Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity

D. Cottam, F. G. Qureshi, S. G. Mattar, S. Sharma, S. Holover, G. Bonanomi, R. Ramanathan, P. Schauer

Research output: Contribution to journalArticle

442 Citations (Scopus)

Abstract

Background: The surgical treatment of obesity in the high-risk, high-body-mass-index (BMI) (>60) patient remains a challenge. Major morbidity and mortality in these patients can approach 38% and 6%, respectively. In an effort to achieve more favorable outcomes, we have employed a two-stage approach to such high-risk patients. This study evaluates our initial outcomes with this technique. Methods: In this study, patients underwent laparoscopic sleeve gastrectomy (LSG) as a first stage during the period January 2002-February 2004. After achieving significant weight loss and reduction in co-morbidities, these patients then proceeded with the second stage, laparoscopic Roux-en-Y gastric bypass (LRYGBP). Results: During this time, 126 patients underwent LSG (53% female). The mean age was 49.5 ± 0.9 years, and the mean BMI was 65.3 ± 0.8 (range 45-91). Operative risk assessment determined that 42% were American Society of Anesthesiologists physical status score (ASA) III and 52% were ASA IV. The mean number of co-morbid conditions per patient was 9.3 ± 0.3 with a median of 10 (range 3-17). There was one distant mortality and the incidence of major complications was 13%. Mean excess weight after LSG at 1 year was 46%. Thirty-six patients with a mean BMI of 49.1 ± 1.3 (excess weight loss, EWL, 38%) had the second-stage LRYGBP. The mean number of co-morbidities in this group was 6.4 ± 0.1 (reduced from 9). The ASA class of the majority of patients had been downstaged at the time of LRYGB. The mean time interval between the first and second stages was 12.6 ± 0.8 months. The mean and median hospital stays were 3 ± 1.7 and 2.5 (range 2-7) days, respectively. There were no deaths, and the incidence of major complications was 8%. Conclusion: The staging concept of LSG followed by LRYGBP is a safe and effective surgical approach for high-risk patients seeking bariatric surgery.

Original languageEnglish (US)
Pages (from-to)859-863
Number of pages5
JournalSurgical Endoscopy and Other Interventional Techniques
Volume20
Issue number6
DOIs
StatePublished - Jun 2006
Externally publishedYes

Fingerprint

Morbid Obesity
Gastrectomy
Weight Loss
Gastric Bypass
Body Mass Index
Morbidity
Bariatric Surgery
Mortality
Incidence
Length of Stay
Obesity
Weights and Measures

Keywords

  • Bariatric surgery
  • Gastric bypass
  • High-risk
  • Laparoscopy
  • Morbid obesity
  • Sleeve gastrectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. / Cottam, D.; Qureshi, F. G.; Mattar, S. G.; Sharma, S.; Holover, S.; Bonanomi, G.; Ramanathan, R.; Schauer, P.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 20, No. 6, 06.2006, p. 859-863.

Research output: Contribution to journalArticle

Cottam, D, Qureshi, FG, Mattar, SG, Sharma, S, Holover, S, Bonanomi, G, Ramanathan, R & Schauer, P 2006, 'Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity', Surgical Endoscopy and Other Interventional Techniques, vol. 20, no. 6, pp. 859-863. https://doi.org/10.1007/s00464-005-0134-5
Cottam, D. ; Qureshi, F. G. ; Mattar, S. G. ; Sharma, S. ; Holover, S. ; Bonanomi, G. ; Ramanathan, R. ; Schauer, P. / Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. In: Surgical Endoscopy and Other Interventional Techniques. 2006 ; Vol. 20, No. 6. pp. 859-863.
@article{c36b50b879b6455e9e61edde0a0600a0,
title = "Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity",
abstract = "Background: The surgical treatment of obesity in the high-risk, high-body-mass-index (BMI) (>60) patient remains a challenge. Major morbidity and mortality in these patients can approach 38{\%} and 6{\%}, respectively. In an effort to achieve more favorable outcomes, we have employed a two-stage approach to such high-risk patients. This study evaluates our initial outcomes with this technique. Methods: In this study, patients underwent laparoscopic sleeve gastrectomy (LSG) as a first stage during the period January 2002-February 2004. After achieving significant weight loss and reduction in co-morbidities, these patients then proceeded with the second stage, laparoscopic Roux-en-Y gastric bypass (LRYGBP). Results: During this time, 126 patients underwent LSG (53{\%} female). The mean age was 49.5 ± 0.9 years, and the mean BMI was 65.3 ± 0.8 (range 45-91). Operative risk assessment determined that 42{\%} were American Society of Anesthesiologists physical status score (ASA) III and 52{\%} were ASA IV. The mean number of co-morbid conditions per patient was 9.3 ± 0.3 with a median of 10 (range 3-17). There was one distant mortality and the incidence of major complications was 13{\%}. Mean excess weight after LSG at 1 year was 46{\%}. Thirty-six patients with a mean BMI of 49.1 ± 1.3 (excess weight loss, EWL, 38{\%}) had the second-stage LRYGBP. The mean number of co-morbidities in this group was 6.4 ± 0.1 (reduced from 9). The ASA class of the majority of patients had been downstaged at the time of LRYGB. The mean time interval between the first and second stages was 12.6 ± 0.8 months. The mean and median hospital stays were 3 ± 1.7 and 2.5 (range 2-7) days, respectively. There were no deaths, and the incidence of major complications was 8{\%}. Conclusion: The staging concept of LSG followed by LRYGBP is a safe and effective surgical approach for high-risk patients seeking bariatric surgery.",
keywords = "Bariatric surgery, Gastric bypass, High-risk, Laparoscopy, Morbid obesity, Sleeve gastrectomy",
author = "D. Cottam and Qureshi, {F. G.} and Mattar, {S. G.} and S. Sharma and S. Holover and G. Bonanomi and R. Ramanathan and P. Schauer",
year = "2006",
month = "6",
doi = "10.1007/s00464-005-0134-5",
language = "English (US)",
volume = "20",
pages = "859--863",
journal = "Surgical Endoscopy",
issn = "0930-2794",
publisher = "Springer New York",
number = "6",

