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Laparoscopic Sleeve Gastrectomy: The Technique

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Obesity, Bariatric and Metabolic Surgery

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Abstract

Sleeve gastrectomy is presently the most popular weight loss procedure globally. The only absolute contraindication to this procedure is the presence of Barrett’s esophagus. Comprehensive preoperative workup, optimization of comorbidities, and adequate preoperative preparation are of paramount importance. Preoperative patient counseling should focus on caution about variable impact of surgery on symptoms of gastroesophageal reflux, if present. Though technically less complex than the gastric bypass, meticulous technique and avoidance of certain pitfalls are essential to achieve an optimal outcome and minimize serious complications including leaks. It is recommended to adopt an unhurried approach during stapling to avoid narrowing at incisura angularis, twisting of sleeve, and ensure adequate hemostasis at the end of the procedure.

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References

  1. 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;13:861–4.

    Article  CAS  Google Scholar 

  2. Zhao H, Jiao L. Comparative analysis for the effect of roux-en-Y gastric bypass vs sleeve gastrectomy in patients with morbid obesity: evidence from 11 randomized clinical trials (meta-analysis). Int J Surg. 2019;72:216–23.

    Article  Google Scholar 

  3. Salminen P, Helmiö M, Ovaska J, Juuti A, Leivonen M, Peromaa-Haavisto P, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA. 2018;319:241–54.

    Article  Google Scholar 

  4. Vigneshwaran B, Wahal A, Aggarwal S, Priyadarshini P, Bhattacharjee H, Khadgawat R, et al. Impact of sleeve gastrectomy on type 2 diabetes mellitus, gastric emptying time, glucagon-like peptide 1 (GLP-1), ghrelin and leptin in non-morbidly obese subjects with BMI 30-35.0 kg/m2: a prospective study. Obes Surg. 2016;26:2817–23.

    Article  CAS  Google Scholar 

  5. Aggarwal S, Kini SU, Herron DM. Laparoscopic sleeve gastrectomy for morbid obesity: a review. Surg Obes Relat Dis. 2007;3:189–94.

    Article  Google Scholar 

  6. Mechanick JI, Apovian C, Brethauer S, Garvey WT, Joffe AM, Kim J, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures – 2019 update: cosponsored by American Association Of Clinical Endocrinologists/American College Of Endocrinology, The Obesity Society, American Society For Metabolic & Bariatric Surgery, Obesity Medicine Association, And American Society Of Anesthesiologists – executive summary. Endocr Pract. 2019;25:1346–59.

    Google Scholar 

  7. Gagner M, Deitel M, Kalberer TL, Erickson AL, Crosby RD. The second international consensus summit for sleeve gastrectomy, March 19–21, 2009. Surg Obes Relat Dis. 2009;5:476–85.

    Article  Google Scholar 

  8. Hong J, Park S, Menzo EL, Rosenthal R. Midterm outcomes of laparoscopic sleeve gastrectomy as a stand-alone procedure in super-obese patients. Surg Obes Relat Dis. 2018;14:297–303.

    Article  Google Scholar 

  9. Singla V, Aggarwal S, Singh B, Tharun G, Katiyar V, Bhambri A. Outcomes in super obese patients undergoing one anastomosis gastric bypass or laparoscopic sleeve gastrectomy. Obes Surg. 2019;29:1242–7.

    Article  Google Scholar 

  10. Ifso Registry | International Federation for the Surgery of Obesity and Metabolic Disorders [Internet]. [cited 2020 Jul 21]. https://www.ifso.com/ifso-registry.php

  11. Gagner M. Is sleeve gastrectomy always an absolute contraindication in patients with Barrett’s? Obes Surg. 2016;26:715–7.

    Article  Google Scholar 

  12. Felsenreich DM, Kefurt R, Schermann M, Beckerhinn P, Kristo I, Krebs M, et al. Reflux, sleeve dilation, and Barrett’s esophagus after laparoscopic sleeve gastrectomy: long-term follow-up. Obes Surg. 2017;27:3092–101.

    Article  Google Scholar 

  13. Ooi GJ, Browning A, Hii MW, Read M. Perioperative screening, management, and surveillance of Barrett’s esophagus in bariatric surgical patients. Ann N Y Acad Sci. 2020;1481:224–35.

