Skip to main content

Laparoscopic Sleeve Gastrectomy for Morbid Obesity: 5 Years Experience from an Asian Center of Excellence

Obesity Surgery volume 23, pages 939–946 (2013)Cite this article

Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) is emerging as a popular “stand-alone” bariatric procedure. We report our 5 years experience with LSG as a single-stage bariatric procedure with which to study the technical progress, learning curve, complications, and follow-up results.

Methods

Prospectively collected data of 228 patients (145 females and 83 males), who underwent LSG for morbid obesity, from February 2007 to March 2012, was retrospectively analyzed.

Results

The mean age was 34.68 years (range, 18–62 years) and the mean preoperative body mass index (BMI) was 37.42 ± 4.75 kg/m2 (range, 32.08–65.69 kg/m2). Mean operative time was 60.63 ± 27.37 min. The mean BMI decreased to 26.15 ± 3.71 kg/m2 at 3 years (p < 0.001) and to 27.94 ± 4.08 kg/m2 at 5 years (p < 0.001). Mean percentage excess weight loss was 71.96 ± 21.30 % at 3 years and 63.71 ± 20.08 % at 5 years. The 30-day readmission rate was 3.07 %.Overall complication rate was 4.3 %, including strictures, leaks, peritonitis, gastrocutaneous fistula, and one (0.43 %) mortality. One patient with weight regain and another with stricture underwent conversion to Roux-en-Y gastric bypass. Complication rates significantly decreased after the first 50 cases (p = 0.022), suggesting an initial learning curve. Resolution of diabetes, hypertension, and hyperlipidemia was 66.67, 100, and 50 %, respectively, at 5 years.

Conclusions

LSG as a single-stage bariatric procedure is safe and durable, achieving weight loss and resolution of comorbidities up to 5 years. Adherence to technical details is pivotal in reducing complications associated with the initial learning phase.

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.

Fig. 1
Fig. 2
Fig. 3

References

  1. Lakdawala MA, Bhasker A, Mulchandani D, et al. Comparison between the results of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass in the Indian population: a retrospective 1 year study. Obes Surg. 2010;20(1):1–6.

    PubMed  Article  Google Scholar 

  2. 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;16:1450–6.

    PubMed  Article  Google Scholar 

  3. Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg. 1998;8:267–82.

    PubMed  Article  CAS  Google Scholar 

  4. 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(6):861–4.

    PubMed  Article  CAS  Google Scholar 

  5. Chu CA, Gagner M, Quinn T, et al. Two-stage laparoscopic biliopancreatic diversion with duodenal switch: an alternative approach to super-super morbid obesity (abstract). Surg Endosc. 2002;16:S069.

    Google Scholar 

  6. Sammour T, Hill AG, Singh P, et al. Laparoscopic sleeve gastrectomy as a single-stage bariatric procedure. Obes Surg. 2010;20(3):271–5.

    PubMed  Article  Google Scholar 

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

    PubMed  Article  Google Scholar 

  8. Akkary E, Duffy A, Bell R. Deciphering the sleeve: technique, indications, efficacy, and safety of sleeve gastrectomy. Obes Surg. 2008;18:1323–9.

    PubMed  Article  Google Scholar 

  9. Lee WJ, Wang W. Bariatric surgery: Asia-Pacific perspective. Obes Surg. 2005;15:751–7.

    PubMed  Article  Google Scholar 

  10. Mechanick JI, Kushner RF, Sugerman HJ, et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient. Surg Obes Relat Dis. 2008;4(Supp):109–84. doi:10.1016/j.soard.2008.08.009.

    Article  Google Scholar 

  11. Trelles N, Gagner M. Updated review of sleeve gastrectomy. The Open Gastroenterol J. 2008;2:41–9.

    Article  Google Scholar 

  12. Vidal J, Ibarzabal A, Romero F, et al. Type 2 diabetes mellitus and the metabolic syndrome following sleeve gastrectomy in severely obese subjects. Obes Surg. 2008;18:1077–82.

    PubMed  Article  CAS  Google Scholar 

  13. Sarela AI, Dexter SP, O'Kane M, et al. Long-term follow-up after laparoscopic sleeve gastrectomy: 8–9-year results. Surg Obes Relat Dis. 2011;8:679–84.

    PubMed  Article  Google Scholar 

  14. Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252:319–24.

    PubMed  Article  Google Scholar 

  15. Prasad P, Tantia O, Patle N, et al. An analysis of 1–3-year follow-up results of laparoscopic sleeve gastrectomy: an Indian perspective. Obes Surg. 2012;22(3):507–14.

    PubMed  Article  Google Scholar 

  16. Chowbey PK, Dhawan K, Khullar R, et al. Laparoscopic sleeve gastrectomy: an Indian experience—surgical technique and early result. Obes Surg. 2010;20:1340–7.

    PubMed  Article  CAS  Google Scholar 

  17. Deitel M, Gagner M, Erickson AL, et al. Third International Summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(6):749–59.

    PubMed  Article  Google Scholar 

  18. Lee WJ, Chong K, Ser KH, et al. Gastric bypass vs. sleeve gastrectomy for type 2 diabetes mellitus: a randomized, controlled trial. Arch Surg. 2011;146:143–8.

