Sleeve gastrectomy: a new surgical approach for morbid obesity

Abstract

While obesity and morbid obesity have reached epidemic proportions worldwide, bariatric surgeons continue to develop safer and more efficacious procedures to battle this lethal disease. Sleeve gastrectomy, a relative new surgical approach, was initially conceived as a restrictive component of the biliopancreatic diversion and duodenal switch in the era of open bariatric surgery. With the advent of minimally invasive surgery in the late 1980s, laparoscopic sleeve gastrectomy (LSG) has been proposed as a step procedure in high-risk patients, followed by a second step Roux-en-Y gastric bypass or biliopancreatic diversion and duodenal switch and, recently, as a standalone bariatric approach. This article reviews the literature and reports the results achieved with LSG performed either as the initial operation for high-risk, high body mass index patients followed by a definitive weight loss operation, or used as a final viable alternative to other well-established bariatric procedures. An extensive literature review was conducted and the information currently available surrounding LSG, such as history, indications and contraindications, mechanism of weight loss, technique and outcomes and controversial issues are discussed. LSG is an accepted procedure for the surgical management of morbid obesity. It is gaining popularity as a primary, staged and revisional operation for its proven safety and simplicity, as well as short-term and mid-term efficacy. Excess weight loss and remission of comorbidities have been reported to take place in a frequency comparable with other well-established procedures. Despite all of the above-mentioned factors, long-term results and larger series are pending.

Keywords::

• bariatric surgery
• laparoscopy
• morbid obesity
• Roux-en-Y-gastric bypass
• sleeve gastrectomy

Financial & competing interests disclosure

Raul J Rosenthal is consultant and has educational grants from Ethicon Endo Surgery, Synovis, Covidien and Karl Storz Endoscopy. For further disclosures log on to www.Clevelandclinicflorida.org. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

Data from [6,39–42].

Data from [6,39–42].