Sleeve Gastrectomy: Surgical Technique, Outcomes, and Complications

The number of bariatric surgical procedures performed worldwide increases every year and has recently exceeded 685,000. Over 50% of these are laparoscopic sleeve gastrectomy (SG), and Roux-en-Y gastric bypass accounts for an additional 30%. Bariatric/metabolic surgery seeks to achieve not only weight loss and the remission of comorbidities, such as diabetes mellitus type II, arterial hypertension, sleep apnea, risk of cancer, non-alcoholic liver steatosis, etc., but also improvements in the patient's quality of life. SG is mainly a restrictive procedure consisting of the resection and removal of a major part of the stomach, which has an additional impact on hormones such as Ghrelin and Glucagon-like Peptide 1. The first part of this article focuses on patient preparation before a bariatric procedure with mandatory and additional examinations to decrease the patient's risk. Next, the surgical technique itself, including positioning of the patient, positioning of the trocars and related tips and tricks, and the postoperative course are described. The second part discusses the outcomes of SG, including weight loss, remission of comorbidities and quality of life. Further possible acute complications of SG such as leaks, bleeding or stenoses as well as long-term complications (reflux, weight regain and malnutrition) and respective treatments are also described. In conclusion, SG is an effective procedure for weight loss with a low risk for the patient to develop malnutrition. In terms of post-operative care, regular check-ups are vital to ensure a positive outcome as well as for the early detection of possible issues. Reflux and weight regain are common issues with SG in a long-term follow-up; thus, patients should be selected carefully for this procedure.