INDIVIDUALIZED APPROACH AND OUTCOMES OF LAPAROSCOPIC SLEEVE GASTRECTOMY IN BARIATRIC SURGERY
Abstract
Obesity is a rapidly escalating global health crisis, with prevalence rates rising across all income levels and geographical regions. According to the World Health Organization (WHO), over 2.5 billion adults were overweight in 2022, including more than 890 million with obesity. Laparoscopic sleeve gastrectomy (LSG) has emerged as one of the most frequently performed bariatric procedures due to its efficacy in inducing substantial weight loss and improving obesity-related comorbidities. However, optimal surgical technique, complication prevention, and individualized patient selection remain critical determinants of success. Objective: To evaluate the clinical outcomes of an individualized approach to LSG, focusing on reducing intraoperative complications, optimizing surgical ergonomics, and enhancing postoperative weight-loss results. Methods: A prospective study was conducted at the Tashkent Medical Academy in 2023, involving 105 patients with a body mass index (BMI) ≥32.5 kg/m² who underwent LSG. An individualized protocol was applied, including preoperative anthropometric assessment, customized trocar placement using proprietary software, optimized patient positioning based on oxygen saturation parameters, and the use of a custom-designed triple-balloon bariatric orogastric tube. Key endpoints included operative time, intraoperative blood loss, postoperative complication rates, and excess weight loss (EWL) at 6 and 12 months. Results: Mean operative times were reduced across all obesity classes (Class I: 48.6 ± 7.3 min; Class II: 58 ± 8.1 min; Class III: 74 ± 10.7 min). Blood loss did not exceed 100 ml in any patient, with 91.4% losing ≤50 ml. At 6 months, patients achieved a mean EWL of 51.7%, increasing to 72.7% at 12 months. Significant improvements were observed in metabolic parameters, including normalization of fasting glucose and liver enzyme levels. Early postoperative complications were minimal (nausea/vomiting in 13.3%, one case of non-operative bleeding), and no cases of stenosis, leak, or mortality were recorded. Conclusion: An individualized approach to LSG incorporating patient-specific anthropometric planning, optimized trocar placement, and triple-balloon calibration significantly improved operative efficiency, minimized complications, and yielded favorable weight-loss and metabolic outcomes. These findings support the integration of tailored surgical strategies into bariatric practice to enhance safety and effectiveness.
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