Sleeve gastrectomy

Much has been published over the last few years about sleeve gastrectomy. It is a bariatric operation that has evolved from both established restrictive and malabsorptive procedures. Originally used as a bridge to definitive surgery in high-risk patients, it has recently been forwarded as a stand-alone procedure. Technical details of laparoscopic sleeve gastrectomy (LSG) vary, but the premise is removal of the vast majority of the stomach, especially the fundus, leaving only a thin gastric tube between the esophagus and the duodenum. This results in weight loss from restrictive as well as neurohormal mechanisms. Review of the literature reveals an average expected excess weight loss (EWL) of 61%. Morbidity and mortality seem to be on par with laparoscopic adjustable gastric banding (LAGB), but with superior weight loss results and an improved long-term complication profile. Unlike popular mixed malabsorptive procedures like Roux en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD-DS), there is no gastrointestinal segment exclusion, maintaining continuity for endoscopic interventions and surveillance. Comorbidity resolution with LSG is variable, though compares favorably with other bariatric procedures. While the early results seem promising, long-term data is still needed to define the place of LSG within the bariatric surgery armamentarium.