Obesity Surgery

, 17:57 | Cite as

Sleeve Gastrectomy — A Restrictive Procedure?

  • John Melissas
  • Sofia Koukouraki
  • John Askoxylakis
  • Maria Stathaki
  • Markos Daskalakis
  • Kostas Perisinakis
  • Nikos Karkavitsas


Diet and surgically-induced weight loss have been shown to lead to alterations in motor and sensory function of the stomach.We investigated the clinical outcome and gastric emptying of solid foods in morbidly obese (MO) patients following sleeve gastrectomy (SG).


We studied 23 MO patients [(7 males, 16 females), mean age 38.9 ±11.0 years (range 20–64 years), mean weight 135.1 ±19.0 kg (range 97–167 kg), mean BMI 47.2 ±4.8 kg/m2 (range 39.6–56.0 kg/m2)] who each underwent a sleeve gastrectomy (SG) for weight reduction. At the monthly follow-up visits, variations in weight and BMI changes, postoperative meal size and frequency, and presence of gastrointestinal symptoms were recorded. 11 patients underwent scintigraphic measurement of the gastric emptying of a solid meal pre- and 6 months postoperatively.


A significant reduction in patients’ weight was evidenced at 6 and 12 months postoperatively [98.6 ±11.8 kg and 87.0 ±10.7 kg respectively (P=0.001)]. BMI decreased to 35.2 ±4.3 kg/m2 at 6 months and to 31.1 ±4.5 kg/m2 at 12 months, respectively (P=0.001). Although meal size was drastically reduced, meal frequency increased postoperatively in 12 patients (52.2%). Only 5 patients (21.8%) reported occasional vomiting after meals following SG. The gastric emptying half-time (T1/2) accelerated (47.6 ±23.2 vs. 94.3 ±15.4, P<0.01) and the T-lag phase duration decreased (9.5 ±2 min vs. 19.2 ±2 min, P<0.05) postoperatively. The percentage of the meal emptied from the stomach 90 min after consumption increased significantly after SG (75.4 ±14.9% vs. 49.2 ±8.7%, P<0.01).


This study indicates that following SG, the stomach empties its contents rapidly into the small intestine and symptoms of vomiting after eating (characteristic of restrictive procedures) are either absent or very mild. Therefore, the term ‘restrictive’ is possibly ill-advised for this new bariatric operation. It remains for other mechanisms of energy intake reduction, such as intestinal distension and satiety signals through gut hormones to be investigated, to comprehensively explain precisely how this ‘food limiting’ procedure results in weight loss.

Key words

Morbid obesity sleeve gastrectomy bariatric surgery scintigraphy gastric emptying 


  1. 1.
    Deitel M. The obesity epidemic. Obes Surg 2006; 16: 377–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obes Surg 2004; 14: 492–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Melissas J, Christodoulakis M, Schoretsanitis G et al. Obesityassociated disorders before and after weight reduction by vertical banded gastroplasty in morbidly vs. super obese individuals. Obes Surg 2001; 11: 475–81.CrossRefPubMedGoogle Scholar
  4. 4.
    Melissas J, Christodoulakis M, Spyridakis M et al. Disorders associated with clinically severe obesity: significant improvement after surgical weight reduction. South Med J 1998; 91: 1143–8.PubMedGoogle Scholar
  5. 5.
    Regan JP, Inabnet WB, Gagner M et al. 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.CrossRefPubMedGoogle Scholar
  6. 6.
    Baltasar A, Serra C, Pérez N et al. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg 2005; 15: 1124–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Mistiaen W, Vaneerdeweg W, Blockx P et al. Gastric emptying rate measurement after vertical banded gastroplasty. Obes Surg 2000; 10: 245–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Tosetti C, Cordinaldesi R, Stanghellini V et al. Gastric emptying of solids in morbid obesity. Int J Obes 1996; 20: 200–5.Google Scholar
  9. 9.
    Naslund E, Gryback P, Backman L et al. Distal small bowel hormones; correlation with fasting antroduodenal motility and gastric emptying. Dig Dis Sci 1998; 43: 945–52.CrossRefPubMedGoogle Scholar
  10. 10.
    Mion F, Napoleon B, Roman S et al. Effects of intragastric balloon on gastric emptying and plasma ghrelin levels in non-morbid obese patients. Obes Surg 2005; 15: 510–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Nasreddine L, Hwalla N, Sibai A et al. Food consumption patterns in an adult population in Beirut, Lebanon. Public Health Nutr 2006; 9: 194–203.CrossRefPubMedGoogle Scholar
  12. 12.
    Deitel M, Greenstein RJ. Recommendations for reporting weight loss. Obes Surg 2003; 13: 159–60.CrossRefPubMedGoogle Scholar
  13. 13.
    Ziessman HA, Fahey FH, Atkins FB et al. Standarization and quantification of radionuclide solid gastric-emptying studies. J Nucl Med 2004; 45: 760–4.PubMedGoogle Scholar
  14. 14.
    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: 859–63.CrossRefPubMedGoogle Scholar
  15. 15.
    Gagner M, Rogula T. Laparoscopic reoperative sleeve gastrectomy for poor weight loss after biliopancreatic diversion with duodenal switch. Obes Surg 2003; 13: 649–54.CrossRefPubMedGoogle Scholar
  16. 16.
    Johnston D, Dachtler J, Sue-Ling HM et al. The Magenstrasse and Mill operation for morbid obesity. Obes Surg 2003; 13: 10–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Carmichael AR, Johnston D, Barker MC et al. Gastric emptying after a new, more physiological anti-obesity operation: the Magenstrasse and Mill procedure. Eur J Nucl Med 2001; 28: 1379–83.CrossRefPubMedGoogle Scholar
  18. 18.
    Horowitz M, Collins PJ, Chatterton BE et al. Gastric emptying after gastroplasty for morbid obesity. Br J Surg 1984; 71: 435–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Gannon MX, Pears DJ, Chandler ST et al. The effect of gastric partitioning on gastric emptying in morbidly obese patients. Br J Surg 1985; 72: 952–4.CrossRefPubMedGoogle Scholar
  20. 20.
    Bended N, Livshitz G, Mindlin L et al. Gastric emptying half-time following silastic ring vertical gastroplasty: a scintigraphic study. Obes Surg 1996; 6: 459–62.CrossRefPubMedGoogle Scholar
  21. 21.
    Christian PE, Datz FL, Moore JG. Gastric emptying studies in the morbidly obese before and after gastroplasty. J Nucl Med 1986; 27: 1686–90.PubMedGoogle Scholar
  22. 22.
    Behrns KE, Soper NJ, Sarr MG et al. Anatomic, motor, and clinical assessment of vertical banded gastroplasty. Gastroenterology 1989; 97: 91–7.PubMedGoogle Scholar
  23. 23.
    Sturm K, Parker B, Wishart J et al. Energy intake and appetite are related to antral area in healthy young and older subjects. Am J Clin Nutr 2004; 80: 656–67.PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • John Melissas
    • 1
    • 4
  • Sofia Koukouraki
    • 2
  • John Askoxylakis
    • 1
  • Maria Stathaki
    • 2
  • Markos Daskalakis
    • 1
  • Kostas Perisinakis
    • 3
  • Nikos Karkavitsas
    • 2
  1. 1.Bariatric Unit and Department of Surgical OncologyCreteGreece
  2. 2.Departments of Nuclear MedicineHeraklion University Hospital, Faculty of Medicine, University of CreteCreteGreece
  3. 3.Medical PhysicsHeraklion University Hospital, Faculty of Medicine, University of CreteCreteGreece
  4. 4.CreteGreece

Personalised recommendations