Sleeve Gastrectomy

  • Gregg H. Jossart


Diabetes is a heterogeneous disease with three main types: type 1, type 2, and latent autoimmune diabetes. The main condition that develops in type 2 diabetes is insulin resistance. In type 1 diabetes and LADA, lack of insulin production is the primary condition but one should be aware that many of these patients also develop a resistance to exogenous insulin if they become obese. It is generally well understood that any weight loss or improved dietary management can help to control diabetes. However, when these attempts prove ineffective, bariatric surgery is considered. This chapter reviews the current role of the Sleeve Gastrectomy in the treatment of obesity related diabetes. Concepts reviewed include diabetes outcomes by BMI, duration of diabetes, time to resolution, C-peptide production, Pouch/Bougie size, and comparison to other procedures. The heterogeneity of diabetes and the variations in sleeve gastrectomy technique make it difficult to analyze outcomes but many reasonable conclusions can be made.


Diabetes Bariatric surgery Sleeve gastrectomy Gastric sleeve Bilopancreatic diversion/Duodenal switch Diabetes resolution 


  1. 1.
    Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes and obesity-related health risk factors, 2001. JAMA. 2003;289(1):76–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339–50.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg. 1998;8(3):267–82.PubMedCrossRefGoogle Scholar
  4. 4.
    Ren CJ. Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg. 2000;10(6):514–23. discussion 524.PubMedCrossRefGoogle Scholar
  5. 5.
    Lee CM. Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc. 2007;21(10):1810–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Bellanger DE, Greenway FL. Laparoscopic sleeve gastrectomy, 529 cases without a leak: short term results and technical considerations. Obes Surg. 2011;21:146–50.PubMedCrossRefGoogle Scholar
  7. 7.
    Mechanik JI, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity. 2013;21:S1–27.CrossRefGoogle Scholar
  8. 8.
    Langer FB, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;14:1024–9.CrossRefGoogle Scholar
  9. 9.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric Surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRefGoogle Scholar
  10. 10.
    Brethauer A, 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
  11. 11.
    Gill RS, Sharma AM, Al-Adra DP, et al. The impact of bariatric surgery in patients with Type-2 diabetes mellitus. Curr Diabetes Rev. 2011;7:185–9.PubMedCrossRefGoogle Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    Cottam D, Dureshi FG, Mattar SF, et al. Laparoscopic sleeve gastrectomy as an initial weight loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20:859–63.PubMedCrossRefGoogle Scholar
  14. 14.
    Vidal J, Ibarzabal A, Romero F, et al. Type 2 diabetes mellitus and the metabolic syndrome following sleeve gastrectomy in severely obese subjects. Obes Surg. 2008;18:1077–82.PubMedCrossRefGoogle Scholar
  15. 15.
    Kehagias I, Spyropoulos C, Karamanakos S, et al. Efficacy of sleeve gastrectomy as sole procedure in patients with clinical severe obesity. Surg Obes Relat Dis. 2013;9(3):363–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Menenkakos E, Stamou K, Albanoupoulos K, et al. Laparoscopic sleeve gastrectomy performed with intent to treat morbid obesity: a prospective single-center study of 261 patients with a median follow-up of 1 year. Obes Surg. 2010;20:276–82.CrossRefGoogle Scholar
  17. 17.
    Basso N, Casella G, Rizzello M. Laparoscopic sleeve gastrectomy as first stage or definitive intent in 300 consecutive cases. Surg Endosc. 2011;25:444–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Magee CJ, Barry J, Arumugasamy M. Laparoscopic sleeve gastrectomy for high-risk patients: weight loss and comorbidity improvement-short-term results. Obes Surg. 2011;21(5):547–50.PubMedCrossRefGoogle Scholar
  19. 19.
    Abbatini F, Capoccia D, Basso N. Type 2 diabetes in obese patients with body mass index of 30-35 kg/m2: sleeve gastrectomy versus medical treatment. Surg Obes Relat Dis. 2012;8(1):20–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Atkins ER, Preen DB, Cohen LD. Improved obesity reduction and co-morbidity resolution in patients treated with 40 French bougie versus 50 French bougie four years after laparoscopic sleeve gastrectomy. Analysis of 294 patients. Obes Surg. 2012;22(1):97–104.PubMedCrossRefGoogle Scholar
  21. 21.
