From December 2004 and June 2007 74 patients (9 men) had a laparoscopic sleeve gastrectomy for morbid obesity. They were aged 43.8 ± 9.4 years with a Body mass index (BMI) of 44.5 ± 8.24. Comorbidities included sleep apnea (34 patients), type 2 diabetes (11) and high blood pressure (21). 40 patients presented with at least 1 comorbid condition. 17 patients had a previous bariatric surgery (16 gastric bands, 1 sleeve gastrectomy) and 3 patients were converted to a sleeve gastrectomy instead of a biliopancreatic diversion with duodenal switch because of peroperative ventilation problems or limited access to the duodenum. Except in 1 case where the band was not removed all the bands were removed prior to (2 cases) or at the time of the sleeve gastrectomy. The sleeve gastrectomy was performed using 6 trocarts and over a 40 French bougie. All the procedures were completed laparoscopically in 73.0 ± 26.1 minutes. 64 of 74 patients had an uneventful postoperative course (86.5%). Major complications included bleeding (1 splenectomy at day 1 and 1 laparoscopic drainage of an hematoma) and an abdominal abcess with a laparoscopic drainage 10 days after the sleeve gastrectomy. Other complications were gastric stricture requiring endoscopic dilatation (2.7%), pneumonia (2.7%), nausea (2.7%) and unexplained fever (1.35%). The mean hospital stay was 3.6 days (range 2 to 8 days). Patients were reviewed in September 2007 : 3 were reoperated on during the follow up for weight regain (2) or food intolerance (1) (1 had a redo sleeve and 2 had a gastric bypass). Patients were reviewed every 3 months during the 1st year and every 6 months during the 2nd year and yearly thereafter. The postoperative BMI evolution was as follows :
The sleeve gastrectomy is a restrictive bariatric procedure with a very low rate of conversion to an open procedure and a short operative time. The morbidity rate is low and no mortality is reported. A significant decrease in BMI is observed at 1 year postoperatively, however a longer follow up will be required to assess the efficacy of the procedure especially in the group of patients with a previous gastric banding.
Program Number: P029