2008 Annual Meeting Abstracts

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Introduction: The vertical sleeve gastrectomy (VSG) is a purely restrictive procedure that was first published in 2002 as the first stage of a two-stage duodenal switch with the idea that it would reduce mortality due to a shorter operative time and no anastomoses. It has also been performed as a single stage alternative to gastric bypass and banding in lower BMI patients. This abstract reports our 5 year experience with 750 patients.
Methods: Laparoscopic VSG was performed in obese patients and compared retrospectively to patients who underwent the Roux-en-Y gastric bypass (RGB). A greater curvature gastrectomy was perfomed using linear GI staplers along a 32 Fr bougie to create a 40-80 ml gastric tube. Staple-line reinforcement with buttress material was used selectively.
Results: Between Nov 2002 and Sep 2007, 750 patients underwent VSG and 487 underwent RGB. The mean age in the VSG group was 43.1 years (range 16-68) and 595 (79%) were female. The mean VSG preop weight was 286±69 lbs (range 201-620) vs. 280±47 lbs (range 190-477) in the RGB. The mean VSG BMI was and 46±9 kg/m2 (range 35-89) vs. 46±6 kg/m2 (range 35-82) in the RGB. Of the 750 patients, 18 (2.4%) had a BMI of 70+ kg/m2, 50 (6.7%) had a BMI of 60-70 kg/m2, and 139 (18.5%) had a BMI of 50-60 kg/m2. The mean OR time for VSG was 79±26mins (range 34-297) vs. 137±37mins (range 90-300) in the RGB. The mean VSG length of stay was 1.7±1.1 days vs. 2.7±1.4 days after RGB. Staple-line dehiscence (only in high risk patients) occurred in 8 (1.0%) of VSG patients vs. 1 (0.2%) in RGB, strictures in 1 (0.1%) VSG vs. 19 (3.9%) in RGB, and bowel obstruction in 1 (0.1%) VSG vs. 12 (2.5%) in RGB. Ulcers occurred in 13 (2.7%) RGB and 0 VSG patients. No conversions to open or deaths occurred in the VSG group. No complications in the VSG group occurred beyond one month after surgery.
Conclusions: Laparoscopic VSG demonstrates comparable weight loss to the RGB after three years with 0% mortality. Long term morbidity is almost nonexistent compared to the RGB.

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