Sleeve Gastrectomy as a Single-Stage Bariatric Operation: Indications and Limitations

Sleeve gastrectomy (SG) was initially described as a first-step procedure followed by either biliopancreatic diversion with duodenal switch or Roux-en-Y gastric bypass in super-super-obese patients. Multiple recent reports have documented SG as single therapy in the treatment of morbid obesity. However, the indications for this procedure are still under evaluation. Accumulating data demonstrate that SG can be an effective and safe procedure for super-super-obese or high-risk patients either as a single operation or as a bridge to more definitive surgery. SG can also be performed in patients who require anti-inflammatory medication or in patients with conditions such as Crohn's disease, cirrhosis, anemia, or severe osteoporosis which preclude intestinal bypass. Furthermore, SG represents not only a safe alternative for morbidly obese patients on anticoagulant medication or immunosuppressive agents but also for those with multiple intra-abdominal adhesions or after failed gastric banding. In addition, SG can be performed safely in morbid obese adolescents. The main limitation of this novel bariatric procedure is the lack of long-term data on sustained weight loss and resolution of obesity-related comorbidities. Moreover, the fact that SG is an irreversible operation adds to its weakness as a bariatric procedure, at least until definitive results concerning its efficacy are obtained. SG is effective and safe as a single-stage procedure for certain cohorts of patients. However, the broad application of SG as a single-stage procedure in the bariatric field can be established only if the procedure is standardized and long-term results are available.