The Metabolic Effects of Laparoscopic Sleeve Gastrectomy: A Review

Bariatric surgery, as a whole, is the only proven modality to manage the severely obese. The laparoscopic sleeve gastrectomy (LSG) is the most recent tool in the armamentarium of bariatric surgery. Once used as the first-stage in a two-stage procedure for the super-obese patient, it is now used as a primary bariatric procedure. Involving the resection of the greater curvature of the stomach, it has been shown to achieve clinically significant excess weight loss and improvements in obesity-related co-morbidities. Its mechanism of action was originally classified as being a restrictive procedure, similar to laparoscopic gastric banding, but is now known to be far more complex. The pronounced effects of LSG on gut hormones such as ghrelin, PYY and incretins, allow this bariatric intervention to be adequately compared to the more historically classified malabsorptive procedures like the gastric bypass. In this review, we explore the metabolic effects and outcomes of LSG in producing significant weight loss and improving the factors associated with the metabolic syndrome.