Morbid Obesity and Sleeve Gastrectomy: How Does It Work?

Abstract

Laparoscopic sleeve gastrectomy is known to be a safe and effective procedure for treating morbid obesity and is performed with increasing frequency both in Europe and the USA. Despite its broad use, many questions about the remaining gastric tube diameter, its long-term efficacy, its effects on gastric emptying, and the hormones involved still remain to be answered. In order to use such a relatively new surgical procedure wisely, it is essential for every surgeon and physician to understand how sleeve gastrectomy acts in obesity and what its potential benefits on the patients' metabolism are. This review focuses on the most important pathophysiologic questions referred to sleeve gastrectomy on the literature so far, in an attempt to evaluate the different issues still pending on the subject.

Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: understanding weight loss and improvements in type 2 diabetes after bariatric surgery

“…In head-to-head comparison, LSG produces ϳ10 -15% greater EWL than LAGB (146,212). LSG reduces gastric volume to 10% of its presurgical volume (150). This can be predicted to restrict food intake and activate stretch mechanoreceptors earlier, to terminate eating (satiation).…”

“…Currently there is no evidence that reducing bougie size, the major operative determinant of sleeve diameter, improves weight loss (56,82). Nonetheless sleeve diameter also varies by proximity of staple line application and mechanical tissue stretch around the bougie (150), and late sleeve dilatation may be more common when larger bougie diameters are employed (213), one proposed mechanism for weight regain following LSG.…”

Quantitative immunohistochemical analysis of duodenal ghrelin cells after sleeve gastrectomy in Wistar rats

“…The hospitalization required after this procedure is shortened with the laparoscopic approach, and the patient can take oral medications and eventually undergo endoscopy 9 .…”

Sleeve Gastrectomy: Procedure, Outcomes, and Complications

“…In addition, it immediately restricts caloric intake, and is less technically demanding relative to malabsorptive bariatric procedures (ie, RYGB). Other advantages include avoidance of dumping syndrome, pylorus preservation, and unaltered absorption of oral medications [10]. However, the most notable disadvantages of LSG are irreversibility and the availability of longterm outcome results [11].…”