Sleeve Gastrectomy Update

From Bariatric.templehealth.org

Before I get to that promised case presentation, I wanted to give a quick update on our experience with the Sleeve Gastrectomy as a metabolic and weight loss procedure.  I saw an article from a December  2012 Summit on Sleeve Gastrectomy in New York, NY, and I thought there would be interest in giving our recent history and impressions as well.

Firstly, and paralleling a presentation on a 6 year study on involving 547 patients in Florida, we have seen a dramatic increase in the number of patients requesting a Sleeve, and following through to have them done. Earlier in this blog, essentially within the past year, I reported our case mix (of our 700+ surgeries per year) as roughly 75% Bypass, 20% Band, and 5% Sleeve.  Now, the mix is more like 70% Bypass and nearly 25-30% Sleeve with a rare Band being done currently.

Additionally, the Metabolic benefits of the Sleeve Gastrectomy are nearly comparable to the Bypass, which is great news for Diabetic or pre-Diabetic patients.  I was just speaking with one of our Surgeons the other day, about how this has shown to be even better than was originally expected, which has been savored by both patients and Endocrinologists alike!

Weight loss amounts have also been very good, again a little more than we had expected, vs. the known track record of the Bypass which is and has been the Gold Standard.  Weight losses over 100 pounds have been common, I even saw a patient today who had lost 180#, now down to a BMI of 29.  The aforementioned study showed average weight loss of just over 60% Excess Weight Lost, with the mean of 137 pounds.  The EWL at 48 months and 60 months post op was 47% and 31% respectively.

Our initial concerns with the Sleeve were mainly centered around it's apparent unimodal mechanism of action : Restriction, and the decreased size of the Gastric reservoir..  We had thought it was more Band-like than Bypass-like in that regard.  We honestly expected relatively easy weight regain from maladaptive eating behaviors just after the 9-12 month time frame.  We have been doing Sleeve Gastrectomies now for over 2 years, and we haven't really seen that as a common theme yet.  This study seemed to support that notion, making it similar to Bypass in rates and degree of weight regain, but no worse.

So with the Sleeve's preservation of the more native GI anatomy, the added metabolic effect from alteration in gut hormones, and the reduction in micronutrient deficiencies from minimized malabsorption, it appears that the Sleeve Gastrectomy is a durable and effective Bariatric and Metabolic procedure that is here to stay.