Third International Summit: Current status of sleeve gastrectomy

Surg Obes Relat Dis. Nov-Dec 2011;7(6):749-59. doi: 10.1016/j.soard.2011.07.017. Epub 2011 Aug 10.

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) has been performed for morbid obesity in the past 10 years. LSG was originally intended as a first-stage procedure in high-risk patients but has become a stand-alone operation for many bariatric surgeons. Ongoing review is necessary regarding the durability of the weight loss, complications, and need for second-stage operations.

Methods: The first International Summit for LSG was held in October 2007, the second in March 2009, and this third in December 2010. There were presentations by experts, and, to provide a consensus, a questionnaire was completed by 88 attendees who had >1 year (mean 3.6 ± 1.5, range 1-8) of experience with LSG.

Results: The results of the questionnaire were based on 19,605 LSGs performed within 3.6 ± 1.5 years (228.8 ± 275.0 LSGs/surgeon). LSG had been intended as the sole operation in 86.4% of the cases; in these, a second-second stage became necessary in 2.2%. LSG was completed laparoscopically in 99.7% of the cases. The mean percentage of excess weight loss at 1, 2, 3, 4, and 5 years was 62.7%, 64.7%, 64.0%, 57.3%, and 60.0%, respectively. The bougie size was 28-60F (mean 36F, 70% blunt tip). Resection began 1.5-7.0 cm (mean 4.8) proximal to the pylorus. Of the surgeons, 67.1% reinforced the staple line, 57% with buttress material and 43% with oversewing. The respondents excised an estimated 92.9% ± 8.0% (median 95.0%) of fundus (i.e., a tiny portion is maintained lateral to the angle of His). A drain is left by 57.6%, usually closed suction. High leaks occurred in 1.3% of cases (range 0-10%); lower leaks occurred in .5%. Intraluminal bleeding occurred in 2.0% of cases. The mortality rate was .1% ± .3%.

Conclusion: According to the questionnaire, presentations, and debates, the weight loss and improvement in diabetes appear to be better than with laparoscopic adjustable gastric banding and on par with Roux-en-Y gastric bypass. High leaks are infrequent but problematic.

Publication types

  • Congress

MeSH terms

  • Ambulatory Surgical Procedures
  • Consensus
  • Diabetes Complications / surgery
  • Gastrectomy / adverse effects
  • Gastrectomy / methods*
  • Gastric Bypass / adverse effects
  • Gastric Bypass / methods*
  • Gastroesophageal Reflux / etiology
  • Gastroscopy / methods
  • Hernia, Hiatal / etiology
  • Humans
  • Laparoscopy / adverse effects
  • Laparoscopy / methods*
  • Length of Stay
  • New York City
  • Obesity, Morbid / surgery*
  • Recurrence
  • Reoperation
  • Surgical Wound Dehiscence / etiology
  • Surveys and Questionnaires
  • Treatment Outcome
  • Weight Loss / physiology*