Laparoscopic vertical sleeve gastrectomy for morbid obesity. The future procedure of choice?

Abstract

I report the general experience of performing sleeve gastrectomy defined as "a partial gastrectomy that results in removal of most of the stomach," as a first-stage procedure for morbidly and super-obese people. I also explore its potential as a single procedure evaluating its advantages and disadvantages. This procedure is designed to reduce the size of the stomach and its distention, whereby the patient feels full sooner and their appetite is decreased. Some posit-increased satiety results from the decreased ghrelin, secreted by the fundus, which is resected during this procedure. The advantages of sleeve gastrectomy are as follows: the stomach is reduced without loss of function, pyloric preservation prevents dumping, it requires only 1 day in the hospital, it provides an effective first-stage procedure for super-obese patients, it is useful in patients with disorders such as anemia or Crohn's disease, which preclude intestinal bypass, it can be performed laparoscopically, even in patients who weigh over 500 lbs, no band adjustment is required, it does not result in malabsorption, and it provides a good educational teaching base for doctors lacking experience in the treatment of gastric ulcers. The disadvantages include the risk of stapling complications and its irreversibility.