Laparoscopic Adjustable Banded Sleeve Gastrectomy as a Primary Procedure for the Super-Super Obese (Body Mass Index > 60 kg/m2)

Abstract

Isolated laparoscopic sleeve gastrectomy is increasingly being used for the treatment of morbid obesity. However, doubts still persist regarding long-term weight loss, and the 5-year results are awaited. Whether the aetiology of failed excess weight loss is the result of an inadequate sleeve or attributable to dilatation of the sleeve is not clear. In an effort to prevent gastric dilatation and increase gastric restriction to promote further weight loss in the long term, we performed a combined procedure of laparoscopic adjustable gastric banding with sleeve gastrectomy. The patient was a 39-year-old woman with a life-long history of obesity and a body mass index of 79.8 kg/m(2). The surgical technique of the laparoscopic adjustable gastric banded sleeve gastrectomy is described. There were no immediate complications, and the patient was discharged home on the third postoperative day. She is doing extremely well on clinic follow-up at 6 weeks. To the best of our knowledge, laparoscopic adjustable gastric banded sleeve gastrectomy, as a primary operation, has not been described in the literature. It is hoped that this combined procedure will be most useful in the super-super obese (body mass index > 60) patients. More patients with a long-term follow-up are necessary to provide definitive conclusions regarding long-term benefits and complications of this combined bariatric procedure.

Surgical management of super–super obese patients: Roux-en-Y gastric bypass versus sleeve gastrectomy

“…In the case of the RYGB group, 29.2, 61.4, 68.5, and 61.6 %EWL was reported at 6-, 12-, 24-, and 36-month follow-up, respectively. These values were consistent with prior publications [20]. At 6-month follow-up, the SG group experienced a 31.8 %EWL and the RYGB group had a 29.2 %EWL, with no significant differences between groups.…”

The influence of laparoscopic adjustable gastric banding and laparoscopic sleeve gastrectomy on weight loss, plasma ghrelin, insulin, glucose and lipids

“…Not only in terms of the potential metabolic benefits must an important remark be made regarding the recently described combination of sleeve gastrectomy and gastric banding as an initial treatment [73]. It would be useful to consider the effects of connection of restrictive and malabsorptive techniques.…”

Impact of laparoscopic sleeve gastrectomy on body mass index, ghrelin, insulin and lipid levels in 100 obese patients.

“…Adequate consideration should be paid to the recently published technique of LSG combined with simultaneous application of adjustable gastric banding (AGB), not only due to the metabolic benefits [48]. We should think what benefits might come from adding restrictive and malabsorptive techniques.…”