    Article  Google Scholar 

  14. Luo JM, Zhang DM, Xiao Y, Huang R, Zhu HJ, Yu JC, et al. Perioperative evaluation of obstructive sleep apnea in bariatric surgery population. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2018;40:617–24.

    Google Scholar 

  15. Vasu TS, Grewal R, Doghramji K. Obstructive sleep apnea syndrome and perioperative complications: a systematic review of the literature. J Clin Sleep Med. 2012;8:199–207.

    Article  Google Scholar 

  16. McGlone ER, Gupta AK, Reddy M, Khan OA. Antral resection versus antral preservation during laparoscopic sleeve gastrectomy for severe obesity: systematic review and meta-analysis. Surg Obes Relat Dis. 2018;14:857–64.

    Article  Google Scholar 

  17. Skrekas G, Lapatsanis D, Stafyla V, Papalambros A. One year after laparoscopic “tight” sleeve gastrectomy: technique and outcome. Obes Surg. 2008;18:810–3.

    Article  Google Scholar 

  18. Wang Y, Yi X-Y, Gong L-L, Li Q-F, Zhang J, Wang Z-H. The effectiveness and safety of laparoscopic sleeve gastrectomy with different sizes of bougie calibration: a systematic review and meta-analysis. Int J Surg. 2018;49:32–8.

    Article  Google Scholar 

  19. Bellanger DE, Greenway FL. Laparoscopic sleeve gastrectomy, 529 cases without a leak: short-term results and technical considerations. Obes Surg. 2011;21:146–50.

    Article  Google Scholar 

  20. Yo LSF, Consten ECJ, Quarles van Ufford HME, Gooszen HG, Gagner M. Buttressing of the staple line in gastrointestinal anastomoses: overview of new technology designed to reduce perioperative complications. Dig Surg. 2006;23:283–91.

    Article  CAS  Google Scholar 

  21. Bingham J, Kaufman J, Hata K, Dickerson J, Beekley A, Wisbach G, et al. A multicenter study of routine versus selective intraoperative leak testing for sleeve gastrectomy. Surg Obes Relat Dis. 2017;13:1469–75.

    Article  Google Scholar 

  22. Liu N, Cusack MC, Venkatesh M, Pontes AL, Shea G, Svoboda DC, et al. 30-day outcomes following intraoperative leak testing for bariatric surgery patients. J Surg Res. 2019;242:136–44.

    Article  Google Scholar 

  23. Aggarwal S, Bhattacharjee H, Chander MM. Practice of routine intraoperative leak test during laparoscopic sleeve gastrectomy should not be discarded. Surg Obes Relat Dis. 2011;7:e24–5.

    Article  Google Scholar 

  24. Lalor PF, Tucker ON, Szomstein S, Rosenthal RJ. Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2008;4:33–8.

    Article  Google Scholar 

  25. Iannelli A, Treacy P, Sebastianelli L, Schiavo L, Martini F. Perioperative complications of sleeve gastrectomy: review of the literature. J Minim Access Surg. 2019;15:1–7.

    Article  Google Scholar 

  26. Mocanu V, Dang J, Ladak F, Switzer N, Birch DW, Karmali S. Predictors and outcomes of bleed after sleeve gastrectomy: an analysis of the MBSAQIP data registry. Surg Obes Relat Dis. 2019;15:1675–81.

    Article  Google Scholar 

  27. Turcu F, Balahura C, Doras I, Constantin A, Copaescu C. Symptomatic stenosis after laparoscopic sleeve gastrectomy – incidence and management in a high-volume bariatric surgery center. Chirurgia (Bucur). 2018;113:826–36.

    Article  Google Scholar 

  28. Mahawar KK, Jennings N, Balupuri S, Small PK. Sleeve gastrectomy and gastro-oesophageal reflux disease: a complex relationship. Obes Surg. 2013;23:987–91.

    Article  Google Scholar 

  29. Sharma A, Aggarwal S, Ahuja V, Bal C. Evaluation of gastroesophageal reflux before and after sleeve gastrectomy using symptom scoring, scintigraphy, and endoscopy. Surg Obes Relat Dis. 2014;10:600–5.

