Numerous studies have demonstrated that bariatric and metabolic surgery (BMS) is a safe and effective option for obese patients. In Japan, national health insurance has covered laparoscopic sleeve gastrectomy (LSG) since 2014, increasing the number of procedures performed. This study analyzed 31 patients who underwent LSG at Okayama University Hospital, a regional core medical institution, between 2017 and 2024, focusing on safety and efficacy.
Results:
The findings revealed no severe complications and indicated significant weight loss and improvements in various metabolic diseases. However, challenges such as weight regain and interruptions in patient follow-up were identified. The remission rates for type 2 diabetes, hypertension, and dyslipidemia were 25%, 28.6%, and 56.3%, respectively. The study also noted potential pitfalls in surgical techniques, highlighting the importance of experienced medical teams.
Conclusion:
Although the weight loss rate in this study was slightly lower than the national average, the results remained promising. A multidisciplinary approach, encompassing thorough preoperative evaluations and consistent postoperative follow-up, was essential for success. BMS is highly effective and stands out as one of the key treatments for obesity. The study concludes that our facility has successfully introduced safe and effective BMS in the regional hub hospital by adhering to established guidelines.
HarutaH, KasamaK, OhtaM, et al.Long-term outcomes of bariatric and metabolic surgery in japan: Results of a multi-institutional survey. Obes Surg, 2017; 27(3):754–762.
2.
OhtaM, KasamaK, SasakiA, et al.; Japan Consortium of Obesity and Metabolic Surgery (JCOMS). Current status of laparoscopic bariatric/metabolic surgery in Japan: The sixth nationwide survey by the Japan Consortium of Obesity and Metabolic Surgery. Asian J Endosc Surg, 2021; 14(2):170–177.
3.
AngrisaniL, SantonicolaA, IovinoP, et al.Bariatric Surgery survey 2018: Similarities and disparities among the 5 IFSO chapters. Obes Surg, 2021; 31(5):1937–1948.
4.
YamaguchiT, TanakaS, IshiharaN, et al.A survey of bariatric/metabolic surgery as a treatment option for patients with severe obesity and type 2 diabetes in japan. Obes SURG, 2022; 32(3):926–929.
5.
SasakiA, YokoteK, NaitohT, et al.; Joint Committee in the Japanese Society for Treatment of Obesity, the Japan Diabetes Society, the Japan Society for the Study of Obesity. Metabolic surgery in treatment of obese Japanese patients with type 2 diabetes: A joint consensus statement from the Japanese Society for Treatment of Obesity, the Japan Diabetes Society, and the Japan Society for the Study of Obesity. Diabetol Int, 2022; 13(1):1–30.
6.
AltunH, BanlıO, KarakoyunR, et al.Direct trocar insertion technique for initial access in morbid obesity surgery: Technique and results. Surg Laparosc Endosc Percutan Tech, 2010; 20(4):228–230.
7.
IkechebeluJI, ElejeGU, Joe-IkechebeluNN, et al.Randomized control trial on effectiveness and safety of direct trocar versus Veress needle entry techniques in obese women during diagnostic laparoscopy. Arch Gynecol Obstet, 2021; 304(3):815–822.
8.
LascanoCA, Kaidar-PersonO, SzomsteinS, et al.Challenges of laparoscopic colectomy in the obese patient: A review. Am J Surg, 2006; 192(3):357–365.
9.
FecsoA, SzaszP, KerezovG, et al.The effect of technical performance on patient outcomes in surgery: A systematic review. Ann Surg, 2017; 265(3):492–501.
10.
LalezariS, MusielakMC, BrounLA, et al.Laparoscopic sleeve gastrectomy as a viable option for an ambulatory surgical procedure: Our 52-month experience. Surg Obes Relat Dis, 2018; 14(6):748–750.
11.
MuracaE, OltoliniA, BindaA, et al.Metabolic and psychological features are associated with weight loss 12 months after sleeve gastrectomy. J Clin Endocrinol Metab, 2021; 106(8):e3087–e3097.
12.
