The sleeve gastrectomy

Abstract

Sleeve gastrectomy (SG), or longitudinal gastric resection, consists in a resection of the greater curvature of the stomach. In bariatric surgery, it was introduced by Hess in 1988 [1] and by Marceau in 1990 [2, 3] as a component of the biliopancreatic diversion with duodenal switch (BPD/DS) (Fig. 18.1). Resecting the greater curvature of the stomach was aimed at reducing the risk of ulcer at the level of the duodeno-ileal anastomosis of the BPD/DS. In fact, for those authors, the amount of stomach removed was estimated to be roughly 60% and the restriction was moderate [4]. With a view to reducing the mortality associated with laparoscopic BPS/DS in super-super-obese patients, Regan et al. described a 60-French (F) bougiecalibrated isolated sleeve gastrectomy (ISG) as a first step in a two-stage program of laparoscopic BPD/DS in 2000 [5, 6]. Since then, primary ISG has gained popularity in a staged surgery program for high-risk patients [7–11]. Although medium- to long-term results are not known, and some technical details are still being discussed, the good short-term results obtained regarding weight loss, as well as co-morbidity and the acceptable rate of complications, have broadened the indications for primary ISG and assured its place in the armamentarium of bariatric surgical procedures [7, 10, 12–20] (⊡ Fig. 18.2). In June 2007, a position statement on SG as a bariatric procedure was endorsed by the ASMBS [21], and in October 2007 the First International Consensus Summit for Sleeve Gastrectomy was held in New York City [22]. Some consider this longitudinal gastrectomy to have some affiliation with the vertical gastroplasty called Magenstrasse and Mill (M & #x0026; M), practiced since 1992 by Johnston [23]. However, in the latter procedure, the stomach is transected and not resected, and the physiological implications could be different (⊡ Fig. 18.3).