State of the Art: Sleeve Gastrectomy

Abstract

In the biliopancreatic diversion (BPD) type duodenal switch, sleeve gastrectomy was applied as the restrictive part instead of a horizontal gastrectomy in the original Scopinaro type BPD. Laparoscopic sleeve gastrectomy (LSG) was used as a first step in a staged concept for high-risk patients undergoing bariatric surgery. However, it is now being increasingly favored as a stand-alone procedure. This article discusses the history, surgical technique, early results, metabolic effects, mid- to long-term results regarding weight loss, improvement of comorbidities and quality of life, management of complications and indications. LSG is a safe and effective bariatric procedure with satisfying weight loss results and effects on comorbidities. Further data are required to assess long-term effectiveness and safety of LSG. In patients with very high initial BMI, LSG can be used in a staged concept. Other indications are: in cases with dense adhesions of the small bowel, patients with inflammatory bowel disease and patients where repeated endoscopy of the duodenum is necessary.

Re-sleeve gastrectomy as revisional bariatric procedure after biliopancreatic diversion with duodenal switch

“…In revisional bariatric surgery, the risk for surgical complications is higher and complications might be more difficult to treat [1,11]. In the present series, we recorded one (5.9%) early complication with a leak at the angle of His within the first week after re-SG.…”

“…In SG, Baltasar et al reported first on two patients who had undergone re-SG for dilation of SG, with subsequent increased successive weight loss [23]. Other authors reported comparable observation with a substantial of weight regain in up to 23% of SG [5,6,11,18]. However, consideration should be given to a possible re-SG since additional gastric volume restriction might jeopardize the patient's psychological balance [8].…”

“…However, consideration should be given to a possible re-SG since additional gastric volume restriction might jeopardize the patient's psychological balance [8]. Also, a radiological examination by gastrographin or barium contrast swallow studies does also not seem completely appropriate to evaluate the volume of the SG [11,24].…”

“…Re-SG has, therefore, to be considered in these patients as recent reports demonstrate that SG has the tendency to dilate over time [11,[13][14][15]. We postulated that re-SG could increase further weight loss after BPD-DS when a dilated SG was present.…”

“…The reevaluation includes a psychologist and a nutritionist that has to rule out any presence of a new mental disorder or dietary behavior [8]. Further examinations should also exclude the appearance of gastroesophageal reflux (GERD) or a possible dilation of the SG [9][10][11]. The treatment than will depend on the different findings of the evaluations.…”