Why I will no longer be suggesting ANYONE uses Dr. Cirangle
Yeah, that is just ONE of the issues one might have with this.
Even assuming a constant stomach "length," the increase in volume as the bougie increases in diameter is not going to be a constant.
And it doesn't really matter if the stomach stretches out, does it?
Here's an interesting paper: http://www.ncbi.nlm.nih.gov/pubmed/21298527
"Gastric volume correlated significantly with the time interval after surgery. Sleeve sizes of 105.3 ± 30.2 ml [~3.5 oz] during early follow-up confirmed correct primary sizing of the sleeve, whereas marked dilation to 196.8 ± 84.3 ml [~6.8 oz] was found in patients with a follow-up of 6 months and longer (p = 0.038). Sleeve area and staple line length were also positively correlated with time after surgery. No correlation was found between gastric volume and excess weight loss."
Interesting how he concludes that the GERD gets better over time.
Ann Surg. 2010 Aug;252(2):319-24.
Long-term results of laparoscopic sleeve gastrectomy for obesity.
Himpens J, Dobbeleir J, Peeters G.
Division of Bariatric Surgery, AZ St-Blasius, Kroonveldlaan, Dendermonde, Belgium.
Comment in:
Abstract
OBJECTIVE: To determine the mid- and long-term efficacy and possible side effects of laparoscopic sleeve gastrectomy as treatment for morbid obesity.
SUMMARY BACKGROUND DATA: Laparoscopic sleeve gastrectomy is still controversial as single and final treatment for morbid obesity. Some favorable short-term results have been published, however long-term results are still lacking.
METHODS: In the period between November 2001 and October 2002, 53 consecutive morbidly obese patients who, according to our personal algorithm, were qualified for restrictive surgery were selected for laparoscopic sleeve gastrectomy. Of the 53 patients, 11 received an additional malabsorptive procedure at a later stage because of weight regain. The percentage of excess weight loss (EWL) was assessed at 3 and 6 years postoperatively. A retrospective review of a prospectively collected database was performed for evaluation after 3 years. Recently, after the sixth postoperative year, patients were again contacted and invited to fill out a questionnaire.
RESULTS: Full cooperation was obtained in 41 patients, a response rate of 78%. Although after 3 years a mean EWL of 72.8% was documented, after 6 years EWL had dropped to 57.3%, which according to the Reinhold criteria is still satisfactory. These results included 11 patients who had benefited from an additional malabsorptive procedure (duodenal switch) and 2 patients who underwent a "resleeve" between the third and sixth postoperative year. Analyzing the results of the subgroup of 30 patients receiving only sleeve gastrectomy, we found a 3-year %EWL of 77.5% and 6+ year %EWL of 53.3%. The differences between the third and sixth postoperative year were statistically significant in both groups. Concerning long-term quality of life patient acceptance stayed good after 6 + years despite the fact that late, new gastro-esophageal reflux complaints appeared in 21% of patients.
CONCLUSIONS: In this long-term report of laparoscopic sleeve gastrectomy, it appears that after 6+ years the mean excess weight loss exceeds 50%. However, weight regain and de novo gastroesophageal reflux symptoms appear between the third and the sixth postoperative year. This unfavorable evolution might have been prevented in some patients by continued follow-up office visits beyond the third year. Patient acceptance remains good after 6+ years.
