and Central Military Hospital, Prague, Czech Republic.
authors.forename: Eva
authors.initials: E
authors.lastname: Vernerova
authors.affiliation: 3 Internal Department General Faculty Hospital, 1 Medical Faculty of Charles University, Prague, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Haluzik
keywords: diabetes; laparoscopic sleeve gastrectomy; morbid obesity; staple line
references.citation: Obes Surg. 2003 Feb;13(1):10-6
references.pmid: 12630607
references.citation: Obes Surg. 2007 Feb;17(2):260-70
references.pmid: 17476884
references.citation: Obes Surg. 2007 Aug;17(8):1069-74
references.pmid: 17953241
references.citation: Perm J. 2010 Fall;14(3):57-62
references.pmid: 20844706
references.citation: Obes Surg. 2011 Jun;21(6):738-43
references.pmid: 21468625
references.citation: Obes Surg. 2011 Sep;21(9):1432-7
references.pmid: 21611877
references.citation: Am J Med. 2009 Mar;122(3):248-256.e5
references.pmid: 19272486
references.citation: Obes Surg. 1998 Jun;8(3):267-82
references.pmid: 9678194
references.citation: Obes Surg. 2008 Oct;18(10):1257-62
references.pmid: 18649114
references.citation: Obes Surg. 2006 Sep;16(9):1138-44
references.pmid: 16989696
references.citation: Obes Surg. 2006 Nov;16(11):1450-6
references.pmid: 17132410
references.citation: Wideochir Inne Tech Maloinwazyjne. 2012 Dec;7(4):251-9
references.pmid: 23362424
references.citation: Wideochir Inne Tech Maloinwazyjne. 2013 Mar;8(1):22-8
references.pmid: 23630550
references.citation: Br J Surg. 2011 Oct;98(10):1339-41
references.pmid: 21751182
references.citation: Obes Surg. 2007 Oct;17(10):1297-305
references.pmid: 18098398
references.citation: Surg Endosc. 2011 Nov;25(11):3540-50
references.pmid: 21638183
references.citation: Obes Surg. 2008 Oct;18(10):1251-6
references.pmid: 18663545
references.citation: Obes Surg. 2005 Aug;15(7):1024-9
references.pmid: 16105401
references.citation: Obes Surg. 2009 Feb;19(2):166-172
references.pmid: 18795383
references.citation: Obes Surg. 2012 Jan;22(1):13-22
references.pmid: 21986646
references.citation: Rozhl Chir. 2007 Nov;86(11):601-6
references.pmid: 18214146
references.citation: Obes Surg. 2011 Dec;21(12):1843-8
references.pmid: 21491136
references.citation: Surg Endosc. 2011 Feb;25(2):444-9
references.pmid: 20607564
references.citation: Obes Surg. 2007 Jul;17(7):962-9
references.pmid: 17894158