}

TY - JOUR

T1 - Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity

AU - Cottam, D.

AU - Qureshi, F. G.

AU - Mattar, S. G.

AU - Sharma, S.

AU - Holover, S.

AU - Bonanomi, G.

AU - Ramanathan, R.

AU - Schauer, P.

PY - 2006/6

Y1 - 2006/6

N2 - Background: The surgical treatment of obesity in the high-risk, high-body-mass-index (BMI) (>60) patient remains a challenge. Major morbidity and mortality in these patients can approach 38% and 6%, respectively. In an effort to achieve more favorable outcomes, we have employed a two-stage approach to such high-risk patients. This study evaluates our initial outcomes with this technique. Methods: In this study, patients underwent laparoscopic sleeve gastrectomy (LSG) as a first stage during the period January 2002-February 2004. After achieving significant weight loss and reduction in co-morbidities, these patients then proceeded with the second stage, laparoscopic Roux-en-Y gastric bypass (LRYGBP). Results: During this time, 126 patients underwent LSG (53% female). The mean age was 49.5 ± 0.9 years, and the mean BMI was 65.3 ± 0.8 (range 45-91). Operative risk assessment determined that 42% were American Society of Anesthesiologists physical status score (ASA) III and 52% were ASA IV. The mean number of co-morbid conditions per patient was 9.3 ± 0.3 with a median of 10 (range 3-17). There was one distant mortality and the incidence of major complications was 13%. Mean excess weight after LSG at 1 year was 46%. Thirty-six patients with a mean BMI of 49.1 ± 1.3 (excess weight loss, EWL, 38%) had the second-stage LRYGBP. The mean number of co-morbidities in this group was 6.4 ± 0.1 (reduced from 9). The ASA class of the majority of patients had been downstaged at the time of LRYGB. The mean time interval between the first and second stages was 12.6 ± 0.8 months. The mean and median hospital stays were 3 ± 1.7 and 2.5 (range 2-7) days, respectively. There were no deaths, and the incidence of major complications was 8%. Conclusion: The staging concept of LSG followed by LRYGBP is a safe and effective surgical approach for high-risk patients seeking bariatric surgery.

AB - Background: The surgical treatment of obesity in the high-risk, high-body-mass-index (BMI) (>60) patient remains a challenge. Major morbidity and mortality in these patients can approach 38% and 6%, respectively. In an effort to achieve more favorable outcomes, we have employed a two-stage approach to such high-risk patients. This study evaluates our initial outcomes with this technique. Methods: In this study, patients underwent laparoscopic sleeve gastrectomy (LSG) as a first stage during the period January 2002-February 2004. After achieving significant weight loss and reduction in co-morbidities, these patients then proceeded with the second stage, laparoscopic Roux-en-Y gastric bypass (LRYGBP). Results: During this time, 126 patients underwent LSG (53% female). The mean age was 49.5 ± 0.9 years, and the mean BMI was 65.3 ± 0.8 (range 45-91). Operative risk assessment determined that 42% were American Society of Anesthesiologists physical status score (ASA) III and 52% were ASA IV. The mean number of co-morbid conditions per patient was 9.3 ± 0.3 with a median of 10 (range 3-17). There was one distant mortality and the incidence of major complications was 13%. Mean excess weight after LSG at 1 year was 46%. Thirty-six patients with a mean BMI of 49.1 ± 1.3 (excess weight loss, EWL, 38%) had the second-stage LRYGBP. The mean number of co-morbidities in this group was 6.4 ± 0.1 (reduced from 9). The ASA class of the majority of patients had been downstaged at the time of LRYGB. The mean time interval between the first and second stages was 12.6 ± 0.8 months. The mean and median hospital stays were 3 ± 1.7 and 2.5 (range 2-7) days, respectively. There were no deaths, and the incidence of major complications was 8%. Conclusion: The staging concept of LSG followed by LRYGBP is a safe and effective surgical approach for high-risk patients seeking bariatric surgery.

KW - Bariatric surgery

KW - Gastric bypass

KW - High-risk

KW - Laparoscopy

KW - Morbid obesity

KW - Sleeve gastrectomy

UR - http://www.scopus.com/inward/record.url?scp=33744753476&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33744753476&partnerID=8YFLogxK

U2 - 10.1007/s00464-005-0134-5

DO - 10.1007/s00464-005-0134-5

M3 - Article

VL - 20

SP - 859

EP - 863

JO - Surgical Endoscopy

JF - Surgical Endoscopy

SN - 0930-2794

IS - 6

ER -