Laparoscopic sleeve gastrectomy with endoscopic guidance in morbid obesity

Background: Sleeve gastrectomy (SG) has been shown to be an effective first-stage procedure for morbidly obese patients. The SG is presently performed over a bougie varying sizes, which is useful, but known to produce injuries on insertion. In a retrospective study, we evaluated the effect of the laparoscopic SG (LSG) on excess weight loss during 1 year of follow-up using a 29F endoscope instead of a bougie. Methods: During a 1-year period, LSG was performed on 20 (18 women and 2 men) consecutive patients. Gamma regression analysis was used to determine whether the variation in gender, age, initial body mass index, Hispanic ethnicity, and interval after surgery were related to excess weight loss. Results: No deaths and 1 minor complication of oozing from the staple line occurred. The excess weight loss increased steadily over time, with a median 20% at 3 months, 32% at 6 months, 42% at 9 months, and 53% at 12 months. The median initial body mass index was 44.5 kg/m(2), and the median age was 50 years. Of the 20 patients, 2 were men (10%) and 18 women (90%); 5 (25%) were Hispanic and 15 (75%) were non-Hispanic. The patients had a median 11.5 co-morbidities. Nausea was common for about 7 days postoperatively. An increase in the initial body mass index and increased co-morbidities were the only, 2 variables directly and statistically connected with the percentage of excess weight loss (P <.05). Conclusion: The results of our study have shown that LSG with endoscopic guidance appears safe and effective and could be tried using a larger set of patients as a single-stage operation. (Surg Obes Relat Dis 2008:4:575-580.) (c) 2008 American Society for Metabolic and Bariatric Surgery. All rights reserved.