THE ANSWERS TO GASTRIC SLEEVE FAILURES
The Gastric Sleeve as an open procedure is known as part of the Duodenal Switch since 1988.
The Laparoscopic Gastric Sleeve on high risk patients started in 2004 as the first stage of the Duodenal Switch (DS) and soon after that date several teams started Laparoscopic Gastric Sleeve programs as primary or solitary surgical procedures for morbidly obese patients.
In 2007 the Gastric Sleeve was proposed as a treatment for Metabolic Disease regardless of the excess weight of the patient.
We don’t have long term follow-up results for Gastric Sleeve Patients as a primary procedure, however due to the increasing popularity of the Laparoscopic Sleeve we are starting to see an increased number of failures.
What we have observed in most of Gastric Sleeve failures is the presence of large stomachs or large sleeves instead of a small volume sleeve. We have also observed in these patients a very poor nutritional and dietary change of habits.
When we started performing Lap Band Procedures we were creating 50 cc pouches; soon after started creating 15 cc pouches in order to give patients restriction and to avoid failures. We are experiencing similar conditions with the Gastric Sleeve. The remaining stomach is too large (large sleeve) so patients don’t have adequate restriction to lose weight as we expected. The use of smaller bougie during surgery to calibrate the size of the sleeve is imperative to avoid such technical failures. The running suture reinforcement will also help to prevent a large stretching of the sleeve.
When we started performing Gastric Sleeves we didn’t have enough appropriate follow-up care for patients because we are assuming the sleeve will work and do its job (by creating enough restriction and decreasing the Ghrelin levels to lower hunger). The truth is patients need to be monitored closely and assisted on a regular basis with support groups and counseling in order to succeed.
We believe that stretching of the Sleeve with time will also play a huge role in all of the cases of failure just as we learned from the lap band.
Dilated pouches (large pouches) played a huge role in Lap Band failure in the past, now in the case of the Gastric Sleeve a large pouch will be responsible for failure.
Arturo Rodríguez, MD