TECHNICAL PROCEDURE: WHAT IS THE SLEEVE GASTRECTOMY? (2nd part)
We shall now examine the goals and the results of this operation and will try to establish the potential indications. In the first place, one should say that sleeve gastrectomy is not officially recorded as a typical bariatric procedure, such as gastric bypass or lap-banding. It is actually difficult for the time being to say if it should be considered as a primary operation, or a pure first step procedure before a "stronger" one. Initially, sleeve gastrectomy has been described as the preliminary stage before the duodenal switch (that we shall analyze furthermore later on). Yet it turns out often that some patients will never benefit from the second step, for psychological or medical reasons. Moreover, one cannot make final statements about the type of operation that should be performed as a second step. Duodenal switch is indeed the landmark operation, but entails potentially a severe malabsorbtion, thus multiple deficiencies. Some would prefer alternative options: a standard gastric bypass (with a "re-division" of the stomach), or a lap-banding (a simple technique, which nevertheless "adds restriction to restriction"), or even a "re-sleeve gastrectomy", i.e. a re-division if the stomach has dilated or if the primary operation has been insufficient. As a matter of fact, it is inevitable that gastric tissues will extend over the time; the second step procedure should then be scheduled one year afterwards, precisely to avoid this rebounce and operate on in easier conditions. Furthermore, ther are specific drawbacks such as vomiting, or gastroesophageal reflux.
What type of indications should be discussed? Ideally the so called "superobese patients" (BMI above 50) and mostly the "triple obese patients" (above 60) because they are more fragile and prone to post-operative severe complications; patients with BMI > 40 and having a severe medical illness; patients with lower BMI; conversions from gastric banding that did fail (weight regain).
This operation is now at a turning point and animated debates take place nowadays on different strategies to fight morbid obesity.