Surgical Endoscopy

, Volume 25, Issue 2, pp 444–449 | Cite as

Laparoscopic sleeve gastrectomy as first stage or definitive intent in 300 consecutive cases

  • N. BassoEmail author
  • G. Casella
  • M. Rizzello
  • F. Abbatini
  • E. Soricelli
  • G. Alessandri
  • C. Maglio
  • A. Fantini



Laparoscopic sleeve gastrectomy (SG) was originally used as a bridge to definitive surgery in high-risk patients. Recently it has been considered as a stand-alone procedure due to its effectiveness on weight loss and comorbidities resolution. This study was designed to evaluate the results of SG on complications, body mass index (BMI), and comorbidities resolution in 300 consecutive obese patients and to analyze the lesson learned from this experience.


From October 2002 to November 2009, 300 patients underwent SG. In the first 100 cases (group 1: mean BMI, 54.4 ± 9.3), SG was intended as a first stage of biliopancreatic diversion with duodenal switch in high risk super-obese patients. In the last 200 cases (group 2: mean BMI, 45.5 ± 7.3), SG was intended as a definitive procedure. No routine reinforcement was performed in group 1. In group 2, oversewn reinforcement was performed routinely. SG was redo surgery in 21 patients (7%).


Mean operative time was 119 ± 48.6 min in group 1 and 72 ± 33.8 in group 2. Conversion rate was 0.6% (massive hepatomegaly). Mortality was 0.6%. Major postoperative complications were registered in 15 patients in group 1 and 11 in group 2. In 3 cases, a reoperation was needed. The mean BMI in group 1 was 46, 43, 39, and 31 at 6, 12, 24, and 36 months, respectively. In group 2, the mean BMI was 32.9, 30.6, and 31.7 at 6, 12, and 18 months. At 12 months, the diabetes, hypertension, and OSAS were cured on 69%, 62%, and 50% in group 1 and 88%, 57%, and 58% in group 2. In group 2, no patient required second stage.


SG is a safe and effective treatment for morbid obesity at mid-term follow-up. SG is effective for comorbidities resolution, especially for the treatment of diabetes. Suture line reinforcement allows a significant reduction of bleeding.


Morbid obesity Sleeve gastrectomy Bariatric surgery 



Drs. Nicola Basso, Giovanni Casella, Mario Rizzello, Francesca Abbatini, Emanuele Soricelli, Giorgio Alessandri, Cristina Maglio, and Aldo Fantini have no conflicts of interest or financial ties to disclose.


