**3. Sleeve gastrectomy (vertical gastrectomy)**

Sleeve gastrectomy was first introduced as a restrictive component of duodenal switch surgery. Adequate weight loss at an early period is seen with sleeve gastrectomy alone in patients who are very obese and at risk with duodenal switch (DS) surgery [8, 9]. This method has been put into practice as a risk-reducing method in patients who cannot tolerate high-risk and long-term procedures [9]. Laparoscopic sleeve gastrectomy (LSG) has become a safe and efficient primary bariatric surgical method with increasing frequency of use and high popularity for both surgeons and patients [2]. Laparoscopic sleeve gastrectomy constitutes 5% of all bariatric surgical procedures, and the number of patients is increasing rapidly [10]. A narrow tubular stomach is created with this method (**Figure 2**). Stomach resection is performed after releasing the large curvatura pylori 2–3 cm proximal to His angle. A tissue stapler 4.5 mm in size (thick) is used in the antrum and 3.8 mm in size (medium) for the other parts of the stomach. To avoid leaving a large fundus pouch, meticulous posterior dissection should be performed so that the His angle is visible. If the lateral traction of the stomach is not good, a spiral-shaped resection line may develop. To decrease the risk of leakage, 1 cm of gastric serosa should be seen on the left side of the stapler cartridge before firing the final stapler. After resection, leakage and hemorrhage in the stapler line is checked with the endoscope. In the case of possible leakage, the omentum is sutured to the suture line in order to create a potential barrier. The sleeve tube is fixed and bending of the stomach from the incisura angularis is prevented by suturing the omentum or gastrocolic fat [11–13].

**79**

**Figure 3.**

*Laparoscopic adjustable gastric band.*

*Treatment Options in Morbid Obesity*

have a BMI of <50 kg/m<sup>2</sup>

*DOI: http://dx.doi.org/10.5772/intechopen.88823*

**4. Laparoscopic adjustable gastric band**

Laparoscopic sleeve gastrectomy is preferred in the super obese and in patients who

in excess weight was reported as 55% with a complication rate of 8% and mortality

method had been preferred [9]. While the diabetes remission rate following laparoscopic sleeve gastrectomy is reported to be 66.2%, a new bariatric procedure may be required later on in 15% of the patients [9]. Laparoscopic sleeve gastrectomy has become a commonly preferred method by itself or combined with other methods in the treatment of morbid obesity [14]. The most important complication is leakage (2%) and is often seen near the angle of His. Placing the end of the stapler line close to the esophagus, stenosis of the incisura angularis and bending of the tubular stomach are among the causes of leakage. Gastroesophageal reflux occurs in 26% of the patients after laparoscopic sleeve gastrectomy [7]. Revision surgery should be

The laparoscopic adjustable gastric band method has been available in the USA since 2001 [15]. This method decreases the food intake with its complete restrictive effect and results in loss of weight. An inflatable silicone band is wrapped around the stomach 3 cm below the esophagogastric junction, and a reservoir of 25–30 cm long is formed at the proximal section. At the other end of the band, there is a subcutaneously placed port (**Figure 3**). The calibration of the gastric opening can be changed by fluoroscopy-guided filling and emptying of the silicone band. The band is initially inserted in completely deflated form. The pars flaccida technique has become the standard since band prolapse and erosion are less common in this way. The laparoscopic adjustable gastric band method requires frequent follow-up and should therefore only be performed in patients who live in close proximity to the hospital. Only multivitamins are recommended after the surgery. Adjustment of the band is as important as the surgery itself, and weight loss of 0.5 kg per week is ideal with this method [16]. Patients lose 58–60% of their extra weight in 7–8 years after

rate of 0.19% in the review of 2500 patients (mean BMI: 51.2 kg/m<sup>2</sup>

performed in the case of treatment-resistant gastroesophageal reflux.

and want to undergo surgery with this method. Mean loss

) where this

**Figure 2.** *Sleeve gastrectomy.*

#### *Treatment Options in Morbid Obesity DOI: http://dx.doi.org/10.5772/intechopen.88823*

*Obesity*

disease (GERD) symptoms.

**3. Sleeve gastrectomy (vertical gastrectomy)**

the comorbid diseases. Mortality is <1% and morbidity is 15%. Complications such as postoperative leakage (1–2%), stenosis (1–19%), small bowel obstruction-internal hernia (7%), and marginal ulcer (3–15%) can be seen. Urgent surgical intervention is required when intestinal obstruction is suspected as it may cause long segment necrosis. Roux-en-Y gastric bypass is more effective than a laparoscopic adjustable gastric band especially in the treatment of type 2 DM and gastroesophageal reflux

Sleeve gastrectomy was first introduced as a restrictive component of duodenal switch surgery. Adequate weight loss at an early period is seen with sleeve gastrectomy alone in patients who are very obese and at risk with duodenal switch (DS) surgery [8, 9]. This method has been put into practice as a risk-reducing method in patients who cannot tolerate high-risk and long-term procedures [9]. Laparoscopic sleeve gastrectomy (LSG) has become a safe and efficient primary bariatric surgical method with increasing frequency of use and high popularity for both surgeons and patients [2]. Laparoscopic sleeve gastrectomy constitutes 5% of all bariatric surgical procedures, and the number of patients is increasing rapidly [10]. A narrow tubular stomach is created with this method (**Figure 2**). Stomach resection is performed after releasing the large curvatura pylori 2–3 cm proximal to His angle. A tissue stapler 4.5 mm in size (thick) is used in the antrum and 3.8 mm in size (medium) for the other parts of the stomach. To avoid leaving a large fundus pouch, meticulous posterior dissection should be performed so that the His angle is visible. If the lateral traction of the stomach is not good, a spiral-shaped resection line may develop. To decrease the risk of leakage, 1 cm of gastric serosa should be seen on the left side of the stapler cartridge before firing the final stapler. After resection, leakage and hemorrhage in the stapler line is checked with the endoscope. In the case of possible leakage, the omentum is sutured to the suture line in order to create a potential barrier. The sleeve tube is fixed and bending of the stomach from the incisura angularis is prevented by suturing the omentum or gastrocolic fat [11–13].

**78**

**Figure 2.** *Sleeve gastrectomy.* Laparoscopic sleeve gastrectomy is preferred in the super obese and in patients who have a BMI of <50 kg/m<sup>2</sup> and want to undergo surgery with this method. Mean loss in excess weight was reported as 55% with a complication rate of 8% and mortality rate of 0.19% in the review of 2500 patients (mean BMI: 51.2 kg/m<sup>2</sup> ) where this method had been preferred [9]. While the diabetes remission rate following laparoscopic sleeve gastrectomy is reported to be 66.2%, a new bariatric procedure may be required later on in 15% of the patients [9]. Laparoscopic sleeve gastrectomy has become a commonly preferred method by itself or combined with other methods in the treatment of morbid obesity [14]. The most important complication is leakage (2%) and is often seen near the angle of His. Placing the end of the stapler line close to the esophagus, stenosis of the incisura angularis and bending of the tubular stomach are among the causes of leakage. Gastroesophageal reflux occurs in 26% of the patients after laparoscopic sleeve gastrectomy [7]. Revision surgery should be performed in the case of treatment-resistant gastroesophageal reflux.
