![gastric sleeve 10 years later gastric sleeve 10 years later](https://i.pinimg.com/736x/22/f9/d3/22f9d383488e871930c671ef53371ec9--gastric-sleeve-before-and-after-sleeve-gastrectomy.jpg)
Statistical analysis of the present study was conducted, using the mean, standard deviation, ANCOVA test, and chi-square test using the SPSS® software package version 24 (IBM. Follow-up of comorbidity resolution was recorded. EBMI loss (excess body mass index loss) and body mass index loss ratio (BML%) were measured, compared with preoperative data, and reported in all cases. Excess weight (EW) = (preoperative weight−ideal weight) was measured using weight values above 85th percentile for age and sex, and excess weight loss ratio (EWL) %= (preoperative weight−current weight/EW) ×100. Measurements such as weight (kg), height (m), and BMI (kg/m 2) as well as waist circumference WC (cm) were recorded in every visit. Postoperatively, physical activity was allowed, and our cases were followed for 1 year.
![gastric sleeve 10 years later gastric sleeve 10 years later](https://i.ytimg.com/vi/G869uUGrqgI/maxresdefault.jpg)
Patients were scheduled to attend our outpatient clinic 2, 6 weeks after surgery, and then 3, 6, and 12 months, then annually to monitor weight loss, appetite, dysphagia or food intolerance, eating behavior, comorbidity status, and any complications. All patients discharged on multivitamins with calcium and vitamin D daily vitamins B1, 6, and 12 intramuscular weekly and proton pump daily for 6 months. Postoperatively, patients were advised to start liquid diet for 2 weeks, then soft diet for 2 weeks, and solid diet after 4 weeks by gradual excess in food texture. Patients started oral intake 12 h postoperatively and were discharged 2 days postoperatively once tolerating adequate oral fluids, their pain was controlled, and they were ambulating easily. Detailed surgical descriptions, including all steps, intraoperative mishaps, and/or complications, were recorded. Fixation of the gastric sleeve to the pre-pancreatic fascia using two 2/0 monofilament sutures was done to prevent twist. No second layer (inverting lambert sutures) was performed titanium clips were used to stop bleeding at the staple line when indicated. After devascularization of the greater curve and complete fundus mobilization using bipolar sealing device (LigaSure™, Medtronic, USA), gastrectomy over size 36 fr bougie starting 4 cm proximal to pylorus was done using Echelon EndoGIA stapler (Johnson and Johnson). Standard 5-port LSG was done using French position with the surgeon standing between the patient’s legs. The following variables were used to orderly define comorbidities: pre-diabetes (fasting glucose FG ≥ 100 and 200 or LDL > 130 or HDL130 mg/dL), and hypertension was diagnosed when systolic and/or diastolic BP greater than the 95th percentile for age, sex, and height. Clinical and laboratory assessments including total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG) (mg/dL), oral glucose tolerance test (OGTT), glycated hemoglobin (HbA1c), transaminases, and abdominal ultrasound for evaluation of hepatic fatty infiltration were obtained preoperatively and 6 and 12 months postoperatively in all cases. Routine preoperative esophagogastroduodenoscopy (OGD), helicobacter test (antigen in stool), and echocardiogram to evaluate left ventricle hypertrophy were obtained in all cases.
![gastric sleeve 10 years later gastric sleeve 10 years later](https://mexicobariatriccenter.com/wp-content/uploads/2019/10/Traci-Gastric-Sleeve-August-2019-800x800.jpg)
Baseline, operative, and follow-up data were thoroughly reviewed, analyzed, and summarized. Their medical records including anthropometric measurements were contemporaneously reviewed, and all data were collected in Excel sheet. All candidates underwent LSG at our University Hospital between August 2015 and August 2017. Our institutional ethical committee approval was obtained before starting the study (No: 35). An informed consent was obtained from parents with assent from patients less than 18 years or directly from patients more than 18 years to be enrolled in the study and possible publication. We excluded patients with hiatal hernia, GERD or had previous open upper GI surgery being pregnant, lactating, or having secondary obesity or having any medical or psychological issues preventing commitment to postoperative regimens. All obese adolescents who failed to achieve significant weight loss (10% of initial weight at 6 months) through non-surgical treatment were indicated to LSG and included in our study. All patients underwent comprehensive evaluations by multidisciplinary team including pediatric endocrinologist, nutritionist, and psychologist preoperatively. Patients and their parents were counseled about potentially available surgical procedures (LSG, gastric band, and Roux-en-Y gastric bypass) including pros and cons, possible outcomes, complications, and optimum postoperative lifestyle changes. Their body mass indices were above 99th percentile for age and sex with or without comorbidities. This was a prospective study which included 35 morbidly obese adolescents aged between 12 and 19 years.