Obesity Surgery

, Volume 20, Issue 8, pp 1171–1177 | Cite as

A Review of Laparoscopic Sleeve Gastrectomy for Morbid Obesity

  • Xinzhe ShiEmail author
  • Shahzeer Karmali
  • Arya M. Sharma
  • Daniel W. Birch


Laparoscopic sleeve gastrectomy (LSG) is an innovative approach to the surgical management of morbid obesity. Weight loss may be achieved by restrictive and endocrine mechanisms. Early data suggest LSG is efficacious in the management of morbid obesity and may have an important role either as a staged or definitive procedure. A systematic review of the literature analyzing the clinical and operational outcomes of LSG was completed to further define the status of LSG as an emerging treatment modality for morbid obesity. Data from LSG were compared to benchmark clinical data and local operational data from laparoscopic adjustable gastric band (LAGB) and laparoscopic gastric bypass (LRYGB). Fifteen studies (940 patients) were identified following systematic review. The percent excessive weight loss (%EWL) for LSG varied from 33% to 90% and appeared to be sustained up to 3 years. The mortality rate was 0-3.3% and major complications ranged from 0% to 29% (average 12.1%). Operative time ranged from 49 to 143 min (average 100.4 min). Hospital stay varied from 1.9 to 8 days (average 4.4 days). The operational impact of LSG has not been described in the literature. According to data from the Royal Alexandra Hospital, the estimated total cost of LSG was $10,317 CAD as compared to LAGB ($7,536 CAD) and LRYGB ($11,666 CAD). These costs did not include further surgical interventions which may be required for an undefined group of patients after LSG. Early, non-randomized data suggest that LSG is efficacious in the surgical management of morbid obesity. However, it is not clear if weight loss following LSG is sustainable in the long term and therefore it is not possible to determine what percent of patients may require further revisional surgery following LSG. The operational impact of LSG as a staged or definitive procedure is poorly defined and must be analyzed further in order to establish its overall health care costs and operational impact. Although LSG is a promising treatment option for patients with morbid obesity, its role remains undefined and it should be considered an investigational procedure that may require revision in a subset of patients.


Laparoscopic Sleeve gastrectomy Morbid Obesity 


Conflict of interest disclosure

The authors declare that they have no conflict of interest.


  1. 1.
    Chronic disease information sheets [database on the Internet]. Accessed 9 June 2009.
  2. 2.
    The International Classification of adult underweight, overweight and obesity according to BMI. Global database 2004. Accessed 28 Apr 2009.Google Scholar
  3. 3.
    Tjepkema M. Adult obesity. Health Rep. 2006;17(3):9–25.PubMedGoogle Scholar
  4. 4.
    IARC. Internation Agency for Research on Cancer: Food, nutrition, physical activity and the prevention of cancer: a global perspective. 2005 [updated 2005; cited]. Accessed 9 June 2009.
  5. 5.
    Calle EE, Rodriguez C, Walker-Thurmond K. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med. 2003;348(17):1625–38.CrossRefPubMedGoogle Scholar
  6. 6.
    Carmichael AR. Obesity and prognosis of breast cancer. Obes Rev. 2006;7(4):333–40.CrossRefPubMedGoogle Scholar
  7. 7.
    Gong Z, Agalliu I, Lin DW. Obesity is associated with increased risks of prostate cancer metastasis and death after initial cancer diagnosis in middle-aged men. Cancer. 2007;109(6):1192–202.CrossRefPubMedGoogle Scholar
  8. 8.
    Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339–50. discussion 50-2.CrossRefPubMedGoogle Scholar
  9. 9.
    NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115(12):956–61.Google Scholar
  10. 10.
    Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234(3):279–89. discussion 89-91.CrossRefPubMedGoogle Scholar
  11. 11.
    Buchwald H. Consensus conference statement bariatric surgery for morbid obesity: health implications for patients, health professionals, and third party payers. Surg Obes Relat Dis. 2005;1(3):371–81.CrossRefPubMedGoogle Scholar
  12. 12.
    Frezza EE. Laparoscopic vertical sleeve gastrectomy for morbid obesity. The future procedure of choice? Surg Today. 2007;37(4):275–81.CrossRefPubMedGoogle Scholar
  13. 13.
    Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15(7):1024–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Arias E, Martinez PR, Ka Ming Li V. Mid-term follow-up after sleeve gastrectomy as a final approach for morbid obesity. Obes Surg. 2009;19(5):544–8.CrossRefPubMedGoogle Scholar
  15. 15.
    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(5):560–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy: a restrictive procedure? Obes Surg. 2007;17(1):57–62.CrossRefPubMedGoogle Scholar
  17. 17.
    Lee CM, Cirangle PT, Jossart GH. Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc. 2007;21(10):1810–6.CrossRefPubMedGoogle Scholar
  18. 18.
    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(9):1138–44.CrossRefPubMedGoogle Scholar
  19. 19.
    Roa PE, Kaidar-Person O, Pinto D. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg. 2006;16(10):1323–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Langer FB, Bohdjalian A, Felberbauer FX, et al. Does gastric dilatation limit the success of sleeve gastrectomy as a sole operation for morbid obesity? Obes Surg. 2006;16(2):166–71.CrossRefPubMedGoogle Scholar
  21. 21.
    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):1450–6.CrossRefPubMedGoogle Scholar
  22. 22.
    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(6):859–63.CrossRefPubMedGoogle Scholar
  23. 23.
    Moon Han S, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg. 2005;15(10):1469–75.CrossRefPubMedGoogle Scholar
  24. 24.
    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):1030–3.CrossRefPubMedGoogle Scholar
  25. 25.
    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 ≥50). Obes Surg. 2005;15(5):612–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Baltasar A, Serra C, Perez N. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg. 2005;15(8):1124–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obes Surg. 2004;14(4):492–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Regan JP, Inabnet WB, Gagner M. 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):861–4.CrossRefPubMedGoogle Scholar
  29. 29.
    Laparoscopic adjustable gastric banding for weight loss in obese adults: clinical and economic review. Canadian Agency for Drugs and Technologies in Health 2007. Accessed April 2009
  30. 30.
    Tice JA, Karliner L, Walsh J. Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med. 2008;121(10):885–93.CrossRefPubMedGoogle Scholar
  31. 31.
    Luo W, Morrison H, de Groh M, et al. The burden of adult obesity in Canada. Chronic Dis Can. 2007;27(4):135–44.PubMedGoogle Scholar
  32. 32.
    Measured obesity: overweight Canadian children and adolescents. Statistics Canada 2005. Accessed April 2009
  33. 33.
    Katzmarzyk PT, Janssen I. The economic costs associated with physical inactivity and obesity in Canada: an update. Can J Appl Physiol. 2004;29(1):90–115.PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  • Xinzhe Shi
    • 1
    Email author
  • Shahzeer Karmali
    • 2
  • Arya M. Sharma
    • 2
  • Daniel W. Birch
    • 1
  1. 1.Centre for the Advancement of Minimally Invasive Surgery (CAMIS)Royal Alexandra HospitalEdmontonCanada
  2. 2.University of AlbertaAlbertaCanada

Personalised recommendations