Sleeve gastrectomy: Technique and results

Abstract

Sleeve gastrectomy (SG), sometimes also called longitudinal gastrectomy, is performedwith increasing frequency in the treatment of morbid obesity, second only to gastric bypass(GBP).SG is the natural offspring of other operations performed for morbid obesity, namely,calibrated vertical gastroplasty (CVG) (or Mason’s vertical banded gastroplasty), theMagenstrasse’s operation and Mill’s operation, mainly performed in the UK [1]. Hess andMarceau introduced the SG into the armamentarium of the bariatric surgeon in 1988 [2]as the restrictive part of the duodenal switch (DS). Gagner and Rogula [3] described thisoperation as the first of two stages of biliopancreatic diversion (BPD) with DS performed6 to 12 months later, in order to decrease the high mortality associated with this complexoperation in the super-obese. The SG was described as an isolated therapeutic modalityfor the first time in 1993 [1].As this procedure has been introduced only recently in bariatric surgery, the techniqueof SG has not yet been standardized in all its steps (the type of stapler, the size of thecalibration bougie, the size of the pouch, the type of staples, the number of firings as wellas whether or not to reinforce the staple line). This variability of technique, along withpoorselectionofcandidatesfortheprocedure(‘‘sweeteaters’’),arepossibleexplanationsfor the wide variations in outcome found in the different published series.Herein we describe the technique of SG, as performed in our unit since 2004 (230interventions—oral communication). Based on the literature and our midterm results wealso report the main complications and their management.