    PubMed  Article  Google Scholar 

  19. Todkar JS, Shah SS, Shah PS, et al. Long-term effects of laparoscopic sleeve gastrectomy in morbidly obese subjects with type 2 diabetes mellitus. Surg Obes Relat Dis. 2010;6:142–5.

    PubMed  Article  Google Scholar 

  20. Gill RS, Birch DW, Shi X, et al. Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surg Obes Relat Dis. 2010;6:707–13.

    PubMed  Article  Google Scholar 

  21. Kiong KL, Ganesh R, Cheng AK, et al. Early improvement in type 2 diabetes mellitus post Roux-en-Y gastric bypass in Asian patients. Singap Med J. 2010;51:937–43.

    CAS  Google Scholar 

  22. Nocca D, Guillaume F, Noel P, et al. Impact of laparoscopic sleeve gastrectomy and laparoscopic gastric bypass on HbA1c blood level and pharmacological treatment of type 2 diabetes mellitus in severe or morbidly obese patients. Results of a multicenter prospective study at 1 year. Obes Surg. 2011;21:738–43.

    PubMed  Article  Google Scholar 

  23. Rosenthal R, Li X, Samuel S, et al. Effect of sleeve gastrectomy on patients with diabetes mellitus. Surg Obes Relat Dis. 2009;5:429–34.

    PubMed  Article  Google Scholar 

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

    PubMed  Article  Google Scholar 

  25. Pereferrer FS, Gonzàlez MH, Rovira AF, et al. Influence of sleeve gastrectomy on several experimental models of obesity: metabolic and hormonal implications. Obes Surg. 2008;18:97–108.

    PubMed  Article  Google Scholar 

  26. Mason EE. The mechanisms of surgical treatment of type 2 diabetes. Obes Surg. 2005;15:459–61.

    PubMed  Article  Google Scholar 

  27. Rubino F, Forgione A, Cummings DE, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg. 2006;244:741–9.

    PubMed  Article  Google Scholar 

  28. Murphy KG, Bloom SR. Gut hormones and the regulation of energy homeostasis. Nature. 2006;444:854–9.

    PubMed  Article  CAS  Google Scholar 

  29. Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247:401–7.

    PubMed  Article  Google Scholar 

  30. Shi X, Karmali S, Sharma AM, et al. A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20(8):1171–7.

    Google Scholar 

  31. Rosenthal RJ et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.

    PubMed  Article  Google Scholar 

  32. 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(1):106–13.

    PubMed  Article  Google Scholar 

  33. Langer FB, Shakeri-Leidenmühler S, Bohdjalian A, et al. Strategies for weight regain after sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech. 2010;20(3):159–61.

    PubMed  Article  Google Scholar 

  34. Iannelli A, Schneck AS, Noel P, et al. Re-sleeve gastrectomy for failed laparoscopic sleeve gastrectomy: a feasibility study. Obes Surg. 2011;21(7):832–5.

    PubMed  Article  Google Scholar 

  35. Dapri G, Cadière GB, Himpens J. Laparoscopic repeat sleeve gastrectomy versus duodenal switch after isolated sleeve gastrectomy for obesity. Surg Obes Relat Dis. 2011;7(1):38–43.

    PubMed  Article  Google Scholar 

  36. Lacy A, Ibarzabal A, Pando E, et al. Revisional surgery after sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech. 2010;20(5):351–6.

    PubMed  Article  Google Scholar 

  37. Karcz WK, Marjanovic G, Grueneberger J, et al. Banded sleeve gastrectomy using the GaBP ring—surgical technique. Obes Facts. 2011;4(1):77–80.

    PubMed  Article  Google Scholar 

  38. D'Hondt M, Vanneste S, Pottel H, et al. Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss. Surg Endosc. 2011;25:2498–504.

    PubMed  Article  Google Scholar 

  39. 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.

    PubMed  Article  Google Scholar 

  40. Bohdjalian A, Langer FB, Shakeri-Leidenmuhler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20:535–40.

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

The authors would like to thank the entire staff of the Bariatric Surgery Center, E-Da Hospital for their help in obtaining the necessary information required for this paper and especially thank Miss Ivy Huang, the case manager, for helping with the data retrieval.

Conflicts of Interest

All authors have no conflicts of interest to declare.

Author information

Affiliations

  1. Department of Bariatric and Metabolic International Surgery Centre, E-Da Hospital, No. 1, E-Da Road, Jiaosu Village, Yan-chau District, Kaohsiung City, 82445, Taiwan

    Sanoop Koshy Zachariah, Po-Chih Chang, Andrea Se En Ooi, Ming-Che Hsin, Jason Yiu Kin Wat & Chih Kun Huang

  2. The Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510182, China

    Chih Kun Huang

Authors
  1. Sanoop Koshy Zachariah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Po-Chih Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea Se En Ooi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ming-Che Hsin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jason Yiu Kin Wat
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chih Kun Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chih Kun Huang.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Zachariah, S.K., Chang, PC., Ooi, A.S.E. et al. Laparoscopic Sleeve Gastrectomy for Morbid Obesity: 5 Years Experience from an Asian Center of Excellence. OBES SURG 23, 939–946 (2013). https://doi.org/10.1007/s11695-013-0887-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-013-0887-1

Keywords

  • Sleeve gastrectomy
  • Laparoscopy
  • Morbid obesity
  • Bariatric surgery