A review of laparoscopic sleeve gastrectomy for morbid obesity.

Laparoscopic sleeve gastrectomy (LSG) is an innovative approach to the surgical management of morbid obesity. Weight loss may be achieved by restrictive and endocrine mechanisms. Early data suggest LSG is efficacious in the management of morbid obesity and may have an important role either as a staged or definitive procedure. A systematic review of the literature analyzing the clinical and operational outcomes of LSG was completed to further define the status of LSG as an emerging treatment modality for morbid obesity. Data from LSG were compared to benchmark clinical data and local operational data from laparoscopic adjustable gastric band (LAGB) and laparoscopic gastric bypass (LRYGB). Fifteen studies (940 patients) were identified following systematic review. The percent excessive weight loss (%EWL) for LSG varied from 33% to 90% and appeared to be sustained up to 3 years. The mortality rate was 0-3.3% and major complications ranged from 0% to 29% (average 12.1%). Operative time ranged from 49 to 143 min (average 100.4 min). Hospital stay varied from 1.9 to 8 days (average 4.4 days). The operational impact of LSG has not been described in the literature. According to data from the Royal Alexandra Hospital, the estimated total cost of LSG was $10,317 CAD as compared to LAGB ($7,536 CAD) and LRYGB ($11,666 CAD). These costs did not include further surgical interventions which may be required for an undefined group of patients after LSG. Early, non-randomized data suggest that LSG is efficacious in the surgical management of morbid obesity. However, it is not clear if weight loss following LSG is sustainable in the long term and therefore it is not possible to determine what percent of patients may require further revisional surgery following LSG. The operational impact of LSG as a staged or definitive procedure is poorly defined and must be analyzed further in order to establish its overall health care costs and operational impact. Although LSG is a promising treatment option for patients with morbid obesity, its role remains undefined and it should be considered an investigational procedure that may require revision in a subset of patients.