    Article  Google Scholar 

  30. Baltasar A, Serra C, Pérez N, Bou R, Bengochea M. Re-sleeve gastrectomy. Obes Surg. 2006;16:1535–8.

    Article  Google Scholar 

  31. Nedelcu M, Noel P, Iannelli A, Gagner M. Revised sleeve gastrectomy (re-sleeve). Surg Obes Relat Dis. 2015;11:1282–8.

    Article  Google Scholar 

  32. Lemmens L, Van Den Bossche J, Zaveri H, Surve A. Banded sleeve gastrectomy: better long-term results? A long-term cohort study until 5 years follow-up in obese and superobese patients. Obes Surg. 2018;28:2687–95.

    Article  Google Scholar 

  33. Fink JM, Hetzenecker A, Seifert G, Runkel M, Laessle C, Fichtner-Feigl S, et al. Banded versus nonbanded sleeve gastrectomy: a randomized controlled trial with 3 years of follow-up. Ann Surg. 2020;272:690–5.

    Article  Google Scholar 

  34. Gentileschi P, Bianciardi E, Siragusa L, Tognoni V, Benavoli D, D’Ugo S. Banded sleeve gastrectomy improves weight loss compared to nonbanded sleeve: midterm results from a prospective randomized study. J Obes. 2020;2020:9792518.

    Article  Google Scholar 

  35. Huang YC, Mitchell D. Multiple concurrent complications of Roux-en-Y gastric bypass with MiniMizer gastric ring-alimentary limb intussusception through slipped ring into pouch, with remnant stomach internal herniation. J Surg Case Rep. 2020;2020:rjaa033.

    Article  Google Scholar 

  36. Franco-Martínez AM, Guraieb-Trueba M, Castañeda-Sepúlveda R, Flores-Villalba EA, Rojas-Méndez J. Silastic band erosion in the bypassed stomach after Fobi-pouch operation for obesity: case report. Int J Surg Case Rep. 2018;47:22–4.

    Article  Google Scholar 

  37. Vives M, Molina A, Danús M, Rebenaque E, Blanco S, París M, et al. Analysis of gastric physiology after laparoscopic sleeve gastrectomy (LSG) with or without antral preservation in relation to metabolic response: a randomised study. Obes Surg. 2017;27:2836–44.

    Article  CAS  Google Scholar 

  38. Abdallah E, El Nakeeb A, Youssef T, Yousef T, Abdallah H, Ellatif MA, et al. Impact of extent of antral resection on surgical outcomes of sleeve gastrectomy for morbid obesity (a prospective randomized study). Obes Surg. 2014;24:1587–94.

    Article  Google Scholar 

  39. Michalsky D, Dvorak P, Belacek J, Kasalicky M. Radical resection of the pyloric antrum and its effect on gastric emptying after sleeve gastrectomy. Obes Surg. 2013;23:567–73.

    Article  Google Scholar 

  40. Peterli R, Borbély Y, Kern B, Gass M, Peters T, Thurnheer M, et al. Early results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Ann Surg. 2013;258:690–4; discussion 695.

    Article  Google Scholar 

  41. DuPree CE, Blair K, Steele SR, Martin MJ. Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease: a national analysis. JAMA Surg. 2014;149:328–34.

    Article  Google Scholar 

  42. Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N. Bariatric surgery worldwide 2013. Obes Surg. 2015;25:1822–32.

    Article  CAS  Google Scholar 

  43. Garg H, Vigneshwaran B, Aggarwal S, Ahuja V. Impact of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastro-oesophageal reflux disease in morbidly obese patients. J Minim Access Surg. 2017;13:103–8.

    Article  Google Scholar 

  44. Mahawar KK, Carr WRJ, Jennings N, Balupuri S, Small PK. Simultaneous sleeve gastrectomy and hiatus hernia repair: a systematic review. Obes Surg. 2015;25:159–66.

    Article  Google Scholar 

  45. Kelty CJ, Falk GL. Mesh repairs in hiatal surgery. The case against mesh repairs in hiatal surgery. Ann R Coll Surg Engl. 2007;89:479–81.

