Sleeve Gastrectomy: Faliure or success as a one stage procedure

Aims: Sleeve gastrectomy (SG) is rapidly gaining popularity around the world as part of a 2 stage or as a one stage treatment of obesity. Many surgeons are advocating SG as a single definitive type of surgery for severely obese patients. The purpose of this study was to analyze the results with all SG patients operated at the University of Freiburg to determine the rate at which it can be expected that SG can function as a single definitive surgical procedure as compared to the number that require transition to the second stage of the procedure. Further on it was evaluated to which extent preoperative eating habits influence postoperative%EWL and the requirement of a further operation.

Methods: Patients undergoing SG were followed for the initial operation from 2007 – 2010 (n = 118). Patient groups preoperatively classified by their eating habits (stress eater, sweet eater, insufficient feeling of satiety) were compared to their reference groups with regard to their postoperative%EWL and requirement of a second step procedure.

Results: Over the period of the study 118 patients underwent SG. The mean EWL after 2 years was 55.9.% During the period of follow up 26.3% of patients undergoing SG required advancement to stage 2 surgery. Most stage 2 operations were done 9 – 12 months after SG. In comparison to their reference group sweet eater showed a 19% higher EWL (p: 0.131), stress eater a 12% higher EWL (p: 0.290) and patients with insufficient feeling of satiety a 7% higher EWL (p: 0.579) 2 years postoperatively. Patients with preoperative BMI > 50 had a PPV of 0.31 for the need of a second step (RR:1.99, p:0.08).

Conclusion: SG is rapidly gaining popularity like the adjustable gastric band before it. Many have made claims that SG can act as a single definitive surgical procedure for the treatment of severe obesity. The present study shows mean EWL of 55.9% after 2 years, with a stage 2 surgery rate of 26.3%. Regarding preoperative eating habits there seems to be no correlation with postoperative%EWL or the requirement of a second step procedure. Further on, patients with a BMI > 50 were about twice more likely to undergo a following operation. Nevertheless SG as a sole procedure seems reasonable.