 Sleeve Gastrectomy
A sleeve gastrectomy is partial gastrectomy that involves resection of the majority of the body, fundus and antrum of the stomach, leaving a 80 - 120 cc “tube” of stomach adjacent to the lesser curve. It is sometimes referred to as a vertical sleeve gastrectomy.
The general belief is that the weight loss following sleeve gastrectomy is primarily due to the restrictive effect of size of the pouch but there are probably additional, yet undefined, effects on gastric emptying and GI hormones.
To reduce morbidity and improve outcomes in the highest risk patient populations some surgeons elected to stage the laparoscopic roux–en-y gastric bypass (LRYGB) or duodenal switch (LDS) procedures in two separate procedures. A laparoscopic sleeve gastrectomy is performed in the first stage. At a specified time interval or weight loss after undergoing LSG the patient then undergoes the second stage, the intestinal bypass portion of a DS or RYGB.
 The clinical results of weight loss and co-morbidity resolution associated with the LSG procedure has prompted some surgeons to defer the second stage for some patients as well as offer LSG as a stand alone procedure for patients with lower BMI’s.
Current clinical evidence reflects short- term outcomes: EWL at 12 months of 45% to 63% with significant co-morbidity improvement or resolution. While some studies have shown 3 year results patients with BMI<55 comparable to RYGB, the long-term durability of the weight loss or co-morbidity resolution associated with the procedure has not yet been established.
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