Sleeve Gastrectomy: Procedure, Outcomes, and Complications

Abstract

Over 300 million adults are considered clinically obese worldwide. Obesity is associated with multiple comorbidities including type 2 diabetes mellitus (T2DM), hypertension, and sleep apnea. Bariatric surgery, as part of a comprehensive weight management strategy, has been shown to produce marked weight loss and improvement of comorbidities. While laparoscopic sleeve gastrectomy (LSG) was initially introduced as the first procedure in a two-staged approach for high-risk super-obese patients, it has emerged as an important stand-alone surgical option. LSG is typically classified as a primarily restrictive procedure; however, recent evidence suggests that it performs better than other restrictive procedures, in terms of weight loss and T2DM remission. The procedure involves creation of a gastric tube with an approximate capacity of 60 to 100 mL. In this review, we explore LSG as a technical procedure, its efficacy in obese patients, and potential complications that may arise.

Anterior Gastric Wall Excision and Retubularization: A Novel Procedure and Modification of Sleeve Gastrectomy for a Patient With Obesity

“…Historically, sleeve gastrectomy was first performed as an open procedure in 1988 by Hess as part of his biliopancreatic diversion with a duodenal switch (BPD-DS) procedure [ 4 ]. With the evolution of laparoscopic surgery in the mid and late 1990s, Gagner performed the first laparoscopic sleeve gastrectomy as part of the BPD-DS in 1999 [ 4 ]. Over the next decades, sleeve gastrectomy was performed as the first of a two-stage bariatric procedure for super-obese patients (BMI > 60 kg/m 2 ).…”

“…This modification permitted the placement of the suture line along the lesser curvature away from the most dependent part of the new stomach, thereby reducing the chance of postoperative leak [ 9 , 10 ]. The two-layer wound closure technique and surface reinforcement with surgical glue are believed to further prevent postoperative bleeding and leaks [ 4 ].…”

“…The surgical principles employed in the planning and implementation of this new surgical technique of gastric sleeving were in line with the recommendations of the International Sleeve Gastrectomy Expert Panel Consensus Statement [ 4 ]. These best-practice guidelines were drawn out from the experience of 12,000 cases performed in 24 bariatric surgery centers across 11 countries.…”

Efectividad de la gastrectomía en manga por laparoscopia

“…La mayoría de estos desenlaces son inherentes a cualquier cirugía, y otros a cirugía minimamente invasiva. Entre aquellos específicos, la fuga gástrica posee una incidencia de 0.7 a 5% con una media de 2.3% (36) y estenosis entre 0.7 y 0.9% (14,36). En la revisión sistemática de Gumbs (21) el promedio de complicaciones fue de 1 a 29%, sin embargo, esta publicación data del año 2007 y estudios más recientes reportan una tasa menor.…”

Role of surgical treatment for obesity in weight reduction and its effect on comorbidities

“…Wybrane procedury bariatryczne wdrażane w leczeniu otyłości, ich efektywność w redukcji masy ciała i wpływ na choroby współistniejące Rękawowa resekcja żołądka SG jako procedurę bariatryczną po raz pierwszy zastosowano w praktyce klinicznej w roku 1988 [27,28]. Ponad 50% realizowanych procedur z zakresu chirurgii bariatrycznej to laparoskopowa rękawowa resekcja żołądka [29,30]. Jest to jedna z restrykcyjnych procedur wykorzystywanych w chirurgii bariatrycznej, która polega na subtotalnej pionowej resekcji 80-90% żołądka z zachowaniem odźwiernika.…”