Journal of Gastrointestinal Surgery

, Volume 12, Issue 4, pp 662–667 | Cite as

Indications for Sleeve Gastrectomy as a Primary Procedure for Weight Loss in the Morbidly Obese

ssat poster presetation

Abstract

Background

Single-stage laparoscopic sleeve gastrectomy (LSG) may represent an additional surgical option for morbid obesity.

Methods

We performed a retrospective review of a prospectively maintained database of LSG performed from November 2004 to April 2007 as a one-stage primary restrictive procedure.

Results

One hundred forty-eight LSGs were performed as primary procedures for weight loss. The mean patient age was 42 years (range, 13–79), mean body mass index of 43.4 kg/m2 (range, 35–75), mean operative time of 60 min (range, 58–190), and mean blood loss of 60 ml (range, 0–300). One hundred forty-seven procedures (99.3%) were completed laparoscopically, with a mean hospital stay of 2.7 days (range, 2–25). A 2.7% major complication rate was observed with four events in three patients and no deaths. Four patients required readmission; mild dehydration in two, choledocholithiasis in one, and a gastric sleeve stricture in one.

Conclusion

Laparoscopic SG is a safe one-stage restrictive technique as a primary procedure for weight loss in the morbidly obese with an acceptable operative time, intraoperative blood loss, and perioperative complication rate.

Keywords

Bariatric surgery Laparoscopy Morbid obesity Roux-en-Y-gastric bypass Sleeve gastrectomy 

