Sleeve Gastrectomy

Sleeve gastrectomy (or gastric sleeve) is a restrictive procedure where the stomach is reduced to about the size of a banana using a large number of staples, and the larger part of the stomach is removed. The smaller stomach restricts or limits the amount of food you can eat but allows for normal digestion and absorption of nutrients. Sleeve gastrectomy is permanent. The procedures was originally developed as a two part treatment where the patient first has sleeve gastrectomy and once their weight reached a certain level, a second treatment such as gastric bypass was performed. In these cases, sleeve gastrectomy was designed for patients with a Body Mass Index (BMI) of 60 or higher.

The Lap Band procedure, on the other hand, involves no cutting or stapling of the stomach or intestinal rerouting, it is adjustable and reversible and designed for sustained weight-loss. The Lap Band procedure is a restrictive procedure during which an adjustable gastric band is placed around the upper part of the stomach. This creates a smaller stomach pouch, which restricts the amount of food that can be consumed at one time and helps the patient to feel full sooner. As a result, patients achieve sustained weight-loss by limiting food intake and reducing appetite while allowing for the normal absorption of nutrients.15

Compared to Lap Band

Procedural Differences

The Lap Band is a restrictive device and requires no cutting, stapling, or removal of any part of your existing stomach. Instead, the Lap Band is placed around the stomach to limit the amount of food it can hold at one time.

Similar to gastric bypass, sleeve gastrectomy (or gastric sleeve) requires stomach cutting and stapling to create a small sleeve-shaped stomach, about the size of a banana — the larger part of the stomach is permanently removed.

Adjustability

The Lap Band can be quickly, easily and non-surgically adjusted to affect weight-loss results — during a brief doctor’s office visit. Since such a large part of the stomach is removed during the gastric sleeve procedure, there are not really any “adjustments” to be made.

Reversibility

While the Lap Band is a long-term weight-loss solution, if necessary, the procedure can be reversed — with the stomach returning to its original shape. Due to stomach cutting and removal, the gastric sleeve procedure is considered permanent and cannot be reversed. It is typically performed as part of a two-part procedure where the second treatment can be gastric bypass, which is also permanent.

Safety

Lap Band is the only gastric banding system with a nine-year safety history — FDA approved since 2001. There is currently no long-term safety data in the U.S. on sleeve gastrectomy.

Results

The Lap Band procedure has been proven in studies to significantly reduce weight and body mass steadily and consistently with patients maintaining their weight-loss over time.1,16 Weight-loss with the Lap Band was shown in one study to resolve (76%) or improve (14%) gastroesophageal reflux (N=48).4 Results are expected to be similar to gastric bypass, which may result in some weight gain. Typically long-term weight-loss results are comparable to adjustable gastric banding.17

Risks

Lap Band

  • No risk of staple-line leakage, as there is no cutting or stapling of the stomach with the Lap Band procedure.
    • Mortality rate: 0.05%19
    • Total complications: 9%20
    • Major complications: 0.2%20
  • Most common complications include:
    • Standard risks associated with major surgery
    • Nausea and vomiting21
    • Lap Band slippage
    • Stoma obstruction
  • In clinical studies, there have been no reported risks for renal failure after the Lap Band procedure.

Gastric Sleeve

  • With sleeve gastrectomy, there is a risk of possible staple-line leakage, which may require additional surgery to resolve. There is also a risk of gastric reflux and esophagitis.18
    • Mortality rate: <1%18
    • Major complications: 2.9%18
  • Complications include:
    • gastric remnant dilation
    • suture line bleeding and leakage
    • gastric strictures22
  • There is a risk of renal failure after having the gastric sleeve procedure.20

References:

1Directions For Use (DFU). LAP-BAND AP® Adjustable Gastric Banding System with OMNIFORM® Design. Allergan, Inc. Irvine, CA. 08/09. The LAP BAND System was approved in the United States on the basis of a nonrandomized, single-arm study (N=299). Significant improvement in percent of excess weight-loss vs. baseline was achieved at 12 months (34.5%), 24 months (37.8%), and 36 months (36.2%).

2O’Brien PE, et al. Systematic review of medium-term weight-loss after bariatric operations. Obes Surg. 2006;16(8):1032-1040.

3American Association of Clinical Endocrinologists/American College of Endocrinology Obesity Task Force. AACE/ACE Position Statement on the Prevention, Diagnosis, and Treatment of Obesity (1998 Revision). Endocr Pract. 1998;4:297-350.

