Skip to main content

Laparoscopic Sleeve Gastrectomy for Morbid Obesity with Intra-operative Endoscopic Guidance. Immediate Peri-operative and 1-year Results after 25 Patients

Obesity Surgery volume 20, pages 1164–1170 (2010)Cite this article

Abstract

Laparoscopic sleeve gastrectomy (LSG) represents a promising alternative option for the surgical treatment of morbid obesity. Its standard technique includes the longitudinal division of the stomach along a bougie of varying diameter. We report in this retrospective study our experience with LSG being performed with the use of intra-operative endoscopy instead of the bougie. Twenty-five consecutive patients (18 women, seven men) with a mean age of 40.2 years and mean body weight of 152.1 kg were submitted to LSG with intra-operative endoscopy in our hospital. The mean preoperative BMI was 53.5 kg/m2. There were no conversions. Mean operative time was 117.5 min. There was no morbidity or mortality. The mean loss of excess body weight (EBW) at 3 months post-op was 19 ± 1.8 kg, at 6 months was 28.6 ± 4.5 kg, and at 1 year post-op was 48.9 ± 3.7 kg (min 11–max 92). In other words the patients had lost 30 ± 5%, 45 ± 7.7%, and 60.8 ± 4.3% of their EBW, respectively. The mean excess body weight loss at the day of the last visit to our outpatient clinic was 52.3 ± 4.3 kg which corresponded to 66.4 ± 4.3% of the total excess weight. LSG with intra-operative endoscopic guidance is a safe and efficient alternative method to treat morbid obesity and is a viable option for surgical units familiar with endoscopic techniques.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. DeMaria EJ, Schauer P, Patterson E, et al. The optimal surgical management of the super obese patient: the debate. Surg Innovation. 2005;12(2):107–21. Presented at the Annual Meeting of The Society of American Gastrointestinal and Endoscopic Surgeons, Hollywood, Florida, USA, April 13–16, 2005.

    Article  Google Scholar 

  2. Frezza E. Laparoscopic vertical sleeve gastrectomy for morbid obesity. The future procedure of choice? Surg Today. 2007;37:275–81.

    Article  PubMed  Google Scholar 

  3. Aggarwal S, Kini S, Herron D. Laparoscopic sleeve gastrectomy for morbid obesity: a review. Surg Obes Relat Dis. 2007;3:189–94.

    Article  PubMed  Google Scholar 

  4. Gumbs AA, Gagner M, Dakin G, et al. Sleeve gastrectomy for morbid obesity. Obes Surg. 2007;17(7):962–9.

    Article  PubMed  Google Scholar 

  5. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2008. Obes Surg. 2009;19:1605–11.

    Article  PubMed  Google Scholar 

  6. Gagner M, Deitel M, Kalberer T, et al. The second International Consensus Summit for Sleeve Gastrectomy, March 19–21, 2009. Surg Obes Relat Dis. 2009;5:476–85.

    Article  PubMed  Google Scholar 

  7. Moy J, Pomp A, Dakin G, et al. Laparoscopic sleeve gastrectomy for morbid obesity. Am J Surg. 2008;196:e56–9.

    Article  PubMed  Google Scholar 

  8. Parikh M, Gagner M, Heakock L, et al. Laparoscopic sleeve gastrectomy: does bougie size affect mean %EWL? Short term outcomes. Surg Obes Relat Dis. 2008;4:528–33.

    Article  PubMed  Google Scholar 

  9. Consten ECJ, Gagner M, Pomp A, et al. Decreased bleeding after laparoscopic sleeve gastrectomy with or without duodenal switch for morbid obesity using a stapled buttressed absorbable polymer membrane. Obes Surg. 2004;14:1360–6.

    Article  PubMed  Google Scholar 

  10. Frezza E, Barton A, Herbert H, et al. Laparoscopic sleeve gastrectomy with endoscopic guidance in morbid obesity. Surg Obes Relat Dis. 2008;4:575–80.

    Article  PubMed  Google Scholar 

  11. Oliak D, Ballantyne GH, Davies RJ, et al. Short-term results of laparoscopic gastric by-pass in patients with BMI > or =60. Obes Surg. 2002;12:643–7.

    Article  PubMed  Google Scholar 

  12. Ren CJ, Patterson E, Gagner M. Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg. 2000;10:514–23. discussion 524.

    Article  CAS  PubMed  Google Scholar 

  13. 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;13:861–4.

    Article  CAS  PubMed  Google Scholar 

  14. Schauer PR, Ikramuddin S, Hamad G, et al. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc. 2003;17:212–5.

    Article  CAS  PubMed  Google Scholar 

  15. 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;16:166–71.

    Article  PubMed  Google Scholar 

  16. Mongol 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;15:1030–3.

    Article  Google Scholar 

  17. Milone L, Strong V, Gagner M. Laparoscopic sleeve gastrectomy is superior to endoscopic intragastrric balloon as a first stage procedure for super-obese patients (BMI ≥ 50). Obes Surg. 2005;15:612–7.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  19. 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.

    Article  CAS  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. Givon-Madhala O, Spector R, Wasserberg N, et al. Technical aspects of laparoscopic sleeve gastrectomy in 25 morbidly obese patients. Obes Surg. 2007;17(6):722–7.

    Article  PubMed  Google Scholar 

  22. Lowham ES, Filipi CJ, Hinder RA, et al. Mechanisms and avoidance of esophageal perforation by anesthesia personnel during laparoscopic foregut surgery. Surg Endosc. 1996;10:979–82.

    Article  CAS  PubMed  Google Scholar 

  23. Trus TL, Bax T, Richardson WS, et al. Complications of laparoscopic paraesophageal hernia repair. J Gastrointest Surg. 1997;1:221–8.

    Article  CAS  PubMed  Google Scholar 

  24. Moon HS, Kim WW, Oh HJ. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg. 2005;15:1469–75.

    Article  Google Scholar 

  25. Sillecchia 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.

    Article  Google Scholar 

  26. Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy: a restrictive procedure? Obes Surg. 2007;17:57–62.

    Article  PubMed  Google Scholar 

  27. Fuks D, Verhaeghe P, Brehant O, et al. Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery. 2009;145:106–13.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Affiliations

  1. Laiko Athens General Hospital, 1st Department of Surgery of the University of Athens, 17 Agiou Thoma St, 11527, Athens, Greece

    T. Diamantis, A. Alexandrou, E. Pikoulis, D. Diamantis, J. Griniatsos, E. Felekouras & E. Papalambros

Authors
  1. T. Diamantis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Alexandrou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Pikoulis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Diamantis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Griniatsos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. Felekouras
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. E. Papalambros
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Alexandrou.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Diamantis, T., Alexandrou, A., Pikoulis, E. et al. Laparoscopic Sleeve Gastrectomy for Morbid Obesity with Intra-operative Endoscopic Guidance. Immediate Peri-operative and 1-year Results after 25 Patients. OBES SURG 20, 1164–1170 (2010). https://doi.org/10.1007/s11695-010-0176-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-010-0176-1

Keywords

  • Morbid obesity
  • Laparoscopy
  • Sleeve gastrectomy
  • Endoscopy