Abbreviations

BPD-DS

biliopancreatic diversion with duodenal switch

BMI

body mass index

GE

gastroesophageal

LAGB

laparoscopic adjustable gastric banding

LRYGB

laparoscopic Roux-en-Y gastric bypass

LSG

laparoscopic sleeve gastrectomy

POD

postoperative day

SG

sleeve gastrectomy

References

  1. 1.
    Maggard MA, Shugarman LR, Suttorp M, Maglione M, Sugerman HJ, Livingston EH, Nguyen NT, Li Z, Mojica WA, Hilton L, Rhodes S, Morton SC, Shekelle PG. Meta-analysis: surgical treatment of obesity. Ann Intern Med 2005;142(7):547–559.PubMedGoogle Scholar
  2. 2.
    DeMaria EJ, Schauer P, Patterson E, Nguyen NT, Jacob BP, Inabnet WB, Buchwald H. The optimal surgical management of the super-obese patient: the debate. Presented at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons, Hollywood, FL, USA, April 13–16, 2005. Surg Innov 2005;12(2):107–121.PubMedCrossRefGoogle Scholar
  3. 3.
    Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg 1998;8(3):267–282.PubMedCrossRefGoogle Scholar
  4. 4.
    Marceau P, Biron S, St Georges R, Duclos M, Potvin M, Bourque RA. Biliopancreatic diversion with gastrectomy as surgical treatment of morbid obesity. Obes Surg 1991;1(4):381–387.PubMedCrossRefGoogle Scholar
  5. 5.
    Scopinaro N, Adami GF, Marinari GM, Gianetta E, Traverso E, Friedman D, Camerini G, Baschieri G, Simonelli A. Biliopancreatic diversion. World J Surg 1998;22(9):936–946.PubMedCrossRefGoogle Scholar
  6. 6.
    Hess DS, Hess DW, Oakley RS. The biliopancreatic diversion with the duodenal switch: results beyond 10 years. Obes Surg 2005;15(3):408–416.PubMedGoogle Scholar
  7. 7.
    Marceau P, Hould FS, Simard S, Lebel S, Bourque RA, Potvin M, Biron S. Biliopancreatic diversion with duodenal switch. World J Surg 1998;22(9):947–954.PubMedCrossRefGoogle Scholar
  8. 8.
    Ren CJ, Patterson E, Gagner M. Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg 2000;10(6):514–523.PubMedCrossRefGoogle Scholar
  9. 9.
    Feng JJ, Gagner M. Laparoscopic biliopancreatic diversion with duodenal switch. Semin Laparosc Surg 2002;9(2):125–129.PubMedCrossRefGoogle Scholar
  10. 10.
    Cottam D, Qureshi FG, Mattar SG, Sharma S, Holover S, Bonanomi G, Ramanathan R, Schauer P. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc 2006;20(6):859–863.PubMedCrossRefGoogle Scholar
  11. 11.
    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):1030–1033.PubMedCrossRefGoogle Scholar
  12. 12.
    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):861–864.PubMedCrossRefGoogle Scholar
  13. 13.
    Moon HS, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg 2005;15(10):1469–1475.CrossRefGoogle Scholar
  14. 14.
    Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obes Surg 2004;14(4):492–497.PubMedCrossRefGoogle Scholar
  15. 15.
    Baltasar A, Serra C, Perez N, Bou R, Bengochea M, Ferri L. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg 2005;15(8):1124–1128.PubMedCrossRefGoogle Scholar
  16. 16.
    Serra C, Perez N, Bou R, Bengochea M, Martinez R, Baltasar A. Laparoscopic sleeve gastrectomy. A bariatric procedure with multiple indications. Cir Esp 2006;79(5):289–292.PubMedCrossRefGoogle Scholar
  17. 17.
    Roa PE, Kaidar-Person O, Pinto D, Cho M, Szomstein S, Rosenthal RJ. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg 2006;16(10):1323–1326.PubMedCrossRefGoogle Scholar
  18. 18.
    Hamoui N, Anthone GJ, Kaufman HS, Crookes PF. Sleeve gastrectomy in the high-risk patient. Obes Surg 2006;16(11):1445–1449.PubMedCrossRefGoogle Scholar
  19. 19.
    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):1450–1456.PubMedCrossRefGoogle Scholar
  20. 20.
    National Institutes of Health. Gastrointestinal surgery for severe obesity. NIH Consens Statement 1991;9(1):1–20.Google Scholar
  21. 21.
    Langer FB, Reza Hoda MA, Bohdjalian A, Felberbauer FX, Zacherl J, Wenzl E, Schindler K, Luger A, Ludvik B, Prager G. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg 2005;15(7):1024–1029.PubMedCrossRefGoogle Scholar
  22. 22.
    Kotidis EV, Koliakos G, Papavramidis TS, Papavramidis ST. The effect of biliopancreatic diversion with pylorus-preserving sleeve gastrectomy and duodenal switch on fasting serum ghrelin, leptin and adiponectin levels: is there a hormonal contribution to the weight-reducing effect of this procedure? Obes Surg 2006;16(5):554–559.PubMedCrossRefGoogle Scholar
  23. 23.
    Cohen R, Uzzan B, Bihan H, Khochtali I, Reach G, Catheline JM. Ghrelin levels and sleeve gastrectomy in super–super obesity. Obes Surg 2005;15(10):1501–1502.PubMedCrossRefGoogle Scholar
  24. 24.
    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):612–617.PubMedCrossRefGoogle Scholar
  25. 25.
    Silecchia G, Boru C, Pecchia A, Rizzello M, Casella G, Leonetti F, Basso N. 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):1138–1144.PubMedCrossRefGoogle Scholar
  26. 26.
    Langer FB, Bohdjalian A, Felberbauer FX, Fleischmann E, Reza Hoda MA, Ludvik B, Zacherl J, Jakesz R, Prager G. Does gastric dilatation limit the success of sleeve gastrectomy as a sole operation for morbid obesity? Obes Surg 2006;16(2):166–171.PubMedCrossRefGoogle Scholar
  27. 27.
    Gagner M, Rogula T. Laparoscopic reoperative sleeve gastrectomy for poor weight loss after biliopancreatic diversion with duodenal switch. Obes Surg 2003;13(4):649–654.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2008

Authors and Affiliations

  1. 1.The Bariatric Institute, Cleveland Clinic FloridaWestonUSA

Personalised recommendations