Perioperative outcome of laparoscopic sleeve gastrectomy for high-risk patients.

Borbély, Yves Michael; Juilland, Olivier; Altmeier, Julia; Kröll, Dino; Nett, Philipp C. (2017). Perioperative outcome of laparoscopic sleeve gastrectomy for high-risk patients. Surgery for obesity and related diseases, 13(2), pp. 155-160. Elsevier 10.1016/j.soard.2016.08.492

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BACKGROUND

Morbidly obese patients with excessive concomitant disease carry a significantly increased perioperative risk. Although they may benefit most from a bariatric intervention, they are often denied surgery. Laparoscopic sleeve gastrectomy (LSG), as it is less complication-prone than other bariatric procedures, suits the needs of those patients.

OBJECTIVE

To review the short-term outcome of LSG for high-risk patients SETTING: University hospital, Switzerland.

METHODS

A total of 110 patients with high perioperative risk undergoing LSG between January 2008 and December 2014 were prospectively recorded. Patients were defined as "high-risk" if they met 2 of the following criteria: American Society of Anesthesiologists physical status score (ASA)>III, Obesity Surgery Mortality Risk Score (OS-MRS)≥4, Revised Cardiac Risk Index (RCRI) class IV, Obstructive Sleep Apnea-Severity Index (OSA-SI)≥5, renal insufficiency chronic kidney disease ≥3, liver cirrhosis, or history of life-threatening perioperative events.

RESULTS

Of the patients, 59 (54%) were male. Median age was 49 years (range: 18-69), and median BMI was 51.7 kg/m(2) (38.7-89.2). Median operating time was 65 minutes (27-260). Eighty-six patients (78%) were classified as ASA IV, 65 (59%) as RCRI class IV, 51 (46%) as OS-MRS≥4 and 63 (57%) as OSA-SI≥5. Eighty-nine (81%) had type 2 diabetes, 70 (64%) were under antiplatelet and or anticoagulant therapy. Four patients (4%) were converted to open. Length of stay was 5 days (1-70). Major complications occurred in 12 patients (11%), including 1 mortality (1%).

CONCLUSION

"High-risk"-patients identified using a combination of established obesity- and co-morbidity-related risk scores profit from LSG as part of a uniform treatment pathway. Given the severity of co-morbidities, LSG can be performed safely. (Surg Obes Relat Dis 2016;X:XXX-XXX.) © 2016 American Society for Metabolic and Bariatric Surgery. All rights reserved.

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