Obesity Surgery

, Volume 18, Issue 10, pp 1251–1256 | Cite as

Sleeve Gastrectomy—A “Food Limiting” Operation

  • John Melissas
  • Markos Daskalakis
  • Sophia Koukouraki
  • Ioannis Askoxylakis
  • Maria Metaxari
  • Efstathios Dimitriadis
  • Maria Stathaki
  • John A. Papadakis
Research Article



Sleeve gastrectomy (SG), which, thus far, is showing good resolution of comorbidities and good weight loss, shows increasing popularity among bariatric surgeons. The aim of this study was to evaluate clinical outcome and the gastric emptying of solid foods, 24 months after SG.


Fourteen morbidly obese patients, four males and ten females, median age 41 years (range 29–65), median body mass index (BMI) 49.46 kg/m2 (range 41.14–55.63), who underwent SG for weight loss, were studied prospectively. Nine patients underwent gastric emptying studies, using radioisotopic technique before, 6 months and 24 months after the operation. The remaining five patients underwent gastric emptying studies, 6 months and 24 months after the operation.


A significant reduction in patients’ weight and BMI was evident at 6, 12 and 24 months postoperatively. In the nine patients who underwent gastric emptying studies pre-, 6 and 24 months postoperatively, the T-lag phase duration significantly decreased, following the SG, from 17.30 (range 15.50–20.90) min, to 12.50 (range 9.20–18.00) min at 6 months and 12.16 (range 10.90–20.00) min at 24 months postoperatively (P < 0.05). The gastric emptying half time (T1/2) accelerated significantly postoperatively from 86.50 (range 77.50–104.60) min, to 62.50 (range 46.30–80.00) min at 6 months and 60.80 (range 54.80–100.00) min at 24 months after SG (P < 0.05). The percentage of gastric emptying (%GE) increased significantly postoperatively, from 52 (range 43–58) % to 72 (range 57–97) % at 6 months and 74 (range 45–82) % at 24 months, following SG (P < 0.05). No differences in gastric emptying were observed, when values at 24 months were compared to those at 6 months postoperatively. When the whole group of 14 patients was studied, there were also no significant changes in T-lag, T1/2 and %GE between 6 and 24 months postoperatively.


Our study indicates the constant effect of SG in the acceleration of gastric emptying of solids, which occurs faster, not only in short but also in long-term postoperatively. Such effects on gastric motility, in combination with the reported alterations in gut hormones, may explain how this ‘food limiting’ operation results in weight loss.


Sleeve gastrectomy Morbid obesity Bariatric surgery Gastric emptying Scintigraphy 


