An update on sleeve gastrectomy

Laparoscopic sleeve gastrectomy (LSG) has emerged as the first step of a two staged operation in biliopancreatic diversion with duodenal switch (DS) or laparoscopic Roux-en-Y gastric bypass (LRYGB) for superobese high-risk patients. Due to the good short-term outcomes in weight loss and resolution of comorbidities and its technical simplicity, LSG has been increasingly applied as a definitive operation for morbidly obese patients. As LSG can be considered easier and faster to perform compared to LRYGB, it could become the procedure of choice in treating morbid obesity providing that long-term results of LSG were comparable with LRYGB regarding weight loss, the resolution of comorbidities and the quality of life improvement. A PubMed literature search was done, identifying over 2000 abstracts. Of these studies 74 original articles were selected as relevant studies for the topic and a secondary analysis. The operation is poorly standardized. There is no general agreement regarding the number of trocars used, the distance from pylorus to start the resection, bougie size, or staple line reinforcement among bariatric surgeons. The mechanisms by which LSG induces favourable metabolic changes and weight loss are not yet completely understood. As obesity is a lifelong disease, longer term comparative effectiveness data are most critical, and are yet to be determined. There is an obvious need for methodologically sound randomized studies concerning long-term results of LSG as a stand-alone operation compared to LRYGB and the effects on comorbidities of obesity. In conclusion, the quantity, quality, and consistency of evidence concerning LSG for obesity is low. Most of the current evidence comes from poorly designed nonrandomized controlled trials and case series and therefore, there is not yet enough evidence supporting the recommendation of LSG as a definitive, stand-alone procedure for morbid obesity.