Laparoscopic sleeve gastrectomy in morbidly obese patients, our experience in a remote tertiary care hospital

M Ishaq Mir; Shahnawaz Mansoor Shah; Mubashir A Shah; Sameer H Naqash; Tariq Hassan Dug

Volume : VI, Issue : XI, November - 2017

Laparoscopic sleeve gastrectomy in morbidly obese patients, our experience in a remote tertiary care hospital

M Ishaq Mir, Shahnawaz Mansoor Shah, Mubashir A Shah, Sameer H Naqash, Tariq Hassan Dug

Abstract :

INTRODUCTION: Obesity is a medical condition in which excess body fat has accumulated to an extent that it may have an adverse effect on health of a person. Obesity is responsible for metabolic dysfunction involving lipid and glucose metabolism. Bariatric surgery remains the only effective treatment for inducing and maintaining satisfactory weight loss and in reducing weight related co morbidities for the morbidly obese patients.

AIM: To evaluate the efficacy of Laparoscopic Sleeve Gastrectomy (LSG) as a definitive procedure for morbidly obese patients.

MATERIAL AND METHODS: The present study was both retrospective and prospective in design and was conducted in the department of general and minimal access surgery, SKIMS, Srinagar. All patients fulfilling inclusion criteria like patients with BMI >40 kg/m²without associated medical co –morbidity, BMI >35kg/m² with an associated medical co– morbidity, failed dietary therapy ,psychiatrically stable without alcohol dependence or illegal drug use & who had undergone bariatric gastrectomy with available techniques from September 2011 to April 2016 were included in the study. 15 morbidly obese patients underwent LSG. The operation was performed through two 12 mm and two 5 mm ports, using the Endo–GIA stapler to create a lesser curve gastric tube over a 36–Fr bougie. The data was analyzed using SPSS software (24) with p<0.001 as the significant value.

RESULTS: A total of 15 patients were included in the study. Age of the patients ranged from 23 to 61 years with a mean age of 44.13 years and SD 12.55 years .There were eleven females and four males, aged 44.13�12.55 yrs and mean pre–operative weight of 122.53�24.82 kg. Post operatively, mean weight at 3 months follow–up was 109.73�22.89 kg, at 6 month follow–up was 94.27�20.10 kg, and at 1 year was 78.80�17.53 kg. At the follow–up (7.5�4.4 months post operatively), the % EWL (Percentage Excess weight loss) was 35.7�10.1.Eight patients who received regular postoperative dietician counseling during follow–up did better than the patients who did not (% EWL 40.4�3.8 vs. 30.2� 4.1, respectively). All patients reported significant loss of appetite. LSG had a significant effect on the state of hypertension, diabetes mellitus and dyslipidemia; though it had an insignificant effect on obstructive sleep apnoea. There was one staple line haemorrhage that led to haemodynamic instability, ultimately requiring surgical exploration with haemostasis.

CONCLUSION: Although the number of patients is relatively small, the data of this study indicate that laparoscopic sleeve gastrectomy is effective in weight reduction, and an increase in %EWL and %EBL, being an acceptable surgical option for morbidly obese patients. It improves the metabolism of insulin, glucose and lipids. The achieved body weight loss improves the patient�s quality of life and improves or resolves co morbidities such as metabolic syndrome. A higher number of patients and longer follow–up period will be necessary to evaluate long–term efficacy.