Copyright ©The Author(s) 2015.
World J Gastroenterol. Nov 7, 2015; 21(41): 11804-11814
Published online Nov 7, 2015. doi: 10.3748/wjg.v21.i41.11804
Table 1 Randomized trials of bariatric surgery studies including laparoscopic sleeve gastrectomy
Ref.CountryFollow-up(mo)Intervention groupsPreoperative BMI (kg/m2)Weight lossT2DMT2DM remissionT2DM remision criteria
Langer et al[53]Austria6SG (10)48.361.4%EWL10%NR
LAGB (10)46.728.7%EWL30%
Himpens et al[54]Belgium36SG (40)39.066%EWLNR
LAGB (40)37.048%EWL
Lee et al[55]Taiwan12SG (30)30.376.3%EWL100%93%FG < 126 mg/dL and A1c < 6.5% without hypoglycemic therapy
RYGB (30)94.4%EWL47%
Karamanakos et al[56]Greece12SG (16)45.169.7%EWL
RYG (16)46.660.5%EWL
Kehagias et al[57]Greece36SG (30)44.968.5%EWL16.7%80%FG < 126 mg/dL without hypoglycemic therapy
RYGB (30)45.862.1%EWL16.7%80%
Peterli et al[58]Switzerland12SG (11)44.765.6%EWL0%
RYGB (12)46.777.0%EWL0%
Schauer et al[59]USA36SG (50)36.281%EWL100%26.5%A1c < 6.0% without hypoglycemic therapy
RYGB (50)37.088%EWL42%
Medical therapy (50)36.813%EWL
Schauer et al[60]USA12SG (50)36.221.1%TWL100%29%A1c < 6.0% without hypoglycemic therapy
RYGB (50)37.024.5%TWL46%
Medical therapy (50)36.84.2%TWL0%
Paluszkiewicz et al[61]Poland12SG (36)46.167.6%EWL27.8%40%FG < 100 mg/dL and A1c < 6.0% without hypoglycemic therapy
RYGB (36)48.664.2%EWL38.9%64.3%
Ramón et al[28]Spain12SG (8)43.5NR25.0%100%NR
RYGB (7)44.228.6%100%
Vix et al[62]USA12SG (45)45.582.9%EWL8.9%NR
RYGB (45)47.080.3%EWL8.9%
Table 2 Complication and mortality rates of the different bariatric surgery techniques according to the American College of Surgeons - Bariatric Surgery Center Network
30-d mortality0.110.050.14
1-yr mortality0.210.080.34
30-d morbidity5.611.4415.91
30-d readmission5.401.7116.47
30-d reoperation2.970.9215.021
Table 3 Sleeve gastrectomy may be preferable to other procedures in the following situations
Extreme obesity (BMI > 50 kg/m2): first-step procedure
ASA IV morbidly-obese patient
Absence of hypercholesterolemia
To avoid drug malabsorption
Extreme ages
BMI of 35-40 kg/m2 with comorbidity
Class I obesity
Crohn’s disease
Prevent potential consequences of hypoglycemia in specific occupations
Table 4 Clinical outcomes of sleeve gastrectomy and Roux-en-Y gastric bypass
Weight lossNo differences with RYGBNo differences with SG
67.1 %EWL at 12 mo[63]68.9% EWL at 12 mo[63]
Type 2 diabetes mellitus remissionEarly improvement before significant weight lossSlightly more effective than SG. HR 1.49, 95%CI: 1.04-2.12 for type 2 diabetes mellitus remission in favor of RYGB[63]
More effective than other restrictive techniques
Hypertension remissionGreater efficacy than other restrictive techniquesMore effective than SG
69% (55-82) Hypertension remission for SG and 45% (27-56) for LAGB[72]HR of 1.47, 95%CI: 1.115-1.86 for Hypertension remission in favor of RYGB[63]
Dyslipidemia remissionSame as other malabsorptive techniques, no hypercholesterolemia improvementClearly more effective than SG. HR = 2.41, 95%CI: 1.87-3.11 for Dyslipidemia remission in favor of RYGB[63]
MortalityNo differences (detailed in table 2)No differences
Surgical complicationsLess surgical time, lowest 30-d morbidity, 30-d readmission and 30-d reoperation. (detailed in table 2)Increased risk of nutritional deficiencies
Characteristic complications: staple line leaks (2.7%[86]; < 1% in expert hands[87])Characteristic complications: severe hypoglycemia
Long-term resultsLimited evidenceEffective and safe in the long term
Other advantagesPossibility of conversion to a malabsorptive surgery