Advertisement

Obesity Surgery

, 17:1297 | Cite as

Laparoscopic Sleeve Gastrectomy — Influence of Sleeve Size and Resected Gastric Volume

  • Rudolf A. WeinerEmail author
  • Sylvia Weiner
  • Ingmar Pomhoff
  • Christoph Jacobi
  • Wojciech Makarewicz
  • Gerhard Weigand
Article

Background

Although the efficacy of laparoscopic sleeve gastrectomy (LSG) for morbidly obese patients with a BMI of <50 kg/m2, the incidence of weight gain by change of eating behaviors, and gastric dilatation following LSG have not been investigated thus far, LSG is becoming more common as a single-stage operation for the treatment morbid obesity.

Methods

This is a prospective study of the initial 120 patients who underwent isolated LSG. Initially, the LSG was performed without a calibration tube and resulted in high sleeve volumes (group 1: n=25). In group 2 (n=32), a calibration tube of 44 Fr and in group 3 (n=63) a calibration tube of 32 Fr were used. The study group consists of 101 patients with high BMI who were scheduled for a two-step LBPD-DS, but rejected the second step after 1 year. Study endpoints include estimated sleeve volume, volume of removed stomach, operative time, complication rates, length of hospital stay, changes in co-morbidity, percentage of excess BMI loss (%EBL) and changes in BMI (kg/m2).

Results

All 3 groups were comparable regarding age, gender, and co-morbidities. There was no hospital mortality, but there was one case of late mortality (0.8%). 2 early leaks (1.7%) were seen. % excess BMI loss was significantly higher for patients who underwent LSG with tube calibrations. LSG with large sleeve volume showed a slight weight gain during 5 years of observation. A total of 16 patients (13.3%) underwent a second stage procedure within a period of 5 years (2 redo-sleeves, 7 LBPD-DS, 3 LRYGBP).

Conclusion

Early weight loss results were not different between the groups, but after 2 years the more restrictive LSG (groups 2, 3) results were significantly better than in patients without calibration. A removed gastric volume of <500 cc seems to be a predictor of failure in treatment or early weight regain. A statistically significant improved health status and quality of life were registered for all groups. The general introduction of LSG as a one-stage restrictive procedure in the bariatric field can be considered only if the procedure is standardized and long-term results are available.

Key words

Morbid obesity bariatric surgery laparoscopic sleeve gastrectomy sleeve volume volume of removed stomach weight loss 

References

  1. 1.
    Mendez MA, Monteiro CA, Popkin BM. Overweight exceeds underweight among women in most developed countries. Am J Clin Nutr 2005; 81: 714–21.PubMedGoogle Scholar
  2. 2.
    Olshansky JF, Passeiro DJ, Hershow RC et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med 2005; 352: 1 1135–7.CrossRefGoogle Scholar
  3. 3.
    European Charter on Counteracting Obesity. www.euro.who.int/document/E89567.pdf (accessed January 16, 2007).
  4. 4.
    Chu CA, Gagner M, Quinn T et al. Two-stage laparoscopic biliopancreatic diversion with duodenal switch: an alternative approach to super-super morbid obesity. Surg Endosc 2003; 16: S069 (abst).Google Scholar
  5. 5.
    Gastrointestinal surgery for severe obesity. National Institutes of Health Consensus Development Conference Draft Statement. Obes Surg 1991; 1: 257–65.Google Scholar
  6. 6.
    Weiner S, Sauerland S, Fein M et al. The Bariatric Quality of Life (BQL) Index: A measure of well-being in obesity surgery patients. Obes Surg 2005; 15: 538–45.CrossRefPubMedGoogle Scholar
  7. 7.
    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
  8. 8.
    Johnston D, Sue-Ling HM. Surgical treatment of morbid obesity. In: Cushieri A, Giles C, Moosa AR, eds. Essential Surgical Practice. London: Butterworth-Heinemann 1995: 1036–44.Google Scholar
  9. 9.
    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
  10. 10.
    Kotidis EV, Koliakos GG, Baltzopoulos VG et al. Serum ghrelin, leptin and adiponectin levels before and after weight loss: comparison of three methods of treatment — a prospective study. Obes Surg 2006; 16: 1425–32.CrossRefPubMedGoogle Scholar
  11. 11.
    Baltasar A, Serra C, Perez N et al. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg 2005; 15: 1124–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Melissas J, Koukouraki S, Askoxylakis J et al. Sleeve gastrectomy: a restrictive procedure? Obes Surg 2007; 17: 57–62.CrossRefPubMedGoogle Scholar
  13. 13.
    Carmichael AR, Johnston D, Barker MCJ 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
  14. 14.
    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
  15. 15.
    Dornonville de la Cour C, Lindquist A, Egecioglu E et al. Ghrelin treatment reverses the reduction in weight gain and body fat in gastrectomized mice. Gut 2005; 54: 907–13.CrossRefPubMedGoogle Scholar
  16. 16.
    Frezza EE. Laparoscopic vertical sleeve gastrectomy for morbid obesity. The future procedure of choice? Surg Today 2007; 37: 275–81.CrossRefPubMedGoogle Scholar
  17. 17.
    Ueda K, Gagner M, Milone L et al. Sleeve gastrectomy with wrapping using polytetrafluoroethylene to prevent gastric enlargement in a porcine model. Surg Obes Relat Dis 2007; (Epub ahead of print).Google Scholar
  18. 18.
    Sjöström L, Nabro K, Sjöstrom CD et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007; 357: 741–52.CrossRefPubMedGoogle Scholar
  19. 19.
    Han MS, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg 2005; 15: 1469–75.CrossRefGoogle Scholar
  20. 20.
    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
  21. 21.
    Baltasar A, Serra C, Perez N et al. Re-sleeve gastrectomy. Obes Surg 2006; 16: 1535–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Cohen R, Uzzan B, Bihan H et al. Ghrelin levels and sleeve gastrectomy in super-super-obesity (Letter). Obes Surg 2005; 15: 1501–2.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Rudolf A. Weiner
    • 1
    • 4
    Email author
  • Sylvia Weiner
    • 1
  • Ingmar Pomhoff
    • 1
  • Christoph Jacobi
    • 2
  • Wojciech Makarewicz
    • 3
  • Gerhard Weigand
    • 1
  1. 1.Center for Minimal-Invasive Surgery, Department of General and Bariatric SurgeryKrankenhaus SachsenhausenFrankfurt/M.Germany
  2. 2.Department of Surgery (Charite`)Humboldt-UniversityBerlinGermany
  3. 3.Department of General, Endocrine and Transplant SurgeryMedical University of GdanskGdanskPoland
  4. 4.Department of SurgeryKrankenhaus SachsenhausenFrankfurt am MainGermany

Personalised recommendations