    Spivak H, Moshe R, Sadot E. Laparoscopic sleeve gastrectomy using a 42-French versus a 32 French bougie: the first-year outcome. Obes Surg. 2014;24(7):1090–3.PubMedCrossRefGoogle Scholar
  22. 22.
    Abdallah E, El Nakeeb A, Yousef T. Impact of extent of antral resection on surgical outcomes of sleeve gastrectomy for morbid obesity (A prospective randomized study). Obes Surg. 2014;24(10):1587–94.PubMedCrossRefGoogle Scholar
  23. 23.
    Rizzello M, Abbatine F, Casella G. Early postoperative insulin-resistance changes after sleeve gastrectomy. Obes Surg. 2010;20(1):50–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Rosenthal R, Li X, Somstein S. Effect of sleeve gastrectomy on patients with diabetes mellitus. Surg Obes Relat Dis. 2009;5(4):429–34.PubMedCrossRefGoogle Scholar
  25. 25.
    Casella G, Basso N. Ten-year duration of type 2 diabetes mellitus as a prognostic factor for remission after sleeve gastrectomy. Surg Obes Relat Dis. 2011;7:697–702.PubMedCrossRefGoogle Scholar
  26. 26.
    Shah PS, Todkar JS, Shah SS. Effectiveness of laparoscopic sleeve gastrectomy on glycemic control in obese Indians with type 2 diabetes mellitus. Surg Obes Relat Dis. 2010;6(2):138–41.PubMedCrossRefGoogle Scholar
  27. 27.
    Slater BJ, Bellatorre N, Eisenberg D. Early postoperative outcomes and medication cost savings after laparoscopic sleeve gastrectomy in morbidly obese patients with type 2 diabetes. J Obes. 2011;2011:350523.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Todkar JS, Shah SS, Shah PS, et al. Long-term effects of laparoscopic sleeve gastrectomy in morbidly obese subjects with type 2 diabetes mellitus. Surg Obes Relat Dis. 2010;6(2):142–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Vidal J, Ibarzabal A, Lacy A. Short term effects of sleeve gastrectomy on type 2 diabetes mellitus in severely obese subjects. Obes Surg. 2007;17:1069–74.PubMedCrossRefGoogle Scholar
  30. 30.
    Bayham BE, Greenway FL, Bellanger DE, et al. Early resolution of type 2 diabetes seen after Roux en Y gastric bypass and vertical sleeve gastrectomy. Diabetes Technol Ther. 2012;14(1):30–4.PubMedCrossRefGoogle Scholar
  31. 31.
    Pham S, Gancel A, Scotte M. Comparison of the effectiveness of four bariatric surgery procedures in obese patients with type 2 diabetes: a retrospective study. J Obes. 2014;2014:638203.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Yip S, Plank LD, Murphy R. Gastric bypass and sleeve gastrectomy for type 2 diabetes: a systematic review and meta-analysis of outcomes. Obes Surg. 2013;23:1994–2003.PubMedCrossRefGoogle Scholar
  33. 33.
    Zhang C, Yuan Y, Qiu C, et al. A meta-analysis of 2-year effect after surgery: laparoscopic Roux en Y gastric bypass versus laparoscopic sleeve gastrectomy for morbid obesity and diabetes mellitus. Obes Surg. 2014;24:1528–35.PubMedCrossRefGoogle Scholar
  34. 34.
    Zhang Y, Wang J, Sun X, et al. Laparoscopic sleeve gastrectomy versus laparoscopic Roux en Y gastric bypass for morbid obesity and related comorbidities: a meta-analysis of 21 studies. Obese Surg. 2015;25:19.CrossRefGoogle Scholar
  35. 35.
    Lee WJ, Hur KY, Lakadawala M, et al. Gastrointestinal metabolic surgery for the treatment of diabetic patients: a multi-institutional intertnational study. J Gastrointest Surg. 2012;16:45–51.Google Scholar
  36. 36.
    Oman JJ, Nguyen SQ, Herron D. Comparison of comorbidity resolution and improvement between laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding. Surg Endosc. 2010;24:2513–7.CrossRefGoogle Scholar
  37. 37.
    Abbatini F, Rizzello M, Casella G. Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes. Surg Endosc. 2010;24:1005–10.PubMedCrossRefGoogle Scholar
  38. 38.
    Schauer PR, Bhatt DL, Kirwan J. Bariatric surgery versus intensive medical therapy for diabetes- 3 year outcomes. N Engl J Med. 2014;371(7):682.PubMedGoogle Scholar
  39. 39.
    Iannelli A, Schneck AS, Topart P. Laparoscopic sleeve gastrectomy followed by duodenal switch in selected patients versus single-stage duodenal switch for superobesity: case-control study. Surg Obes Relat Dis. 2013;9(4):531–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Prachand VN, Ward M, Alverdy JC. Duodenal switch provides superior resolution of metabolic comorbidities independent of weight loss in the super-obese (BMI > 50kg/m2) compared with gastric bypass. J Gastrointest Surg. 2010;14:211–20.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.California Pacific Medical CenterSan FranciscoUSA

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