title: Long-Term Outcome of Laparoscopic Sleeve Gastrectomy in Morbidly Obese Japanese Patients.
abstract: BACKGROUND
  Recently, laparoscopic sleeve gastrectomy (LSG) as a standalone bariatric procedure has rapidly gained popularity worldwide mainly because of its technical simplicity and the relatively good short-term outcome. In Japan, according to a domestic survey, 71 % of the bariatric procedures performed were LSG. However, the number of studies reporting long-term results are still not enough; particularly, data for Asian patients are scarce.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the long-term outcomes for LSG in morbidly obese Japanese regarding weight loss and safety.
  
  
  METHODS
  Between October 2005 and July 2013, 179 morbidly obese Japanese patients (Female 89/Male 90) underwent LSG as a standalone procedure. The mean age was 40.7 years (range, 20-72 years), and the mean preoperative body weight and body mass index (BMI) were 120.4 kg (range, 71.4-231.6 kg) and 43.3 kg/m(2) (range, 30.9-76.5 kg/m(2)), respectively. All patients were evaluated and managed under a strict multidisciplinary team approach.
  
  
  RESULTS
  The mean BMI declined to 30.0 ± 8.7 kg/m(2) at 1 year, 29.1 ± 8.6 kg/m(2) at 2 years, 28.8 ± 8.7 kg/m(2) at 3 years, 29.3 ± 9.2 kg/m(2) at 4 years, and 32.7 ± 13.6 kg/m(2) at 5 years or more (p < 0.001). The mean percent total body weight loss (%TWL) achieved was 32.4 ± 12.9 % at 1 year, 34.3 ± 12.9 % at 2 years, 34.4 ± 11.6 % at 3 years, 32.8 ± 10.9 % at 4 years, and 29.5 ± 11.8 % at 5 years or more. Super morbidly obese patients and patients whose gastric tube was created using a thicker (45 Fr.) bougie had a tendency to achieve less weight loss. Early and late complications occurred in 16 patients (8.9 %) and in seven patients (3.9 %), respectively. Revision surgeries were required in six patients (3.4 %). The reasons for revision surgery were insufficient weight loss in five patients and intractable gastroesophageal reflux disease (GERD) in one patient.
  
  
  CONCLUSIONS
  LSG for Japanese morbidly obese patients is safe, effective, and acceptably durable up to 5 years although some complications unique to the procedure such as leakage from the staple line and intractable GERD occur. For super morbidly obese patients, other surgical options may be required.
authors.affiliation: Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan. seki@mcube.jp.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Seki
authors.affiliation: Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kasama
authors.affiliation: Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.
authors.forename: Kenkichi
authors.initials: K
authors.lastname: Hashimoto
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007564:Japan; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation / Q000706:statistics & numerical data; D015431:Weight Loss; D055815:Young Adult
keywords: Asia; Japanese; Laparoscopic sleeve gastrectomy; Long-term