III Technical Considerations
Standardization of Technique in Sleeve Gastrectomy
Jayshree Todkar and Rachel Maria Gomes
Laparoscopic sleeve gastrectomy (LSG) is a restrictive bariatric procedure without a diverting malabsorptive component. It involves resection of a large part of the body and the fundus of the stomach along the greater curvature to provide increased satiety and decreased appetite. The LSG has been seen over time to be an effective bariatric surgery operation and a sensible option in high risk patients . It has thus evolved to be the most popular bariatric stand-alone operation in India .
LSG for weight loss was first described by Marceau in 1993 as a component of the bilio-pancreatic diversion with duodenal switch (BPD/DS) . Here the distal gastrectomy of Scopinaro’s BPD/DS was modified into a vertical gastrectomy or a sleeve gastrectomy. LSG was subsequently performed as a component of single staged BPD/DS and as the initial stage of a two-staged approach for super obese patients who were considered a high risk group for a combined procedure . Regan et al. in 2003 also described it as the initial stage of a two-staged laparoscopic roux-en-Y gastric bypass (LRYGB), consisting of LSG followed by LRYGB in superobese patients . Over time in addition to the safety profile of LSG in super obese patients, the effectiveness of LSG in isolation was identified in regards to
J. Todkar, MS, Dip. Laparoscopic Surg, FBMS Department of Bariatric Surgery, Ruby Hall Clinic,
R.M. Gomes, MS, FMAS (*)
© Springer Nature Singapore Pte Ltd. 2017
P.R. Palanivelu et al. (eds.), Bariatric Surgical Practice Guide,
percentage of excess weight loss (%EWL) and resolution of obesity comorbid conditions. LSG has now evolved to be a standard bariatric stand-alone operation.
Besides safety profile and effectiveness LSG has been a popular surgical approach among the bariatric community due to its perceived simplicity of surgical technique. Its prominent advantages are lack of an intestinal bypass (thus avoiding an anastomosis and diversion malabsorption), shorter operating times and no implantation of a foreign body. The wide variation in technique used by different bariatric surgeons has however been a part of evolution of this procedure with many showing to have an effect on eventual mid-term and long-term outcomes. The aim of this chapter was to summarize the existing evidence on LSG technique.