4Dixon JB, O’Brien PE, Gastroesophageal reflux in obesity: the effect of Lap-Band placement. Obes Surg. 1999;9:527-531.

5Dixon JB, Chapman L, O’Brien P. Marked improvement in asthma after Lap Band surgery for morbid obesity. Obes Surg. 1999;9:385-389.

6Dixon JB, O’Brien PE. Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care. 2002;25:358-363.

7Dixon JB, Schachter LM, O’Brien PE. Sleep disturbance and obesity. Arch Intern Med. 2001;161:102-106.

8A Surgical Aid in the Treatment of Morbid Obesity, LAP BAND System Information for Patients (P/N 94829). Allergan, Inc. Irvine, CA. April, 2008.

9Weiner R, Blanco-Engert R, Weiner S, et al. Outcome after laparoscopic adjustable gastric banding – 8 years experience. Obes Surg. 2003;13:427-434.

10Data on File. Allergan, Inc. Irvine, CA. November, 2009.

11FDA approves REALIZE™ adjustable gastric band for morbid obesity. Ethicon Endo-Surgery, Ind., press release. Available at: http://www.ethiconendo.com/dtcf/pages/press_room_4.htm. Accessed on September 23, 2008.

12Mittermair RP, Weiss HG, et al. Band Leakage after Laparoscopical Adjustable Gastric Banding. Obes Surg. 2003; 13:913-917.

13Reijnen M, Naus JH, et al. Mechanical Evaluation of a Ruptured Swedish Adjustable Gastric Band. Obes Surg. 2004;14:253-255.

14Piorkowski JR, Ellner SJ, Mavanur AA, Barba CA, Preventing port site inversion in laparoscopic adjustable gastric banding, Surg Obes Relat Dis. 2007 Mar-Apr;3(2):159-61; discussion 161-162.

15Weight-control Information Network (WIN), an information service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Gastrointestinal Surgery for Severe Obesity. December 2004. Available at: http://win.niddk.nih.gov/publications/gastric.htm. Accessed May 2, 2007.

16Data on File. Allergan, Inc. Irvine, CA. April, 2009.

17Weiner RA, et al. Laparoscopic Sleeve Gastrectomy – Influence of Sleeve Size and Resected Gastric Volume. Obes Surg. 2007;17(10):1297-1305.

18Lalor PF, et al. Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2008;4:33-38.

19Chapman A, et al. Systematic review of laparoscopic adjustable gastric banding for the treatment of obesity: update and re-appraisal. Executive summary. ASERNIP-S Report No. 31. Second edition. Adelaide, South Australia: ASERNIP-S, June 2002.

20Parikh MS, et al. Objective Comparison of Complications Resulting from Laparoscopic Bariatric Procedures. J Am Coll Surg. 2006; 202:252-261.

21Clegg AJ, et al. The clinical effectiveness and cost-effectiveness of surgery for people with morbid obesity: a systematic review and economic evaluation. Health Technol Assess. 2002;6:1-153.

22Aggarwal S, et al. Laparoscopic sleeve gastrectomy for morbid obesity: a review. Surg Obes Relat Dis. 2007;3:189-194.

23Fakhro, J. Comparison between laparoscopic gastric banding and laparoscopic sleeve gastrectomy. World Journal of Laparoscopic Surg. 2008; 1(2): 29-31.

24Faria SL, Kelly E, Faria OP. Energy Expenditure and Weight Regain in Patients Submitted to Roux-en-Y Gastric Bypass. Obes Surg. Apr 28 2009.

25Bernert CP, et al. Nutritional Deficiency after Gastric Bypass: Diagnosis, Prevention and Treatment. Diabetes & Metab. 2007; 33:13-24.

26Vilarrasa, N. Evaluation of bone disease in morbidly obese women after gastric bypass and risk factors implicated in bone loss. Obes Surg. 2009; 19: 860-866.

27Chaston TB, Dixon JB, O’Brien PE. Changes in fat-free mass during significant weight-loss: a systematic review. Int J Obes (Lond). May 2007;31(5):743-50.

28Dixon JB, O’Brien PE. Nutritional Outcomes of Bariatric Surgery. In: Buchwald H, Cowan GSM, Pories WJ, eds. Surgical Management of Obesity. Philadelphia, PA: Saunders Elsevier; 2007:357-364.

29O’Brien PE, et al. LAP BAND: Outcomes and Results. J Laparoendosc Adv Surg Tech A. 2003; 13(4):265-270. 

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