  1. 1.
    World Health Organization fact sheet No 311, September 2006.
  2. 2.
    Deitel M. The obesity epidemic. Obes Surg. 2006;16:377–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRefGoogle Scholar
  4. 4.
    Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59.PubMedGoogle Scholar
  5. 5.
    Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240:416–23.PubMedCrossRefGoogle Scholar
  6. 6.
    Melissas J. IFSO guidelines for safety, quality, and excellence in bariatric surgery. Obes Surg. 2008;18:497–500.PubMedCrossRefGoogle Scholar
  7. 7.
    Baltasar A, Serra C, Pérez N, et al. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg. 2005;15:1124–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg. 2008;18:487–96.PubMedCrossRefGoogle Scholar
  9. 9.
    Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obes Surg. 2004;14:492–7.PubMedCrossRefGoogle Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    Tucker ON, Szomstein S, Rosenthal RJ. Indications for sleeve gastrectomy as a primary procedure for weight loss in the morbidly obese. J Gastrointest Surg. 2008;12:662–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Näslund E, Hellström PM, Kral JG. The gut and food intake: an update for surgeons. J Gastrointest Surg. 2001;5:556–67.PubMedCrossRefGoogle Scholar
  13. 13.
    Wynne K, Stanley S, Bloom S. The gut and regulation of body weight. J Clin Endocrinol Metab. 2004;89:2576–82.PubMedCrossRefGoogle Scholar
  14. 14.
    Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy: a restrictive procedure? Obes Surg. 2007;17:57–62.PubMedCrossRefGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    Deitel M, Gawdat K, Melissas J. Reporting weight loss 2007. Obes Surg. 2007;17:565–68.PubMedCrossRefGoogle Scholar
  17. 17.
    Ziessman HA, Fahey FH, Atkins FB, et al. Standardization and quantification of radionuclide solid gastric-emptying studies. J Nucl Med. 2004;45:760–4.PubMedGoogle Scholar
  18. 18.
    Tosetti C, Corinaldesi R, Stanghellini V, et al. Gastric emptying of solids in morbid obesity. Int J Obes Relat Metab Disord. 1996;20:200–5.PubMedGoogle Scholar
  19. 19.
    Verdich C, Madsen JL, Toubro S, et al. Effect of obesity and major weight reduction on gastric emptying. Int J Obes Relat Metab Disord. 2000;24:899–905.PubMedCrossRefGoogle Scholar
  20. 20.
    Jackson SJ, Leahy FE, McGowan AA, et al. Delayed gastric emptying in the obese: an assessment using the non-invasive (13)C-octanoic acid breath test. Diabetes Obes Metab. 2004;6:264–70.PubMedCrossRefGoogle Scholar
  21. 21.
    Mistiaen W, Vaneerdeweg W, Blockx P, et al. Gastric emptying rate measurement after vertical banded gastroplasty. Obes Surg. 2000;10:245–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Nocca D, Krawczykowsky D, Bomans B, et al. A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obes Surg. 2008;18:560–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Melissas J, Christodoulakis M, Schoretsanitis G, et al. Obesity-associated disorders before and after weight reduction by vertical banded gastroplasty in morbidly vs super obese individuals. Obes Surg. 2001;11:475–81.PubMedCrossRefGoogle Scholar
  24. 24.
    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.PubMedCrossRefGoogle Scholar
  25. 25.
    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.PubMedCrossRefGoogle Scholar
  26. 26.
    Weiner RA, Weiner S, Pomhoff I, et al. Laparoscopic sleeve gastrectomy—influence of sleeve size and resected gastric volume. Obes Surg. 2007;17:1297–305.PubMedCrossRefGoogle Scholar
  27. 27.
    Kojima M, Hosoda H, Date Y, et al. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature. 1999;402:656–60.PubMedCrossRefGoogle Scholar
  28. 28.
    Lee HM, Wang G, Englander EW, et al. Ghrelin, a new gastrointestinal endocrine peptide that stimulates insulin secretion: enteric distribution, ontogeny, influence of endocrine and dietary manipulations. Endocrinology. 2002;143:185–90.PubMedCrossRefGoogle Scholar
  29. 29.
    Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15:1024–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Kotidis EV, Koliakos G, Papavramidis TS, et al. 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;16:554–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Morinigo R, Moizé V, Musri M, et al. Glucagon-like peptide-1, peptide YY, hunger and satiety after gastric bypass surgery in morbidly obese subjects. J Clin Endocrinol Metab. 2006;91:1735–40.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • John Melissas
    • 1
  • Markos Daskalakis
    • 1
  • Sophia Koukouraki
    • 2
  • Ioannis Askoxylakis
    • 1
  • Maria Metaxari
    • 3
  • Efstathios Dimitriadis
    • 1
  • Maria Stathaki
    • 2
  • John A. Papadakis
    • 4
  1. 1.Bariatric Unit Department of Surgical Oncology, Heraklion University Hospital, Medical SchoolUniversity of CreteCreteGreece
  2. 2.Department of Nuclear Medicine, Heraklion University Hospital, Medical SchoolUniversity of CreteCreteGreece
  3. 3.Department of Anaesthesiology, Heraklion University Hospital, Medical SchoolUniversity of CreteCreteGreece
  4. 4.Department of Internal Medicine, Heraklion University Hospital, Medical SchoolUniversity of CreteCreteGreece

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