Obesity Surgery

, Volume 18, Issue 12, pp 1567–1570 | Cite as

Laparoscopic Sleeve Gastrectomy with Minimal Morbidity Early Results in 120 Morbidly Obese Patients

  • Moshe RubinEmail author
  • Ronit Tzioni Yehoshua
  • Michael Stein
  • Doron Lederfein
  • Suzana Fichman
  • Hanna Bernstine
  • Leonid A. Eidelman
Research Article



In recent years, laparoscopic sleeve gastrectomy (LSG) as a single-stage procedure for the treatment of morbid obesity is becoming increasingly popular. Of continuing concern are the rate of postoperative complications and the lack of consensus as to surgical technique.


A prospective study assessment was made of 120 consecutive morbidly obese patients with body mass index (BMI) of 43 ± 5 (30 to 63), who underwent LSG using the following technique: (1) division of the vascular supply of the greater gastric curvature and application of the linear stapler-cutter device beginning at 6–7 cm from the pylorus so that part of the antrum remains; (2) inversion of the staple line by placement of a seroserosal continuous suture close to the staple line; (3) use of a 48 Fr bougie so as to avoid possible stricture; (4) firing of the stapler parallel to the bougie to make the sleeve as narrow as possible and prevent segmental dilatation.


Intraoperative difficulties were encountered in four patients. There were no postoperative complications—no hemorrhage from the staple line, no anastomotic leakage or stricture, and no mortality. In 20 patients prior to the sleeve procedure, a gastric band was removed. During a median follow-up of 11.7 months (range 2–31 months), percent of excess BMI lost reached 53 ± 24% and the BMI decreased from 43 ± 5 to 34 ± 5 kg/m2. Patient satisfaction scoring (1–4) at least 1 year after surgery was 3.6 ± 0.8.


The good early results obtained with the above-outlined surgical technique in 120 consecutive patients undergoing LSG indicate that it is a safe and effective procedure for morbid obesity. However, long-term results are still pending.


Bariatric surgery Sleeve gastrectomy Laparoscopy Morbid obesity 



The authors thank Ruth Fradkin for her assistance.


  1. 1.
    Mognol P, Chosidow C, Marmuse JP. Laparoscopic sleeve gastrectomy as an initial bariatric operation for high-risk patients: initial results in 10 patients. Obes Surg 2005;15:1030–3.PubMedCrossRefGoogle Scholar
  2. 2.
    Cottam D, Qureshi FG, Mattar G, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc 2006;20:859–63.PubMedCrossRefGoogle Scholar
  3. 3.
    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
  4. 4.
    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
  5. 5.
    Bernante P, Foletto M, Busetto L, et al. Feasibility of laparoscopic sleeve gastrectomy as a revision procedure for prior laparoscopic gastric banding. Obes Surg 2006;16:1327–30.PubMedCrossRefGoogle Scholar
  6. 6.
    Roa PA, Kaidar-Person O, Pinto D, et al. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg 2006;16:1323–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Givon-Madhala O, Spector R, Wasserberg N, et al. Technical aspects of laparoscopic sleeve gastrectomy in 25 morbidly obese patients. Obes Surg 2007;17:722–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Gumbs A, Gagner M, Dakin G, et al. Sleeve gastrectomy for morbid obesity. Obes Surg 2007;17:962–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Lalor PF, Tucker ON, Szomstein S, et al. Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2008;4:33–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Lee CM, Cirangle PT, Jossart GH. Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc 2007;21:1810–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Baltasar A, Serra C, Pérez N, et al. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg 2005;15:1124–8.PubMedCrossRefGoogle Scholar
  12. 12.
    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
  13. 13.
    Benjaminov N, Beglaibter L, Gindy R, et al. The effect of low-carbohydrate diet on the nonalcoholic fatty liver in morbidly obese patients prior to bariatric surgery. Surg Endosc 2007;21:1423–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Milone L, Strong V, Gagner M. Laparoscopic sleeve gastrectomy is superior to endoscopic intragastric balloon as a first stage procedure for super-obese patients. Obes Surg 2005;15:615–7.CrossRefGoogle Scholar
  15. 15.
    Serra C, Baltasar A, Andreo L, et al. Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. Obes Surg 2007;17:1408–10.PubMedCrossRefGoogle Scholar
  16. 16.
    Constent ECJ, Dakin GF, Gagner M. Intraluminal migration of bovine pericardial strips used to reinforce the gastric staple-line in laparoscopic bariatric surgery. Obes Surg 2004;14:549–54.CrossRefGoogle Scholar
  17. 17.
    Shikora SA, Kim JJ, Tarnoff ME. Reinforcing gastric staple-lines with bovine pericardial strips may decrease the likelihood of gastric leak after laparoscopic Roux-en-y gastric bypass. Obes Surg 2003;13:37–44.PubMedCrossRefGoogle Scholar
  18. 18.
    Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy—volume and pressure assessment. Obes Surg 2008 doi: 10.1007/s11695-008-9576-x.
  19. 19.
    Silecchia G, Boru C, Pecchia A, et al. 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;16:1138–44.PubMedCrossRefGoogle Scholar
  20. 20.
    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
  21. 21.
    Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy—a restrictive procedure? Obes Surg 2007;17:57–62.PubMedCrossRefGoogle Scholar
  22. 22.
    Van Hout GCM, Vreeswijk CMJ, Van Heck GL. Bariatric surgery and bariatric psychology: evolution of the Dutch approach. Obes Surg 2008;18:321–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Moshe Rubin
    • 1
    • 4
    • 6
    Email author
  • Ronit Tzioni Yehoshua
    • 1
  • Michael Stein
    • 4
  • Doron Lederfein
    • 1
  • Suzana Fichman
    • 3
  • Hanna Bernstine
    • 5
  • Leonid A. Eidelman
    • 2
  1. 1.Felsenstein Medical Research Center, Beilinson Campus, Petach-Tikva, Sackler School of MedicineTel-Aviv UniversityTel-AvivIsrael
  2. 2.Department of Anesthesiology, Beilinson Campus, Petach-Tikva, Sackler School of MedicineTel-Aviv UniversityTel-AvivIsrael
  3. 3.Department of Pathology, Beilinson Campus, Petach-Tikva, Sackler School of MedicineTel-Aviv UniversityTel-AvivIsrael
  4. 4.Department of Surgery, Beilinson Campus, Petach-Tikva, Sackler School of MedicineTel-Aviv UniversityTel-AvivIsrael
  5. 5.Department of Nuclear Medicine, Beilinson Campus, Petach-Tikva, Sackler School of MedicineTel-Aviv UniversityTel-AvivIsrael
  6. 6.Department of Surgery “B”Rabin Medical CenterPetah TiqvaIsrael

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