State of the art: sleeve gastrectomy.

In the biliopancreatic diversion (BPD) type duodenal switch, sleeve gastrectomy was applied as the restrictive part instead of a horizontal gastrectomy in the original Scopinaro type BPD. Laparoscopic sleeve gastrectomy (LSG) was used as a first step in a staged concept for high-risk patients undergoing bariatric surgery. However, it is now being increasingly favored as a stand-alone procedure. This article discusses the history, surgical technique, early results, metabolic effects, mid- to long-term results regarding weight loss, improvement of comorbidities and quality of life, management of complications and indications. LSG is a safe and effective bariatric procedure with satisfying weight loss results and effects on comorbidities. Further data are required to assess long-term effectiveness and safety of LSG. In patients with very high initial BMI, LSG can be used in a staged concept. Other indications are: in cases with dense adhesions of the small bowel, patients with inflammatory bowel disease and patients where repeated endoscopy of the duodenum is necessary.