    Article  Google Scholar 

  46. Nocca D, Nedelcu M, Loureiro M, Palermo M, Silvestri M, de Jong A, et al. The Nissen Sleeve Gastrectomy: technical considerations. J Laparoendosc Adv Surg Tech A. Mary Ann Liebert, Inc., publishers. 2020;30:1231–6.

    Google Scholar 

  47. Cunningham-Hill M, Mazzei M, Zhao H, Lu X, Edwards MA. The impact of staple line reinforcement utilization on bleeding and leak rates following sleeve gastrectomy for severe obesity: a propensity and case-control matched analysis. Obes Surg. 2019;29:2449–63.

    Article  Google Scholar 

  48. Shikora SA, Mahoney CB. Clinical benefit of gastric staple line reinforcement (SLR) in gastrointestinal surgery: a meta-analysis. Obes Surg. 2015;25:1133–41.

    Article  Google Scholar 

  49. Sroka G, Milevski D, Shteinberg D, Mady H, Matter I. Minimizing hemorrhagic complications in laparoscopic sleeve gastrectomy – a randomized controlled trial. Obes Surg. 2015;25:1577–83.

    Article  Google Scholar 

  50. Gagner M, Kemmeter P. Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surg Endosc. 2019;34:396.

    Article  Google Scholar 

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Acknowledgments

“The authors are grateful to Dr. Pratyusha Priyadarshini for her work in producing this chapter in the first edition of the book.”

Author information

Authors and Affiliations

  1. Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi, India

    Sandeep Aggarwal, Mehul Gupta & Vitish Singla

  2. Department of Surgery, Hôpital du Sacré Coeur, Montreal, QC, Canada

    Michel Gagner

Authors
  1. Sandeep Aggarwal
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  2. Mehul Gupta
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  3. Vitish Singla
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  4. Michel Gagner
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Corresponding author

Correspondence to Sandeep Aggarwal .

Editor information

Editors and Affiliations

  1. Homerton University Hospital, London, UK

    Sanjay Agrawal

Section Editor information

  1. Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi, India

    Sandeep Aggarwal MBBS, MS, FACS

1 Electronic Supplementary Materials

Dissection of omentum from greater curvature of stomach (MPG 171367 kb) (MP4 505,804 kb) (MP4 505804 kb)

Sequential firing of stapler using buttressing material (MP4 504,441 kb) (MP4 504441 kb)

Video 3

Placement of Nathanson’s hook liver retractor (MPG 67002 kb) (MPG 67002 kb)

Completion of Sleeve and Dissection of hiatus (MP4 502,215 kb) (MP4 502215 kb)

Posterior crural repair (MP4 434,140 kb) (MP4 434140 kb)

Video 6

Lysis of omentum from greater curvature of stomach (MPG 416357 kb) (MPG 416357 kb)

Video 7

Dissection near gastro-esophageal junction leading to complete visualization of left crura and phrenoesophageal membrane (MPG 68616 kb) (MPG 68616 kb)

Video 8

Dissection of greater omentum distally till 3–4 cm from pylorus (MPG 162452 kb) (MPG 162452 kb)

Video 9

Placement of the bougie into first part of duodenum (MPG 88075 kb) (MPG 88075 kb)

Video 10

Firing of first stapler after ensuring its placement away from incisura to avoid narrowing and stricture Creation of gastric sleeve using sequential firings of the stapler (MPG 171367 kb) (MPG 171367 kb)

Video 11

Creation of gastric sleeve using sequential firings of the stapler (MPG 372328 kb) (MPG 372328 kb)

Video 12

Firing of the last stapler (MPG 151679 kb) (MPG 151679 kb)

Video 13

Leak test using methylene blue dye (MPG 178669 kb) (MPG 178669 kb)

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Aggarwal, S., Gupta, M., Singla, V., Gagner, M. (2023). Laparoscopic Sleeve Gastrectomy: The Technique. In: Agrawal, S. (eds) Obesity, Bariatric and Metabolic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-60596-4_26

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  • DOI: https://doi.org/10.1007/978-3-030-60596-4_26

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-60595-7

  • Online ISBN: 978-3-030-60596-4

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