***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: INTRODUCTION The South Pacific has a high prevalence of obesity and super-obesity . We review ed our experience with laparoscopic sleeve gastrectomy ( LSG ) to evaluate its efficacy and safety . METHODS A retrospective review of a prospect ively collected data base of LSGs carried out by one surgeon in one center . The percentage of excess weight loss and the rate of resolution or improvement of comorbidities reflected efficacy , and major complications or mortalities reflected safety . RESULTS From January 2008 to February 2013 , we performed 510 surgeries and included 494 consecutive patients ( 367 females ) ( 45.5 ± 11.2 years ) in our study .  LSG was the primary procedure in 384 patients , 6 patients had redo bariatric surgery after failure of initial LSG , 57 patients had a history of gastric b and ing with insufficient weight loss or b and -related complications , and 46 super-obese patients had an intragastric balloon placed before LSG . Average starting body mass index was 47.8 kg m(-2 ) . Mean percent excess weight loss was 64.3 % at 1 year ; 67.3 % at 2 years and 66.4 % at 3 years . The percentages of resolved comorbidities were as follows : hypertension : 48.3 % , type 2 diabetes mellitus : 72.5 % , dyslipidemia : 61.0 % , and obstructive sleep apnea : 77.8 % . The mortality rate was 1/494 . The postoperative morbidity included gastric fistula in 3.0 % , hemorrhaging in 2.4 % , and postoperative gastroesophageal reflux in 9.4 % . CONCLUSIONS In the South Pacific , LSG is a safe and effective means of treating morbid obesity with sustained weight loss and resolution of comorbid medical conditions Background Laparoscopic sleeve gastrectomy ( LSG ) is emerging as a popular “ st and -alone ” bariatric procedure . We report our 5 years experience with LSG as a single-stage bariatric procedure with which to study the technical progress , learning curve , complications , and follow-up results . Methods Prospect ively collected data of 228 patients ( 145 females and 83 males ) , who underwent LSG for morbid obesity , from February 2007 to March 2012 , was retrospectively analyzed . Results The mean age was 34.68 years ( range , 18–62 years ) and the mean preoperative body mass index ( BMI ) was 37.42 ± 4.75 kg/m2 ( range , 32.08–65.69 kg/m2 ) . Mean operative time was 60.63 ± 27.37 min . The mean BMI decreased to 26.15 ± 3.71 kg/m2 at 3 years ( p < 0.001 ) and to 27.94 ± 4.08 kg/m2 at 5 years ( p < 0.001 ) . Mean percentage excess weight loss was 71.96 ± 21.30 % at 3 years and 63.71 ± 20.08 % at 5 years . The 30-day readmission rate was 3.07 % .Overall complication rate was 4.3 % , including strictures , leaks , peritonitis , gastrocutaneous fistula , and one ( 0.43 % ) mortality . One patient with weight regain and another with stricture underwent conversion to Roux-en-Y gastric bypass  . Complication rates significantly decreased after the first 50 cases ( p = 0.022 ) , suggesting an initial learning curve . Resolution of diabetes , hypertension , and hyperlipidemia was 66.67 , 100 , and 50 % , respectively , at 5 years . Conclusions LSG as a single-stage bariatric procedure is safe and durable , achieving weight loss and resolution of comorbidities up to 5 years . Adherence to technical details is pivotal in reducing complications associated with the initial learning phase BACKGROUND Bariatric surgery is considered as being contraindicated for morbidly obese patients who also have inflammatory bowel disease ( IBD ) . The aim of our study was to report the outcomes of bariatric surgery in morbidly obese IBD patients . METHODS The prospect ively collected data of all the patients diagnosed as having IBD who underwent bariatric operations in 2 medical centers between October 2006 and January 2014 were retrieved and analyzed . RESULTS One male and 9 female morbidly obese IBD patients ( 8 with Crohn 's disease and 2 with ulcerative colitis ) underwent bariatric surgery .  Their mean age was 40 years , and their mean body mass index was 42.6 kg/m2 . Nine of them underwent a laparoscopic sleeve gastrectomy and 1 underwent a laparoscopic adjustable gastric b and .  Eight patients had obesity-related co-morbidities , including type 2 diabetes , hypertension , sleep apnea , osteoarthropathy , etc  . After a median follow-up of 46 months ( range 9 - 67 ) , all of the patients lost weight , with an excess weight loss of 71 % , and 10 out of 16 obesity-related co-morbidities were resolved . There was 1 complication not related to IBD , and no IBD exacerbation . CONCLUSION Bariatric surgery was safe and effective in our morbidly obese IBD patients . The surgical outcome in this selected patient group was similar to that of comparable non-IBD patients Introduction : Laparoscopic sleeve gastrectomy ( LSG ) is gaining acceptance as a st and -alone bariatric procedure with proven efficacy on weight loss and obesity-related comorbidities . A specific and potentially severe complication of LSG is the staple line leak ( SLL ) . Our aim was to report the SLL rate and its management in a prospect i ve cohort of 378 LSGs . Patients and Methods : A total of 378 patients underwent LSG from July 2005 to July 2011 . The gastric transection was performed by an initial 60 mm firing of 4.5 mm staples at the antrum and successive 60 mm firings of 3.5 mm staples at the gastric body and fundus toward the left diaphragmatic crus . A 36 Fr bougie was used to calibrate the gastric tube . The staple line was systematic ally reinforced with a partial-thickness running suture . Results : The overall complications and SLL rate were 20/378 ( 5.29 % ) and 9/378 ( 2.38 % ) , respectively . SLLs were managed by laparoscopic ( n=2 ) or open ( n=1 ) exploration , drainage and endoscopic self-exp and able covered stent , computed tomography – guided percutaneous drainage ( n=2 ) , or a self-exp and able covered stent alone ( n=4 ) . Medical support including total parenteral nutrition and adapted antibiotics was started in all patients . The combined treatment modalities