Sleeve Gastrectomy: Good Idea or Mistake ?

Restrictive part of the duodenal switch, sleeve gastrectomy (SG) was first performed as a first step, to reduce mortality in BMI higher than 50, before being proposed as a final gesture, given the strong showing short-term. In France, the SG has become the most performed bariatric operation, from 0% in 2003 to 57% in 2013.Technically simpler than the gastro-jejunal bypass (GBP), the SG decreases satiety by decreasing the secretion of ghrelin, and is not a restrictive procedure. A good result requires to not let posterior fundus pocket and calibrate the gastric tube, a probe greater than or equal to 40 Fr, not affecting the quality of weight loss, but reducing the risk of fistula post procedure.The fistula rate was 4% in the serie of the Coelio Club, favored by a first ring, with a stent therapy in 75% of cases. Strengthening the staple line does not seem to improve results.The medium and long-term results are not known, but in case of weight recovery, transformation in GBP seems the best solution. However, the good results described in the short term must be tempered by the fact that excess weight loss of 50% is considered as a success, while some patients BMI remains above 40.In conclusion, the SG requires a specialized team, surrounded by radiology or interventional endoscopy opportunities, with a close ICU. Prolonged and regular monitoring is required to provide in time a transformation in BPG, often necessary.