Sleeve Gastrectomy as a Stand alone Bariatric Procedure for Obesity: A Technology Assessment

Judith Walsh, MD, MPH

CTAF

Abstract and Introduction

Abstract

The California Technology Assessment Forum (CTAF) has been requested to review the scientific evidence for the use of sleeve gastrectomy (SG) also known as vertical sleeve gastrectomy (VSG) or laparoscopic sleeve gastrectomy (LSG) as a stand alone surgical treatment for the treatment of obesity. There are several surgical procedures commonly performed for the treatment of morbid obesity. VSG is promoted as a less invasive alternative to Roux-en-Y gastric bypass, the bariatric surgery most frequently performed in the U.S. CTAF recently assessed the evidence for laparoscopic adjustable silicone gastric banding for obesity, but has not previously reviewed this topic.

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Cite this: Sleeve Gastrectomy as a Stand alone Bariatric Procedure for Obesity: A Technology Assessment - Medscape - Oct 13, 2010.

Table 1. Characteristics of the studies comparing laparascopic sleeve gastrectomy to other treatments
Study	Design	Arm	N	Age	BMI kg/m2	F/u months
Himpens, 2006³⁰	RCT	LSG GBand	40 40	40 36	39 37	36 months
Karamanakos, 2008⁴⁴	RCT	LRYGB LSG	16 16	37 30.6	46.6 45.1	12 months
O'Keefe, 2010⁵³	Non-random Retrospective analysis	RYGB GBand VSG	157 34 6	67.3 not reported by group	48.5 45.9 50.0	12 months
Lee, 2007³¹	Non-random Retrospective Analysis	VSG GBand RYGB DS	216 271 303 56	43 42 43 42	49 42 46 47	24 months
Strain, 2009⁵⁴	Prospective non-randomized	GB BPD/DS GBand VSG	101 49 41 30	44.3 43.9 39.8 41.9	44.3 53.2 46.7 61.4	19.1 27.5 21.4 16.7
Abbatini, 2010⁵⁵	Retrospective	Gband GB SG	24 16 20	49,3 53 46.6	43.7 47.4 51.6	36 months
Lakdawala,	Retrospective	SG LRYGB	50 50	38 42	46 45.2	12 months

Table 2. Outcomes of studies comparing laparoscopic sleeve gastrectomy to other surgical treatments
Study	Arm	Weight loss at 12 months	12 month Median decrease in BMI kg/m2	36 month median decrease in BMI kg/m2	BMI Kg/m2 at 12 months	%EWL at 12 months	% EWL at 36 months	Mean change in BMI kg/m2 (varying follow up)	%EWL at various lengths of follow-up	% with resolution Type 2 DM at 12 months	% with resolution of HTN at 12 months
Himpens, 2006³⁰	LSG GBand	26 kg 14 kg*	25 15.5 *	27.5 18*		58 41*	66 48*
Karamanakos, 2008⁴⁴	LRYGB LSG				31.5 28.9	60.5 69.7*	--
O'Keefe, 2010⁵³	RYGB GBand VSG				32.7 39.4 42.0	59.8 33.5 34.3	--
Lee, 2007³¹	VSG GBand RYGB DS	129 lb 58 lb 110 lb 120 lb	--	---	37 32 28 27	59 47 75 79	--
Strain, 2009⁵⁴	GB BPD/DS GBand SG	---	---	28 27 32 37*	---	---	---	15.6 24 7.5 18	70% 84% 38% 49%*
Abbatini, 2010⁵⁵	Gband GB SG									60.8% 81.2% 80.9	44% 72.2% 66.6%
Lakdawala, 2010⁵⁶	SG LRYGB				26.3 31	76.1 62.2				98% 100%	98% 100%

Statistically significant with a p value of at least at p<0.05
O'Keefe, Lee, Abbatini, and Lakdawala did not report statistically significant comparisons between surgical procedures.

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