Laparoscopic Gastric Tubulization– Sleeve Gastrectomy – Another Option for Bariatric Food Intake Restriction in Morbidly Obese Subjects

Overview

Introduction:
Nowadays, obesity is the commonest multifactorial metabolic disorder. The role of bariatric surgery, i.e. surgery specializing in the treatment of obesity, in the management of obese patients, where conservative therapy failed and who have high incidence of obesity relapses, or in morbidly obese subjects (BMI > 40, resp. BMI > 35), as well as in superobese subjects (BMI > 60), is irreplacable. Most of the surgical procedures for the morbid obesity treatement use miinvasive laparocopic techniques. Recent options include the method of gastric tubulization– Sleeve Gastrectomy (SG), which , as a “single procedure“ has been performed in some clinics since 2003.

Material and Methodology:
In the Ist Surgical Clinic of the 1st Medical faculty of the Charles University and General Faculty Hospital, the authors have intensively studied the problematics of bariatric surgery since 1983. Since Janury 2006, a total of 39 morbidly obese patients (MO), where adjustable gastric bandage had not been indicated for various reasons, have been indicated for laparoscopic sleeve gastrectomy. Gastric bandage was not indicated, for instance, in cases where poor cooperation („sweet-eaters, binge-eaters“) could be expected or when good cooperation and adherence to diet restrictions in patients with SAGB could not be guaranteed.

Results:
Our study group of 39 morbidly obese patients included 30 females and 9 males. The mean age was 37.6 y.o.a., the mean weight was 127 kg, the mean height 164 cm and the mean BMI was 41.3. A nine- month follow up phase could be assessed only in 27 heavily obese subjects following SGs. The mean weight loss was 17.3 kg, the mean percentile excess weight loss (EWL) was 28.1 % and the final mean reduction in BMI was 12.1. No serious late complications were recorded in the study group.

Conclusion:
Sleeve gastrectomy presents with a rather higher risk rates compared to gastric bandage, however, the risk remains considerably lower compared to that in malabsorption procedures. Unfortunately, there is no long- term experience regarding maintanance of the weight loss or possible development of serious late complications. Current excellent long- term weight reduction clinical results are very promissing.

Key words:
morbid obesity – laparoscopy – sleeve gastrectomy