Sleeve Gastrectomy

Sleeve Gastrectomy

When ?Indications

Contraindications ?

Sleeve Gastrectomy

• First step in Super Super Morbidly Obese Patient

– Followed by RYGBP or BPD

• First step to a Non Bariatric second procedure

– Followed by Hip replacement, Recurrent

Incisional Hernia, pull through procedure for

UC, etc

Indications

Sleeve Gastrectomy

• Final step in ASA IV Morbidly Obese Patient

– Low EF, Heart ort Kidney transplant

• Final step if that is the patients choice

• Final step in Cohn's disease

• Final step in extremes of age

– Adolescents ( no needles !!!!!!)

– Elderly

Indications

Sleeve Gastrectomy

• Final Step after failed Malabsorptive procedure

– Reversal of JIBP

• Final step in poor candidate for RYGBP/BPD

– Smoker, Coumadin, etc

• Final step in high risk stomach

– Chile, Colombia, Japan. High incidence of

gastric cancer !!

Indications

Sleeve Gastrectomy

Technical ConsiderationsHow to do it

Sleeve Gastrectomy

• Surgical technique

• 7 ports

• Harmonic scalpel

• 38 Fr boogie

Sleeve Gastrectomy

Sleeve Gastrectomy

Sleeve Gastrectomy

Jossart et al

Sleeve Gastrectomy

LSG first or final step ?Results

Sleeve Gastrectomy

Sleeve Gastrectomy

Sleeve Gastrectomy

LSG as a first step ?

Sleeve GastrectomyProbability of Developing Complications after Gastric Bypass according to

Weight

Livingston et al. Annals of Surg. Nov 2002. 576-582

Sleeve Gastrectomy

Review of the Literature

• Almogy G, Crookes PF, Anthone GJ. Longitudinal

gastrectomy as a treatment for the high-risk super-obese

patient. Obes Surg. 2004 Apr;14(4):492-7

RESULTS:

• At 12months: Median weight loss: 44.5 kg,

• % EWL 45.1%.

• After 1 year: 40% of the followed patients achieved

more than 50% EWL and another 50% needed less

medications for their associated co-morbidities

Sleeve Gastrectomy

Sleeve to LGB

January 2002 to February 2004

N 2186 Primary bariatric procedures

performed.

N 123 Consecutive laparoscopic sleeve

gastrectomies using a 50 F Bougie

N 23 Patients completed the second stage

LRYGBP.

Schauer et al

Sleeve Gastrectomy

Results of LSG

Operative time 174 ± 51 min

Length of stay 3 ± 1.7 days

Death 0

EWL one year 46 %

Schauer et al

Sleeve Gastrectomy

Change in BMI over Time

Schauer et al

Sleeve Gastrectomy

Down staging Pre-SGL Pre-LRYGB

BMI 63 48

ASA IV 56% 1%

ASA III 43% 34%

ASA II 65 % 0%

Co morbidities 10 6

Sleep Apnea 82% 43%

T2DM 60% 23%

Peripheral edema 100% 0%

Schauer et al

Sleeve Gastrectomy

Sleeve Gastrectomy

LSG as A Final Step?

Sleeve Gastrectomy

RESULTS

N 130 N 130

LSG between Nov 04 and Jan 07LSG between Nov 04 and Jan 07

2.4 2.4 femalefemale : 1 male : 1 male

Mean age Mean age 45.645.6 (12 -79) years (12 -79) years

Mean preop. weight was Mean preop. weight was 122.4122.4 (95.5 - (95.5 -

206.1) Kg206.1) Kg

The mean BMI was The mean BMI was 43.243.2 (30.2 - 75.4) Kg/m2 (30.2 - 75.4) Kg/m2

Sleeve Gastrectomy

RESULTS

Mean operative time Mean operative time 9797 (range: 58 – 180) (range: 58 – 180)

minsmins

No conversionsNo conversions

Mean hospital stay was Mean hospital stay was 3.23.2 (range: 1 – 19) (range: 1 – 19)

days.days.

There was There was no mortality no mortality in this series.in this series.

Sleeve Gastrectomy

RESULTS

N 130Initial 3 m 6 m 12 m 18 m

24 m

BMI (Kg/m2)

WL (Kg) *

%EWL

43.2

0

0

36.9

21.0

33.1

32.8

31.2

50.8

29.5

37.4

62.2

28.0

39.5

64.4

27.1

41.7

67.9

Sleeve Gastrectomy

Results

Table 1. Total Sample Demographic Characteristics (N=30)

Age (Yrs) Gender Type of DM Duration

(N=30) (N=30) (N=30) (N=30)

42.3 F - 21(70%) Type I - 3 (10%) <5 years-16(53%)

(21-69) M - 9 (30%) Type II - 27 (90%) >5 years-14(47%)

Sleeve Gastrectomy

DISCUSSIONAuthor No Initial BMI

(g/m2)

Follow up in

(Months)

%EWL

1 to 2 years

Baltasar

Cottam

Han

Himpens

Hammoui

Lee

Mognol

Silecchia

Rosenthal

31

126

60

40

118

216

10

41

130

*

65

37

39

55

49

64

57

43.2

3 – 27

12

12

12

12

24

12

12

24

62.3/NR

45/NR

81/NR

58/NR

49/NR

58 / 83

51/NR

NR/NR

62.2 / 67.9

Sleeve Gastrectomy

Conclusions and questions

Sleeve Gastrectomy

Questions that remain open to be answered:

• What will be the %EWL at 15 years when compared

to RGBP ?

• Will the gastric tube dilate ?

• What is the best size of the boogie ?

• Will Ghrelin levels drop and stay down as expected ?

Sleeve Gastrectomy

Questions that remain open to be answered:

• What % of SG will be converted to RYGBP ?

• Will the long term results be as good as other

purely restrictive procedures as LAGB/VBG

Sleeve Gastrectomy

Conclusions

• Not all bariatric patients face the same

operative risk

• Sleeve Gastrectomy is a valid surgical option

for weight loss with excellent short term

outcomes

Sleeve Gastrectomy

Conclusions

• Unknown long term outcomes

• May be an option for the very low and very

high risk patients

• Excellent option for the elderly and

adolescents

Sleeve Gastrectomy

Thank you!