were successful in all cases . Conclusions : SLL was the most common complication of LSG accounting for half of the overall complications . Percutaneous drainage and self-covered stents combined with antibiotics and parenteral nutrition are effective for SLL and should be proposed as first-line treatment in stable patients Background Single incision laparoscopy remains controversial due to technical challenges which may cause suboptimal outcomes . This study aims to evaluate the feasibility and equivalency of the single incision sleeve gastrectomy ( SISG ) when compared to the traditional multiport sleeve gastrectomy ( MPSG ) approach in a matched cohort evaluating technical aspects and postoperative results . Methods This is a retrospective analysis of prospect ively collected data in a consecutive cohort of 113 SG ( MPSG = 77 , SISG = 36 ) . The 36 patients who underwent SISG were included as the case group . Thirty-six MPSG patients were included in the control group , in 1:1 ratio with cases after matching for BMI , age , race , gender , and additional demographic data . Operative time ( OT ) in minutes and length of stay ( LOS ) in days was measured and excess weight loss ( EWL ) at 6 months and 1 year was collected and evaluated . Results Mean BMI was equivalent ( SISG 43.06 , MPSG 43.72 , p = 0.36 ) . Mean OT for the SISG was 116.78 and 118.25 for the MPSG ( p = 0.84 ) , and mean LOS was 1.80 for the SISG and 1.75 for the MSPG ( p = 0.75 ) . EWL at 6 months was 58.4 % for the SISG and 58.5 % for the MPSG ( p = 0.98 ) and 72.3 and 74.1 % ( p = 0.77 ) for 1 year , respectively . There were no leaks in either group . There was one reoperation for postoperative bleeding in the MPSG group . Conclusions Sleeve gastrectomy can be performed safely using single incision techniques with equivalent outcomes for weight loss Background One of the most serious complications after  laparoscopic sleeve gastrectomy ( LSG )  is gastric leak . Few publications exist concerning the treatment of gastric leak . We sought to determine by way of a prospect i ve study the clinical presentation , postoperative course , and treatment of gastric leak after LSG for obesity . Methods From October 2005 to August 2008 , 214 patients with different degrees of obesity underwent LSG .  During surgery , each patient received saline with methylene blue by way of nasogastric tube and had a drain placed . All patients underwent radiologic study with liquid barium sulphate on postoperative day 3 . Results Seven patients developed gastric leak . Leak in two patients ( 28.6 % ) was diagnosed by upper gastrointestinal tract ( UGI ) study . Two patients had type I leak ( 28.6 % ) , and five patients had type II leak ( 71.4 % ) . Four patients underwent reoperation . Three patients were managed medically with enteral or parenteral feeding ; the drain was maintained in situ ; and collection s were drained by percutaneous punctions guided by computed axial tomography . Mean hospital length of stay was 28.8 days , and time to leakage closure was 43 days after surgery . Conclusion Different ways exist to manage gastric leak , depending on the magnitude of the collection and the clinical repercussions . When treatment necessitates reintervention and is performed early , suture repair is more likely to be successful . Leakage closure time will vary Background Bariatric operations mostly combine a restrictive gastric component with a rerouting of the intestinal passage . The pylorus can thereby be alternatively preserved or excluded . With the aim of performing a “ pylorus-preserving gastric bypass ” , we present early results of a proximal postpyloric loop duodeno-jejunostomy associated with a sleeve gastrectomy ( LSG ) compared to results of a parallel , but distal LSG with a loop duodeno-ileostomy as a two-step procedure . Methods 16 patients underwent either a two-step LSG with a distal loop duodeno-ileostomy ( DIOS ) as revisional bariatric surgery or a combined single step operation with a proximal duodeno-jejunostomy ( DJOS ) .  Total small intestinal length was determined to account for inter-individual differences . Results Mean operative time for the second-step of the DIOS operation was 121 min and 147 min for the combined DJOS operation . The overall intestinal length was 750.8 cm ( range 600 - 900 cm ) with a bypassed limb length of 235.7 cm in DJOS patients . The mean length of the common channel in DIOS patients measured 245.6 cm . Overall excess weight loss ( % EWL ) of the two-step DIOS procedure came to 38.31 % and 49.60 % , DJOS patients experienced an % EWL of 19.75 % and 46.53 % at 1 and 6 months , resp . No complication related to the duodeno-enterostomy occurred . Conclusions Loop duodeno-enterosomies with sleeve gastrectomy can be safely performed and may open new alternatives in bariatric surgery with the possibility for inter-individual adaptation Background To evaluate changes in obesity-related diseases and micronutrients after  laparoscopic sleeve gastrectomy ( LSG ) .  Methods We started the procedure in May 2007 , and by December 2011 , 117 patients could be evaluated for a two year follow-up . Comparisons of preoperative status with 12 and 24 months postoperative status were made for body mass index ( BMI ) , obesity-related diseases and micronutrients . Results Major complications included bleeding requiring transfusion at 5.1 % , leak at 1.7 % and abscess without a visible leak at 0.9 % . Mean BMI was reduced from 46.6 ( st and ard deviation ( SD ) 6.0 ) kg/m2 to 30.6 ( SD 5.6 ) kg/m2 at two years , and resolution occurred for 80.7 % of patients with type 2 diabetes , 63.9 % with hypertension , 75.8 % with hyperlipidemia , 93.0 % with sleep apnea 
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Conclusions This systematic review of staple-line leaks following LSG demonstrated a significantly lower rate using APM staple-line reinforcement as compared to oversewing , use of sealants , BPS reinforcement , or no reinforcement .
Variation in surgical technique may also contribute to leak rates