10 years of sleeve gastrectomy in the Czech Republic in terms of the surgical procedure

Česká verze

Authors: M. Kasalický ^1,2; A. Bařinka ³; M. Čierny ⁴ ; M. Fried ⁵ ; A. Gryga ⁶; P. Holéczy ⁷; M. Hrubý K. ⁸; Malčánková ⁹; D. Michalský ¹⁰; V. Procházka ¹¹ ; I. Satinský ¹² ; I. Šimonik ¹³; M. Vraný ¹⁴; P. Zonča ¹⁵
Authors place of work: primář: MUDr. B. Firla ; Chirurgická klinika 2. LF Univerzity Karlovy a ÚVN, Praha přednosta: prof. MUDr. M. Ryska, CSc ¹; FZaSP v Trnave dekan: Prof. MUDr. J. Slaný, CSc. ²; Chirurgické oddělení Nemocnice Vlašské Meziříčí primář: MUDr. A. Beránek ³; Chirurgické oddělení Nemocnice Břeclav primář: MUDr. M. Kříž ⁴; OB Klinika, Praha přednosta: prof. MUDr. M. Fried, CSc. ⁵; Chirurgické oddělení Nemocnice Prostějov primář: MUDr. A. Gryga, CSc. ⁶; Chirurgické oddělení Vítkovická nemocnice primář: MUDr. M. Mazur, PhD, MBA ⁷; Chirurgické oddělení Panochova nemocnice, Turnov primář: MUDr. J. Hain ⁸; CPLO Iscare, Praha primář: MUDr. P. Beňo, CSc. ⁹; 1. Chirurgická klinika 1. LF Univerzity Karlovy a VFN, Praha přednosta: prof. MUDr. Z. Krška, DrSc. ¹⁰; Chirurgická klinika LF Masarykovy univerzity FN Brno Bohunice přednosta: prof. MUDr. Z. Kala, CSc. ¹¹; Chirurgické oddělení Nemocnice s pol. Havířov ¹²; Nemocnice Sv. Zdislavy, Mostiště primář: MUDr. J. Tvarůžek ¹³; Chirurgické oddělení Nemocnice Jablonec n. N. primář: MUDr. M. Vraný ¹⁴; Chirurgická klinika FN Ostrava přednosta: doc. MUDr. P. Zonča, PhD. ¹⁵
Published in the journal: Rozhl. Chir., 2016, roč. 95, č. 12, s. 425-431.
Category: Souhrnné sdělení

Summary

Introduction:
Sleeve gastrectomy (SG) as a single bariatric/metabolic procedure has been performed since 2003 in the world, and since 2006 in the Czech Republic. We report 10 years’ experience with SG in the Czech Republic from 2006 to 2015.

Method:
Prospectively collected data from 14 surgical departments was evaluated retrospectively using descriptive statistics for every year from 2006 to 2015 and subsequently evaluated and compared for the entire period. The number of the patients, mean age, mean weight and BMI at the time of surgery, the number of patients with T2DM after SG, mean follow-up, mean %BMIL (% Body Mass Index Loss), distance of the starting point of the resection line from the pylorus, the size of the calibration bougie, the rate of complications, and the number and type of conversion procedures were evaluated.

Results:
4134 sleeve gastrectomies were done in the Czech Republic from 2006 to 2015 with the mean follow-up of 32.9 months (range 21−45 months) from the procedure. The mean weight at the time of surgery fluctuated between 114.2 kg and 128.9 kg; mean BMI fluctuated between 42.3 and 46.7. Mean %BMIL was 63.2% for the entire evaluated period. The distance of the starting point of the resection line from the pylorus changed from the mean 6.1 cm (range 6−7 cm) to mean 4.2 cm (range 3−6 cm) and the size of the calibration bougie changed from the mean 39.2 F (range 36−42 F) to mean 37.1 F (range 35−42 F). As regards early postoperative complications, bleeding from the resection line occurred in 1.4% and a leak from the staple line occurred in 1.1%. The gastroesophageal reflux disease and hiatal hernia occurred in 17.3% as the most frequent late complications. Conversion to another bariatric procedure was approached in 3.8% in the event of an unsatisfactory effect of the SG.

Conclusion:
Bariatric or metabolic surgery, respectively, is a safe and effective surgical method for the treatment of severe obesity and T2DM in morbidly obese patients. Currently, SG is the most widely used bariatric/metabolic procedure in the Czech Republic as well as in most other countries and the long-time results are similar in comparison with other authors.

Key words:
bariatric surgery – sleeve gastrectomy – resection line – complications

Zdroje

1. Tham JC, Howes N, Roux CW. The role of bariatric surgery in the treatment of diabetes. Ther Adv Chronicle Dis 2014;5:149−51.

2. Frühbeck G. Bariatric and metabolic surgery: a shift in eligibility and success criteria. Nat Rev Endocrinol 2015;11:465−77.

3. Kasalicky M. Pohled na současnou bariatricko-metabolickou chirurgii. Rozhl Chir 2012;91:5−11.

4. Coleman KJ, Huang YC, Hendee F, et al. Three-year weight outcomes from a bariatric surgery registry in a large integrated healthcare system. Surg Obes Relat Dis 2014;10:396−403.

5. Angrisani L. Bariatric surgery worldwide 2014. Obes Surg 2015;25:1822−32.

6. Gagner M, Hutchinson C, Rosenthal R. Fifth International Consensus Conference: current status of sleeve gastrectomy. Surg Obes Relat Dis 2016;12:750−6.

7. Kasalicky M, Michalsky D, Fried M, et al. Laparoscopic sleeve gastrectomy without an over-sewing of the staple line. Obes Surg 2008;18:1257−62.

8. Li F, Sheng Ch, Song K, et al. Preventative sleeve gastrectomy contributes to maintaining β cell function in db/db diabetic mouse. Obes Surg 2016;26:2402−10.

9. Regan JP, Inabnet W, Gagner M, et al. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super-obese patient. Obes Surg 2003;13:861–4.

10. Alvarenga ES, Lo Menzo E, Szomstein S, et al. Safety and efficacy of 1020 consecutive laparoscopic sleeve gastrectomies performed as a primary treatment modality for morbid obesity. A single-center experience from the metabolic and bariatric surgical accreditation quality and improvement program. Surg Endosc 2016;30:2673–8.

11. Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy. Annals of Surgery 2013;2:231−7.

12. Anand G, Katz PO. Gastroesophageal reflux disease and obesity. Rev Gastroenterol Disord 2008;8:233–9.

13. Oor JE, Roks DJ, Ünlü C, et al. Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis. The American Journal of Surgery 2016;211:250−67.

14. Fried M, Gryga A, Herlesova J, et al. Obecné indikace a kontraindikace k bariatrii. Rozhl Chir 2013;92:41−4.

15. Rebecchi F, Allaix ME, Giaccone C, et al. Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy: physiopathologic evaluation. AnnSurg 2014;260:909−14.

16. Kasalicky M, Bařinka A, Čierny M, et al: Česká bariatrie v roce 2010. Rozhl Chir 2011; 90:222−5.