Complications and Nutrient Deficiencies Two Years after Sleeve Gastrectomy

Nicole Pech; Frank Meyer; Hans Lippert; Thomas Manger; Christine Stroh


BMC Surg. 2012;12(13) 

In This Article


From September 26, 2005 to May 28, 2009, 100 patients underwent SG in the Surgery Department of the SRH Wald-Klinikum Gera Hospital. All patients had to agree with an informed consent. Data collection and analysis was performed in compliance with the Helsinki Declaration.

After we ensured compliance with international and German guidelines all patients had to take part in an informational seminar.[9] Patient's evaluation was performed by experienced bariatric surgeons.

Data collection took place prospectively and analyzed retrospectively. Patients were classified according to the WHO classifications of obesity (35–39.9 kg/m2; 40–49.9 kg/m2) with expansions to "super obesity" (50–59.9 kg/m2) and "super-super obesity" (= 60 kg/m2). Analyzed parameters are listed in Table 1 . Acute and postoperative complications were evaluated.

Sleeve Gastrectomy-operation Technique

SG was performed in the French position in a 30° reverse Trendelenburg position. Pneumoperitoneum was established to 15 mmHg. First trocar for placing the camera was inserted 15 cm distal to the xiphoid process. Another trocar was placed on the epigastric angle for liver retraction. Two trocars were located on the right and left upper quadrants. A bougie 31–36 French was used. The dissection of the greater curve began 5–6 cm proximal to the pylorus and extended to the angle of His. Sleeve resection of the stomach was performed using an Endo GIA stapler (green) made by Covidien, Germany® using staple line reinforcement in 88 % of the patients. Staple line was not oversewn. To exclude leakage of staple line a methylene blue test was performed. The resected stomach was filled with water to determine the resected gastric volume. Histopathological analysis was performed on the specimen. In all patients for single shot antibiosis a third generation cephalosporine was given.

Postoperative Follow Up

All of the patients were examined throughout a 24-month follow-up period (at 3, 6, 12, 18 and 24 months postoperatively) in our clinical outpatient department. Furthermore, short- and long-term results with regard to BMI, weight, %EWL and important laboratory parameters (iron, zinc, selenium, alkaline phosphatase, hemoglobin, MCV, albumin, vitamin B12, folic acid, calcium and parathyroid hormone levels) were registered (Table 1).