  1. 1.
    James PT, Rigby N, Leach R, International Obesity Task Force (2004) The obesity epidemic, metabolic syndrome and future prevention strategies. Eur J Cardiovasc Prev Rehabil 11(1):3–8CrossRefPubMedGoogle Scholar
  2. 2.
    Haslam DW, James WP (2005) Obesity. Lancet 366(9492):1197–1209CrossRefPubMedGoogle Scholar
  3. 3.
    Mason EE, Renquist K, Jiang D (1992) Predictors of two obesity complications; diabetes and hypertension. Obes Surg 2(3):231–237CrossRefPubMedGoogle Scholar
  4. 4.
    Kral JG (2001) Morbidity of severe obesity. Surg Clin North Am 81(5):1039–1061CrossRefPubMedGoogle Scholar
  5. 5.
    Ren CJ, Patterson E, Gagner M (2000) Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg 10(6):514–523CrossRefPubMedGoogle Scholar
  6. 6.
    Silecchia G, Boru C, Pecchia A, Rizzello M, Casella G, Leonetti F, Basso N (2006) Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg 16(9):1138–1144CrossRefPubMedGoogle Scholar
  7. 7.
    Tucker ON, Szomstein S, Rosenthal RJ (2008) Indications for sleeve gastrectomy as a primary procedure for weight loss in the morbidly obese. J Gastrointest Surg 12(4):662–667CrossRefPubMedGoogle Scholar
  8. 8.
    Frezza EE (2007) Laparoscopic vertical sleeve gastrectomy for morbid obesity. The future procedure of choice? Surg Today 37(4):275–281CrossRefPubMedGoogle Scholar
  9. 9.
    Lee CM, Cirangle PT, Jossart GH (2007) Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc 21(10):1810–1816 Epub 2007 Mar 14CrossRefPubMedGoogle Scholar
  10. 10.
    Himpens J, Dapri G, Cadière GB (2006) A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg 16(11):1450–1456CrossRefPubMedGoogle Scholar
  11. 11.
    Cottam D, Qureshi FG, Mattar SG, Sharma S, Holover S, Bonanomi G, Ramanathan R, Schauer P (2006) Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc 20(6):859–863CrossRefPubMedGoogle Scholar
  12. 12.
    Moon Han S, Kim WW, Oh JH (2005) Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg 15(10):1469–1475CrossRefPubMedGoogle Scholar
  13. 13.
    Akkary E, Duffy A, Bell R (2008) Deciphering the sleeve: technique, indications, efficacy, and safety of sleeve gastrectomy. Obes Surg 18(10):1323–1329CrossRefPubMedGoogle Scholar
  14. 14.
    Karamanakos SN, Vagenas K, Kalfarentzos F, Alexandrides TK (2008) Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg 247(3):408–410CrossRefGoogle Scholar
  15. 15.
    Soricelli E, Casella G, Rizzello M Calì B, Alessandri G, Basso N (2010) Initial experience with laparoscopic crural closure in the management of hiatal hernia in obese patients undergoing sleeve gastrectomy. Obes Surg (Epub ahead of print)Google Scholar
  16. 16.
    Regan JP, Inabnet WB, Gagner M, Pomp A (2003) Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg 13(6):861–864CrossRefPubMedGoogle Scholar
  17. 17.
    Casella G, Soricelli E, Fantini A, Basso N (2010) A time-saving technique for specimen extraction in sleeve gastrectomy. World J Surg 34(4):765–767CrossRefPubMedGoogle Scholar
  18. 18.
    Casella G, Soricelli E, Rizzello M, Trentino P, Fiocca F, Fantini A, Salvatori FM, Basso N (2009) Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obes Surg 19(7):821–826CrossRefPubMedGoogle Scholar
  19. 19.
    Dapri G, Cadière GB, Himpens J (2010) Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing three different techniques. Obes Surg 20(4):462–467CrossRefPubMedGoogle Scholar
  20. 20.
    Consten EC, Gagner M, Pomp A, Inabnet WB (2004) Decreased bleeding after laparoscopic sleeve gastrectomy with or without duodenal switch for morbid obesity using a stapled buttressed absorbable polymer membrane. Obes Surg 14(10):1360–1366CrossRefPubMedGoogle Scholar
  21. 21.
    Gagner M, Deitel M, Kalberer TL, Erickson AL, Crosby RD (2009) The Second International Consensus Summit for Sleeve Gastrectomy, March 19–21, 2009. Surg Obes Relat Dis 5(4):476–485CrossRefPubMedGoogle Scholar
  22. 22.
    Burgos AM, Braghetto I, Csendes A, Maluenda F, Korn O, Yarmuch J, Gutierrez L (2009) Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg 19(12):1672–1677CrossRefPubMedGoogle Scholar
  23. 23.
    Croce E, Olmi S (2006) Chirurgia del reflusso gastroesofageo UTET, Torino, p 18Google Scholar
  24. 24.
    Suzuki K, Prates JC, DiDio LJ (1978) Incidence and surgical importance of the posterior gastric artery. Ann Surg 187(2):134–136CrossRefPubMedGoogle Scholar
  25. 25.
    Vidal J, Ibarzabal A, Romero F, Delgado S, Momblán D, Flores L, Lacy A (2008) Type 2 diabetes mellitus and the metabolic syndrome following sleeve gastrectomy in severely obese subjects. Obes Surg 18(9):1077–1082CrossRefPubMedGoogle Scholar
  26. 26.
    Abbatini F, Rizzello M, Casella G, Alessandri G, Capoccia D, Leonetti F, Basso N (2010) Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes. Surg Endosc 24(5):1005–1010CrossRefPubMedGoogle Scholar
  27. 27.
    Rizzello M, Abbatini F, Casella G, Alessandri G, Fantini A, Leonetti F, Basso N (2010) Early postoperative insulin-resistance changes after sleeve gastrectomy. Obes Surg 20(1):50–55CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • N. Basso
    • 1
    Email author
  • G. Casella
    • 1
  • M. Rizzello
    • 1
  • F. Abbatini
    • 1
  • E. Soricelli
    • 1
  • G. Alessandri
    • 1
  • C. Maglio
    • 2
  • A. Fantini
    • 1
  1. 1.Surgical-Medical Department for Digestive DiseasesPoliclinico “Umberto I,” University of Rome “Sapienza,”RomeItaly
  2. 2.Department of Clinical SciencesPoliclinico “Umberto I,” University of Rome “Sapienza,”RomeItaly

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