The laparoscopic sleeve-gastrectomy has established itself within a short time as one of the leading bariatric procedures worldwide and is now one of the leading adiposity surgical and metabolic procedures in Germany and the USA. Sleeve-gastrectomy is performed according to a standardized technique and has a low complication rate in experienced hands. The weight-reducing effects, as well as the positive effect of the obesity associated diseases, are good.
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Principle of sleeve-gastrectomy
Sleeve-gastrectomy was first described by Marceau in 1993. Originally, sleeve gastrectomy was part of biliopancreatic diversion with duodenal switch, but since 2008 it has been performed as a sole bariatric surgical procedure. During the operation, a large part of the stomach is removed laparoscopically, leaving a residual tubular stomach. The normal passage of food through the stomach into the small intestine remains, which is why later gastric endoscopies (oesophagogastroduodenoscopy), which are necessary for whatever reason, are still possible without any problems.
Complications after sleeve-gastrectomy
In experienced hands, sleeve-gastrectomy is a safe procedure. Compared to gastric bypass, the complication rate is lower. The few complications are usually a leak in the row of sutures on the remaining tubular stomach, post-operative bleeding or abscesses.
Mechanism of action
The active principle of sleeve-gastrectomy is based on the one hand on food restriction, on the other hand, the peptide hormone levels are changed, which control the feeling of hunger and satiety. The feeling of satiety occurs faster, the feeling of hunger is suppressed.
Results after sleeve-gastrectomy
The average weight reduction after 2 years is between 60 - 70 %. But not only the overweight is reduced, but the intervention also achieves favourable results with regard to high blood pressure, diabetes mellitus type 2, sleep apnoea syndrome and other obesity-related diseases. A lack of vitamins and micronutrients is rarely observed after sleeve-gastrectomy, but supplementation is nevertheless recommended. The patients after SG predominantly report a good quality of life. In contrast to gastric banding and gastric bypass surgery, sleeve-gastrectomy is not reversible.
Bilbiography sources:
ASMBS online statements/guidelines (2012)Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis 3: 573–576.
Agarwal S, Kini SU, Herron DM (2007) Laparoscopic sleeve gastrectomy for morbid obesity: a review. Surg Obes Relat Dis 3: 189–194.
Brethauer SA, Hammel J, Schauer PR (2009) Systematic review of sleeve gastrectomy as a staging and primary bariatric operation. Surg Obes Relat Dis 5: 469–475.
Buchwald H, Avidor Y, Braunwald E, et al. (2004) Bariatric surgery. A systematic review and meta analysis. JAMA 292: 1774–1737.
Colquitt, J. L.; Pickett, K.; Loveman, E.; Frampton, G. K. (2014): Surgery for weight loss in adults. In: The Cochrane database of systematic reviews 8, Cd003641.
Fischer, L.; Hildebrandt, C.; Bruckner, T.; Kenngott, H.; Linke, G. R.; Gehrig, T. et al. (2012): Excessive weight loss after sleeve gastrectomy: a systematic review. In: Obesity surgery 22, S. 721–731.
Gagner M, Gumbs AA, Milone L, et al. (2008) Laparoscopic sleeve gastrectomy for the super-super-obese. Surg Today 38: 399–403.
Gagner M, Deitel M, Kalberer TL, et al. (2009) The Second international consensus summit for sleeve gastrectomy. Surg Obes Relat Dis 5: 476–485.
Helmio, M.; Victorzon, M.; Ovaska, J.; Leivonen, M.; Juuti, A.; Peromaa-Haavisto, P. et al. (2014a): Comparison of laparoscopic sleeve gastrectomy and gastric bypass in the treatment of morbid obesity: A prospective randomized controlled multicentre sleevepass study with 4year follow-up. In: Obesity surgery 24 (8), S. 1214.
Himpens J, Dobbeleir J, Peeters G (2010) Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg 252: 319–324.
Lee, W. J.; Chong, K.; Lin, Y. H.; Wei, J. H.; Chen, S. C. (2014a): Laparoscopic sleeve gastrectomy versus single anastomosis (mini-) gastric bypass for the treatment of type 2 diabetes mellitus: 5-year results of a randomized trial and study of incretin effect. In: Obesity surgery 24 (9), S. 1552–1562.
Marceau, P.; Biron, S.; Bourque, R.A.; Potvin, M.; Hould, F.S.; Simard, S. (1993): Biliopancreatic diversion with a new type of gastrectomy. In: Obesity surgery 3 (1), S. 29–35.
Osland, E.; Yunus, R. M.; Khan, S.; Alodat, T.; Memon, B.; Memon, M.A. (2016): Postoperative early major and minor complications in laparoscopic vertical sleeve gastrectomy (LVSG) versus laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures. A meta-analysis and systematic review. In: Obesity surgery 26 (10), S. 2273–2284.
Peterli, R.; Borbely, Y.; Kern, B.; Gass, M.; Peters, T.; Thurnheer, M. et al. (2013): Early results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. In: Annals of surgery 258, 690-4.
Regan, J. P.; Inabnet, W. B.; Gagner, M.; Pomp, A. (2003): Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. In: Obesity surgery 13 (6), S. 861–864.
Rosenthal RJ (2012) International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12 000 cases. Surg Obes Relat Dis 8: 8–19.
Schauer, P. R.; Bhatt, D. L.; Kirwan, J. P.; Wolski, K.; Brethauer, S. A.; Navaneethan, S. D. et al. (2014): Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes. In: The New England journal of medicine 370, S. 2002–2013.
Weiner RA, Weiner S, Pomhoff I, et al. (2007) Laparoscopic sleeve gastrectomy - influence of sleeve size and resected gastric volume. Obes Surg 17: 1297–1305.
