Perioperative outcome of laparoscopic sleeve gastrectomy for high-risk patients

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) Obesity Surgery Mortality Risk Score (OS-MRS) 4, Revised Cardiac Risk Index (RCRI) class IV, Obstructive Sleep Apnea-Severity Index (OSA-SI) 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). Eightysix 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 comorbidity-related risk scores profit from LSG as part of a uniform treatment pathway. Given the severity of co-morbidities, LSG can be performed safely. (C) 2017 Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery.