Skip to main content

Advertisement

SpringerLink
Log in

Sleeve Gastrectomy — A Restrictive Procedure?

  • Published:
Obesity Surgery Aims and scope Submit manuscript

Background

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).

Methods

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.

Results

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).

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Deitel M. The obesity epidemic. Obes Surg 2006; 16: 377–8.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  6. Baltasar A, Serra C, Pérez N et al. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg 2005; 15: 1124–8.

    Article  PubMed  Google Scholar 

  7. Mistiaen W, Vaneerdeweg W, Blockx P et al. Gastric emptying rate measurement after vertical banded gastroplasty. Obes Surg 2000; 10: 245–9.

    Article  CAS  PubMed  Google Scholar 

  8. Tosetti C, Cordinaldesi R, Stanghellini V et al. Gastric emptying of solids in morbid obesity. Int J Obes 1996; 20: 200–5.

    CAS  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  12. Deitel M, Greenstein RJ. Recommendations for reporting weight loss. Obes Surg 2003; 13: 159–60.

    Article  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  16. Johnston D, Dachtler J, Sue-Ling HM et al. The Magenstrasse and Mill operation for morbid obesity. Obes Surg 2003; 13: 10–6.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  18. Horowitz M, Collins PJ, Chatterton BE et al. Gastric emptying after gastroplasty for morbid obesity. Br J Surg 1984; 71: 435–7.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  22. Behrns KE, Soper NJ, Sarr MG et al. Anatomic, motor, and clinical assessment of vertical banded gastroplasty. Gastroenterology 1989; 97: 91–7.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Bariatric Unit and Department of Surgical Oncology, Crete, Greece

    John Melissas MD, John Askoxylakis MD & Markos Daskalakis MD

  2. Departments of Nuclear Medicine, Heraklion University Hospital, Faculty of Medicine, University of Crete, Crete, Greece

    Sofia Koukouraki MD, Maria Stathaki MD & Nikos Karkavitsas MD

  3. Medical Physics, Heraklion University Hospital, Faculty of Medicine, University of Crete, Crete, Greece

    Kostas Perisinakis PhD

  4. 15 Delaporta St., Heraklion, 71409, Crete, Greece

    John Melissas MD

Authors
  1. John Melissas MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sofia Koukouraki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Askoxylakis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maria Stathaki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Markos Daskalakis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kostas Perisinakis PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nikos Karkavitsas MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John Melissas MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Melissas, J., Koukouraki, S., Askoxylakis, J. et al. Sleeve Gastrectomy — A Restrictive Procedure?. OBES SURG 17, 57–62 (2007). https://doi.org/10.1007/s11695-007-9006-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-007-9006-5

Key words

Search

Navigation