South Texas Lap-Band

Laparoscopic Sleeve Gastrectomy

The bariatric procedure commonly called "Sleeve Gastrectomy” is a form of unbanded gastroplasty involving partial gastric resection for creation of a long lesser curve-based gastric conduit “sleeve” (Figure 1). The mechanism of weight loss and resultant comorbidity improvement seen following Sleeve Gastrectomy may be related to gastric restriction or to neurohumoral changes observed following the procedure due to the gastric resection or some other unidentified factor(s). There are currently 15 published reports in the peer-reviewed literature describing short-term outcomes in 775 patients after sleeve gastrectomy. 2-16 A single study provides data up to 3 years after the procedure and no follow-up beyond 3 years has been reported. 7 The reports describe surgical treatment of patients with preoperative body mass index ranging from 35 to 69 kg/m2 and excess weight loss up to 83%.

Comorbidity resolution 12 to 24 months after Sleeve Gastrectomy has been reported in 345 patients 3-6 demonstrating resolution rates of diabetes, hypertension, hyperlipidemia, and sleep apnea after Sleeve Gastrectomy are comparable to results of other restrictive procedures.

Similar to other forms of gastroplasty, perioperative risk for Sleeve Gastrectomy appears to be relatively low, even in high risk patients. Only a single study7 is published which compares sleeve gastrectomy to a more widely accepted bariatric procedure. In that trial, Sleeve Gastrectomy was found to be at least as effective and durable as adjustable gastric banding at one and three years following surgery.

The Sleeve Gastrectomy procedure has been utilized as a first-stage bariatric procedure to reduce surgical risk in high-risk patients by induction of weight loss and this may be its most useful application at the present time. Sleeve gastrectomy appears to be a technically easier and/or faster laparoscopic procedure than Roux-en Y Gastric Bypass or malabsorptive procedures in complex or high risk patients including the super-super-obese patient (BMI > 60 kg/m2).

Long-term (> 5 yr) weight loss and comorbidity resolution data for Sleeve Gastrectomy have not been reported at this time. Weights regain or a desire for further weight loss in a super-super-obese patient may require the procedure to be revised to a Gastric Bypass.

The ASMBS recognizes performance of Sleeve Gastrectomy may be an option for carefully selected patients undergoing bariatric surgical treatment, particularly those who are high risk or super-super-obese. In addition, it is suggested that surgeons performing sleeve gastrectomy inform patients regarding the lack of published evidence for sustained weight loss beyond 3 years and provide them with information regarding alternative procedures with published long-term (= 5 years) data confirming sustained weight loss and comorbidity resolution based upon available literature at this time.

References

Johnston D, Dachtler J, Sue-Ling HM, et al. The Magenstrasse and Mill operation for morbid obesity. Obes Surg 2003; 13(1):10-6.
Lee CM, Cirangle PT, Jossart GH. Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc 2007.
Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc 2006; 20(6):859-63.
Hamoui N, Anthone GJ, Kaufman HS, Crookes PF. Sleeve gastrectomy in the high-risk patient. Obes Surg 2006; 16(11):1445-9.
Moon Han S, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg 2005; 15(10):1469-75.
Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg 2006; 16(9):1138-44.
Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg 2006; 16(11):1450-6.
Baltasar A, Serra C, Perez N, et al. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg 2005; 15(8):1124-8.
Roa PE, Kaidar-Person O, Pinto D, et al. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg 2006; 16(10):1323-6.
Langer FB, Bohdjalian A, Felberbauer FX, et al. Does gastric dilatation limit the success of sleeve gastrectomy as a sole operation for morbid obesity? Obes Surg 2006; 16(2):166-71
Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy: a restrictive procedure? Obes Surg 2007; 17(1):57-62
Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obes Surg 2004; 14(4):492-7
Milone L, Strong V, Gagner M. Laparoscopic sleeve gastrectomy is superior to endoscopic intragastric balloon as a first stage procedure for super-obese patients (BMI > or =50). Obes Surg 2005; 15(5):612-7
Mognol P, Chosidow D, Marmuse JP. Laparoscopic sleeve gastrectomy as an initial bariatric operation for high-risk patients: initial results in 10 patients. Obes Surg 2005; 15(7):1030-3
Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg 2005; 15(7):1024-9
Regan JP, Inabnet WB, Gagner M, Pomp A. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg 2003; 13(6):861-4
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