Laparoscopic and Open Sleeve Gastrectomy
The laparoscopic or open sleeve gastrectomy is one of the newer surgical procedures which has gained increasing popularity over the past few years. The sleeve gastrectomy is also a surgical component of the laparoscopic or open duodenal switch procedure. When performed alone or as a stand alone procedure it has shown surprising and better than expected results.
Recent European studies are demonstrating a 56.3% EBL [Excess body weight] at one year and a 71.3% EBL at three years which is actually comparable to the laparoscopic gastric bypass with Roux Y limb. Other Asian studies are also reporting more dramatic weight loss up to 84% EBL at one year. Currently, there are sparse long term studies but the few results available are showing a sustained EBL over 70% at six years. Longer studies will be needed to confirm the performance of this bariatric procedure.
However, this procedure is also associated with a minimal major complication rate which is around 1.5% versus 2.6% for the gastric band versus 6.5% for the laparoscopic/open gastric bypass with Roux Y Limb versus 22.7% for the duodenal switch. These results alone are explaining the increasing demand for this procedure.
Traditionally this procedure is performed via laparoscopy. In our service, we rarely perform it open. Technically, ninety percent of the stomach of the patient will be removed via laparoscopy. The surgeon performing this procedure will actually transform the stomach into a gastric tube with a limited volume capacity. The term sleeve gastrectomy comes from the actual technique used to remove or resect the stomach; it is completed by doing a sleeve resection or again the portion of the removed stomach looks like a sleeve.
Unlike other bariatric procedures, this procedure does not have the dumping side effect, the increase incidence of post-surgery anemia or the low absorption of vitamins or protein. For some bariatric surgeons, this is actually considered a superb weight loss procedure with really no side effects. The only results missing are long term studies.
The sleeve gastrectomy works very differently than all other bariatric procedures. First, it dramatically decreases the volume capacity of the stomach which in turn decrease the intake capacity of the patient. Most important, all studies are showing it immediately decreases the level of Ghrelin which is the hormone responsible for generating an appetite. Most of us believe that removing the portion of the stomach called the fundus is responsible for this alteration of the Ghrelin level which in turn generates the ensuing major weight loss.
In summary, this procedure is new but very promising. We personally believe it will become one of the bariatric procedures of choice in the future.