title: Analysis of Morbidity Data of 308 Cases of Laparoscopic Sleeve Gastrectomy--the Soroka Experience.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) became a prevalent bariatric procedure in Israel, while laparoscopic adjustable gastric banding (LAGB) was losing ground, due to high failure rates (40 % at 10 years). Many patients after LAGB failure choose LSG as a further bariatric surgery (secondary LSG). However, LAGB often impairs upper stomach anatomy and physiology, which may contribute to complications increased risk after secondary LSG, in comparison to surgery-naive obese patients choosing LSG (primary LSG).
  
  
  METHODS
  A retrospective cohort study was conducted on a prospective database, looking at morbidly obese patients for LSG surgery. All procedures were done by a single surgeon at the Soroka Medical Center between January 2008 and March 2013. Data were collected from hospitalization charts on demographics, biometric and bariatric status, medical and bariatric surgical history, post-LSG morbidity, and mortality.
  
  
  RESULTS
  Three hundred eight patients underwent LSG during the study period, 181 (58.8 %) had a primary LSG while 127 (41.2 %) had a secondary LSG. No mortality occurred in both groups. Odds ratio for major complication (leak, stenosis) was 3.12 [CI 0.90-10.75] among the secondary LSG group, compared to the primary LSG (p = 0.071). The risk for major complication was doubled (OR = 2, 95 % CI [1.36-3.06]) for each one of previous bariatric procedure underwent (p = 0.001). Significant differences were found between the two groups regarding number and length of readmissions and number of imaging tests (p value = 0.027, 0.022, and 0.049, respectively).
  
  
  CONCLUSIONS
  Primary LSG is a safe and efficient bariatric procedure. After failed LAGB, secondary LSG should be carefully considered, because of a potentially higher risk of complications.
authors.affiliation: Surgery Department B, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 151, Beer Sheva, 84101, Israel. ohadguetta@gmail.com.
authors.forename: Ohad
authors.initials: O
authors.lastname: Guetta
authors.affiliation: Surgery Department B, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 151, Beer Sheva, 84101, Israel. amnono@clalit.org.il.
authors.forename: Amnon
authors.initials: A
authors.lastname: Ovnat
authors.affiliation: Surgery Department B, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 151, Beer Sheva, 84101, Israel. gadish@clalit.org.il.
authors.forename: Gad
authors.initials: G
authors.lastname: Shaked
authors.affiliation: Surgery Department B, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 151, Beer Sheva, 84101, Israel. dudyc@clalit.org.il.
authors.forename: David
authors.initials: D
authors.lastname: Czeiger
authors.affiliation: Surgery Department B, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 151, Beer Sheva, 84101, Israel. GilbertS@clalit.org.il.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Sebbag
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000379:methods / Q000706:statistics & numerical data; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005743:Gastrectomy / Q000379:methods / Q000706:statistics & numerical data; D015391:Gastroplasty / Q000379:methods; D006801:Humans; D007557:Israel / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Morbidity; Obesity; Sleeve gastrectomy