SurveA, CottamD, ZaveriH, et al.Does the future of laparoscopic sleeve gastrectomy lie in the outpatient surgery center? A retrospective study of the safety of 3162 outpatient sleeve gastrectomies. Surg Obes Relat Dis, 2018; 14(10):1442–1447.
13.
OhtaM, EndoY, FujinagaA, et al.Predictors of early withdrawal from follow-up visits after laparoscopic sleeve gastrectomy in a Japanese institution. Surg Today, 2022; 52(1):46–51.
14.
LeeWJ, AlmulaifiA, TsouJJ, et al.Laparoscopic sleeve gastrectomy for type 2 diabetes mellitus: Predicting the success by ABCD score. Surg Obes Relat Dis, 2015; 11(5):991–996.
15.
MizeraM, WysockiM, BartosiakK, et al.Type 2 diabetes remission 5 years after laparoscopic sleeve gastrectomy: Multicenter cohort study. Obes Surg, 2021; 31(3):980–986.
16.
SaikiA, KanaiR, NakamuraS, et al.Impact of mental health background and nutrition intake on medium-term weight loss in Japanese patients undergoing laparoscopic sleeve gastrectomy. Obes Facts, 2020; 13(4):371–383.
17.
NaitohT, KasamaK, SekiY, et al.Efficacy of sleeve gastrectomy with duodenal-jejunal bypass for the treatment of obese severe diabetes patients in japan: A retrospective multicenter study. Obes Surg, 2018; 28(2):497–505.
18.
MaH, LinYH, DaiLZ, et al.Efficacy and safety of GLP-1 receptor agonists versus SGLT-2 inhibitors in overweight/obese patients with or without diabetes mellitus: A systematic review and network meta-analysis. BMJ Open, 2023; 13(3):e061807.
19.
PalmerSC, TendalB, MustafaRA, et al.Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes: Systematic review and network meta-analysis of randomised controlled trials. BMJ, 2021; 372:m4573.
20.
MarxN, HusainM, LehrkeM, et al.GLP-1 receptor agonists for the reduction of atherosclerotic cardiovascular risk in patients with type 2 diabetes. Circulation, 2022; 146(24):1882–1894.
21.
SalmanM, NoureldinK, IssaM, et al.SP2.1.3 Effect of laparoscopic sleeve gastrectomy on vasoactivemediators in obese hypertensive patients: A prospective study. Br J Surg, 2022; 109(Supplement_5); doi: 10.1093/bjs/znac247.017
22.
GolombI, Ben DavidM, GlassA, et al.Long-term metabolic effects of laparoscopic sleeve gastrectomy. JAMA Surg, 2015; 150(11):1051–1057.
23.
OhiraM, YamaguchiT, SaikiA, et al.Laparoscopic sleeve gastrectomy significantly increases serum lipoprotein lipase level in obese patients. Obes Facts, 2019; 12(3):357–368.
24.
IsoH, NaitoY, SatoS, et al.Serum triglycerides and risk of coronary heart disease among Japanese men and women. Am J Epidemiol, 2001; 153(5):490–499.
25.
FranssenR, MonajemiH, StroesESG, et al.Obesity and dyslipidemia. Med Clin North Am, 2011; 95(5):893–902.
26.
KikkasEM, SillakiviT, SuumannJ, et al.Five-year outcome of laparoscopic sleeve gastrectomy, resolution of comorbidities, and risk for cumulative nutritional deficiencies. Scand J Surg, 2019; 108(1):10–16.
27.
EmileSH, ElfekiH, ElalfyK, et al.Laparoscopic sleeve gastrectomy then and now: An updated systematic review of the progress and short-term outcomes over the last 5 years. Surg Laparosc Endosc Percutan Tech, 2017; 27(5):307–317.
28.
BergkvistD, HekmatK, SvenssonT, et al.Obesity in orthopedic patients. Surg Obes Relat Dis, 2009; 5(6):670–672.
29.
MarcusMD, WildesJE. Obesity: Is it a mental disorder? Int J Eat Disord, 2009; 42(8):739–753.
