Laparoscopic obesity surgery in an Asian Institute: A 10‐year prospective study with review of literature

Abstract

Objective: Obesity surgery is the most effective treatment for morbid obesity and leads to dramatic improvement in related co-morbidities. The aim of this study was to present the long-term results of a prospective trial studying the efficacy of laparoscopic obesity surgery in a group of oriental patients. patients who underwent obesity surgery in a single bariatric center in Asia were recruited. Various procedures have been adopted so far, including laparoscopic vertical banded gastric partition in 652 patients (27.3%), laparoscopic gastric bypass (LGB) in 1228 patients (51.5%), laparoscopic adjustable gastric banding in 226 patients (9.5%), laparoscopic sleeve gastrectomy in 128 patients (5.4%), gastric balloon in 68 patients (2.8%) and laparoscopic revision surgery in 83 patients (3.5%). We evaluated the clinical data and effect of obesity surgery on different procedures. Results: Overall, the major complication rate and mortality were 1.5% and 0.12%. There was an increase of surgical risk in laparoscopic sleeve gastrectomy and laparoscopic revision surgery patients. The mean total weight loss for the population was 28.1%, 33.9%, 21.3% 18.7% and 17.4% at 1, 3, 5, 7 and 9 years after surgery, respectively. LGB had a better weight loss (30.1%) than that of the restrictive-type procedures (20.9%) at 5 years after surgery. After surgery, most of the obesity-associated co-morbidities were resolved or improved in these patients. Conclusion: Laparoscopic obesity surgery resulted in significant and sustained weight loss in morbidly obese Asian patients with resolution of associated comorbidities.LGB had a better result in weight reduction than other restrictive procedures. Table 1 Started year and accumulated numbers of bariatric procedures LAGB, laparoscopic adjustable gastric banding; LMGB, laparoscopic mini-gastric bypass; LSG, laparoscopic sleeve gastrectomy; LRYGB, laparoscopic Roux-en-Y gastric bypass; LVBG, laparoscopic vertical banded gastric partition.Obesity surgery in Asia W-J Lee et al.

A population-based analysis of use and outcomes of laparoscopic bariatric surgery across socioeconomic groups in Taiwan

“…Our findings are similar with data from a study in the United States that reported a higher rate of utilization of the minimally invasive bariatric surgery among higher SES patients and those with private insurance [ 19 ]. Most patients treated with minimally invasive approach because of smaller incisions and quicker recovery [ 2 , 3 ]. In addition, morbidly obese patients who had undergone bariatric surgery typically had multiple obesity-related comorbidities that might have substantially increased their surgical risk [ 20 ].…”

“…Bariatric surgery has been proven as an attractive and effective control method for morbid obesity and associated metabolic disorders [ 1 , 2 ]. With the development of advanced surgical instrumentation and introduction, the numbers of laparoscopic bariatric procedures have grown substantially in developed and developing countries in the past decade [ 3 – 5 ]. In Taiwan, the annual number of bariatric surgery cases, particularly laparoscopic bariatric surgery (LBS), has increased over the past few years [ 6 ].…”

“…However, LBS is only covered by Taiwan’s National Health Insurance (NHI) payment for surgical fee, ward fee, examination fee, treatment fee and medication fee, not for some of special material fees of LBS. The average surgical costs for LBS per patient had to pay extra-expenses between 150,000 and 250,000 new Taiwan dollars (approximately 4688–7813 US dollars) [ 3 ]. In addition, hospital treatment costs at different hospital levels were reimbursed under the national health insurance system, the highest of which were generally received by medical centers and the lowest of which were received by local hospitals [ 6 ].…”

“…Numerous studies have shown that gastric surgery with laparoscopic assistance has the advantages of low morbidity, short length of hospital stay (LOS), expedient return to normal activity [ 1 , 7 ], and improved patients’ quality of life [ 8 ]. However, this procedure also carries a potential risk of perioperative complications [ 2 , 7 ] and has a recognized steep learning curve, even for experienced surgeons [ 3 , 5 , 9 ]. To our knowledge, although the use of bariatric surgery differs considerably across socioeconomic groups [ 10 – 13 ], it is unclear whether the choice of LBS could be influenced by socioeconomic status (SES).…”

Initial Japanese experience with the LAP‐BAND system

“…In Asia, LAGB has been performed in Singapore and Taiwan since 1999 (11,12), but to our knowledge, few intermediate-or long-term results have been reported in the English-language literature until now. Lee et al from Taiwan only recently reported their 5-year data (13). In Japan, Kasama et al first reported data on LAGB with the LAP-BAND system in English (14), but their data only covered up to 18 months of follow-up and reported a high complication rate (30.8%).…”