Advertisement

Sleeve Gastrectomy

  • Joo Ho LeeEmail author
  • Do Joong Park
Chapter
  • 1.1k Downloads

Abstract

Sleeve gastrectomy (SG) is a vertical left gastrectomy of the body and fundus to create a long, narrow tubular gastric sleeve along the lesser curvature that reduces the size of gastric reservoir to 80–120 ml (Fig. 7.1). SG was originally intended as a bridge procedure for high-risk super obese patients preceding the definitive bariatric procedure such as biliopancreatic diversion with duodenal switch (BPD/DS) or Roux-en-Y gastric bypass (RYGB). However, the initial promising results of SG in terms of weight loss and resolution of comorbidities have rendered it popular not only as a first-stage procedure but also as a primary bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) is now considered as a newer stand-alone operation being performed with increasing frequency, which is approved by both the American Society for Metabolic and Bariatric Surgery (ASMBS) and the American College of Surgeons (ACS). In 2011, it occupied over 25 % of bariatric procedures worldwide, which became the second most commonly performed bariatric procedure after RYGB. While the mechanism of action seen after SG is mainly regarded as restriction of calorie intake, the hormonal changes related to gastric resection and expedited food transport to distal small bowel might be involved as well. Ghrelin is a hunger-regulating peptide hormone mainly produced from the fundus of the stomach. Besides its well-known function in modulating appetite, ghrelin may directly regulate glucose homeostasis. Although the effect of ghrelin to incretins remains unclear, it has been suggested that the low levels of ghrelin after surgery are attributable to the secretion of endogenous gastrointestinal hormones such as GLP-1 and PYY that stimulate pancreatic beta cells. The pattern of rapid gastric emptying could be another factor that influences diabetes resolution. Rapid meal emptying into small intestine could contribute to shorter contact time of food with proximal gut and rapid arrival of food to terminal ileum. As a consequence, the hormonal environment of diabetes patients could be ameliorating (hindgut theory). It also has advantages including relatively simple surgical technique, no intestinal anastomosis thus excluding the risk of internal herniation and marginal ulcer, no foreign body, normal intestinal absorption, prevention of the dumping syndrome by pylorus preservation, fewer metabolic and nutritional complications, and preservation of endoscopic access to the upper gastrointestinal tract. The drawback of LSG has been the lack of data based on the well-designed prospective randomized study and long-term results. However, recently several prospective randomized controlled trials and 5 years or more of midterm results about laparoscopic sleeve gastrectomy proved this procedure is safe, effective, and durable.

Keywords

Gastric Bypass Hiatal Hernia Sleeve Gastrectomy Laparoscopic Sleeve Gastrectomy Staple Line 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

albert neal thyroglossal duct cyst2 (148 KB)

Further Reading

  1. Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5(4):469–75.PubMedCrossRefGoogle Scholar
  2. Buchwald H. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRefGoogle Scholar
  3. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta analysis. Am J Med. 2009;122(3):248–56.e5.PubMedCrossRefGoogle Scholar
  4. Buchwald H, Oien DM. Metabolic/bariatric surgery Worldwide 2008. Obes Surg. 2009;19(12):1605–11.PubMedCrossRefGoogle Scholar
  5. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.PubMedCrossRefGoogle Scholar
  6. Akkary E, Duffy A, Bell R. Deciphering the sleeve: technique, indications, efficacy, and safety of sleeve gastrectomy. Obes Surg. 2008;18:1323–9.PubMedCrossRefGoogle Scholar
  7. Gagner M, Deitel M, Kalberer TL, Erickson AL, Crosby RD. The second international consensus summit for sleeve gastrectomy, March 19–21, 2009. Surg Obes Relat Dis. 2009;5(4):476–85.PubMedCrossRefGoogle Scholar
  8. 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.PubMedCrossRefGoogle Scholar
  9. Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252:319–24.PubMedCrossRefGoogle Scholar
  10. Braghetto I, Lanzarini E, Korn O, Valladares H, Molina JC, Henriquez A. Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients. Obes Surg. 2010;20:357–62.PubMedCrossRefGoogle Scholar
  11. Langer FB, Reza Hoda MA, Bohdjadian A, Felberbauer FX, Zacherl J, Wenzl E, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15(7):1024–9.PubMedCrossRefGoogle Scholar
  12. Ferrer-Márquez M, Belda-Lozano R, Ferrer-Ayza M. Technical controversies in laparoscopic sleeve gastrectomy. Obes Surg. 2012;22:182–7.PubMedCrossRefGoogle Scholar
  13. Gagner M. Leaks after sleeve gastrectomy are associated with smaller bougies prevention and treatment strategies. Surg Laparosc Endosc Percutan Tech. 2010;20(3):166–9.PubMedCrossRefGoogle Scholar
  14. Parikh M, Issa R, McCrillis A, Saunders JK, Ude-Welcome A, Gagner M. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257(2):231–7.PubMedCrossRefGoogle Scholar
  15. Peterli R, Wolnerhanssen B, Peters T, et al. Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg. 2009;250:234–41.PubMedCrossRefGoogle Scholar
  16. Rosenthal RJ, for the International Sleeve Gastrectomy Expert Panel. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8:8–19.PubMedCrossRefGoogle Scholar
  17. Woelnerhanssen B, Peterli R, Steinert RE, Peters T, Borbely Y, Beglinger C. Effects of post bariatric surgery weight loss on adipokines and metabolic parameters: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy-a prospective randomized trial. Surg Obes Relat Dis. 2011;7:561–8.PubMedCrossRefGoogle Scholar
  18. Victorzon M. An update on sleeve gastrectomy. Minerva Chir. 2012;67(2):153–63.PubMedGoogle Scholar
  19. Choi YY, Bae J, Hur KY, Choi D, Kim YJ. Reinforcing the staple line during laparoscopic sleeve gastrectomy: does it have advantages? A meta-analysis. Obes Surg. 2012;22:1206–13.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Department of SurgeryEwha Womans University School of MedicineSeoulKorea
  2. 2.Department of SurgerySeoul National University College of MedicineSeoulKorea

Personalised recommendations