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Obesity Surgery

, Volume 19, Issue 10, pp 1371–1376 | Cite as

Experience with Laparoscopic Sleeve Gastrectomy for Morbid Versus Super Morbid Obesity

  • Nobumi TagayaEmail author
  • Kazunori Kasama
  • Rie Kikkawa
  • Eiji Kanahira
  • Akiko Umezawa
  • Takashi Oshiro
  • Yuka Negishi
  • Yoshimochi Kurokawa
  • Tetsuya Nakazato
  • Keiichi Kubota
Research Article

Abstract

Background

We evaluated the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) for super morbid obesity in patients with an initial body mass index (BMI) of <50 or ≥50.

Methods

Between October 2005 and January 2008, we performed LSG in 30 patients. There were 20 males and 10 females with a mean age of 38 years. Mean initial body weight and BMI were 139 kg and 49.1 kg/m2, respectively. Sleeve gastrectomy was carried out using a linear stapler from the greater curvature of the antrum 5 cm proximal from the pyloric ring up to the angle of His alongside a 45-Fr. bougie.

Results

Laparoscopic procedures were performed successfully in all patients. The mean operation time was 92 min, and blood loss was minimal. The BMI change and weight loss at the 1-, 3-, 6-, 9-, 12-, and 18-month follow-up points of patients with an initial BMI of <50 and ≥50 were 34.2 and 57.4, 32.1 and 53.7, 29.6 and 50.8, 29.5 and 51.2, 27.8 and 52.2, and 29.7 and 45.5 kg/m2 and 96.8 and 172.2, 89.5 and 157.0, 83.4 and 144.8, 84.0 and 145.4, 78.0 and 153.4, and 84.5 and 119.5 kg, respectively. The patients with a BMI of <50 obtained good outcomes, but weight loss reached a plateau at 9 months after surgery in patients with a BMI of ≥50. Postoperative complications included leakage, bleeding, stricture, and peritonitis in one patient each. There was no surgical mortality. Most of the co-morbidities improved after surgery.

Conclusions

Sleeve gastrectomy is a feasible and safe treatment for super morbid obesity, but evaluation of long-term outcome is necessary to determine whether it is a durable procedure in terms of effectiveness. We expect that patients with a BMI of <50 are good candidates for LSG as a definitive treatment, and, if those with a BMI of ≥50 hope for further weight loss, a second-step procedure may be required.

Keywords

Super morbid obesity Bariatric surgery Sleeve gastrectomy Laparoscopic surgery 

References

  1. 1.
    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.CrossRefGoogle Scholar
  2. 2.
    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 patients. Obes Surg 2003;13:861–4.CrossRefGoogle Scholar
  3. 3.
    Baltasar A, Serra C, Perez N, et al. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg 2005;15:1124–8.CrossRefGoogle Scholar
  4. 4.
    Milone L, Strong V, Gagner M. Laparoscopic sleeve gastrectomy is superior to endoscopic intragastric balloon as a first stage procedure for super-obese patients (BMI>50). Obes Surg 2005;15:612–7.CrossRefGoogle Scholar
  5. 5.
    Han SM, Kim WW, Oh J, et al. Results of laparoscopic sleeve gastrectomy at 1 year in morbid obese Korean patients. Obes Surg 2005;15:1469–75.CrossRefGoogle Scholar
  6. 6.
    Mognol 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.CrossRefGoogle Scholar
  7. 7.
    Tucker ON, Szomstein S, Rosenthal RJ. Indications for sleeve gastrectomy as a primary procedure for weight loss in the morbidity obese. J Gastrointest Surg 2008;12:662–7.CrossRefGoogle Scholar
  8. 8.
    Silecchia 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.CrossRefGoogle Scholar
  9. 9.
    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.CrossRefGoogle Scholar
  10. 10.
    Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy (SG). New York City, October 25–27, 2007.Google Scholar
  11. 11.
    Kotidis EV, Koliakos GG, Baltzopoulos VG, et al. Serum ghrelin, leptin and adiponectin levels before and after weight loss: comparison of three methods of treatment—a prospective study. Obes Surg 2006;16:1425–32.CrossRefGoogle Scholar
  12. 12.
    Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy: a restrictive procedure. Obes Surg 2007;17:57–62.CrossRefGoogle Scholar
  13. 13.
    Melissas J, Daskalakis M, Koukouraki S, et al. Sleeve gastrectomy—a “food limiting” operation. Obes Surg 2008;18:1251–6.CrossRefGoogle Scholar
  14. 14.
    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.CrossRefGoogle Scholar
  15. 15.
    Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg 2005;15:1024–9.CrossRefGoogle Scholar
  16. 16.
    Cottam DR, Mattar SG, Schauer PR, et al. Laparoscopic era of operations for morbid obesity. Arch Surg 2003;138:367–75.CrossRefGoogle Scholar
  17. 17.
    Vidal J, Ibarzabal A, Nicolau J, et al. Short-term effects of sleeve gastrectomy on type 2 diabetes mellitus in severely obese subjects. Obes Surg 2007;17:1069–74.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Nobumi Tagaya
    • 1
    Email author
  • Kazunori Kasama
    • 2
  • Rie Kikkawa
    • 2
  • Eiji Kanahira
    • 2
  • Akiko Umezawa
    • 2
  • Takashi Oshiro
    • 2
  • Yuka Negishi
    • 2
  • Yoshimochi Kurokawa
    • 2
  • Tetsuya Nakazato
    • 2
  • Keiichi Kubota
    • 1
  1. 1.Second Department of SurgeryDokkyo Medical UniversityMibuJapan
  2. 2.Minimally Invasive Surgery CenterYotsuya Medical CubeTokyoJapan

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