BOSS

Aims: The laparoscopic sleeve gastrectomy (LSG) was developed in 1999 by McMahon as an evolution of the long vertical gastric stapling, known as the Magenstrasse & Mill operation (M&M), introduced in 1987 by Johnston. The rationale was to create a simple and effective restrictive gastroplasty: a long narrow gastric tube. The LSG has recently gained popularity as first-stage procedure for a more complex malabsorbtive operation: the laparoscopic duodenal switch (DS). Methods: From March 1999 to October 2004, 34 morbidly obese patients were treated. The median age was 39 (range, 23–63) years with a body mass index (BMI) of 48 (range, 36–74). In the initial six patients the M&M was precisely reproduced laparoscopically and in the following 28 cases the LSG was performed. Patient postoperative quality of life (QoL) was also assessed using SF36v2 and BAROS-II models. Results: No operative mortality or conversion occurred. Median operative time was 140 minutes. Major complications included four proximal staple-line leaks, treated laparoscopically. Median hospital stay was 3 days. At 1 year median BMI was 32 achieving 67% of excess weight loss (EWL). Results improved at 2 years (BMI 30 and 76% EWL), were maintained at 3 years (BMI 31 and 72% EWL) and were associated with good QoL scores. On account of unsatisfactory weight loss, late conversions were performed laparoscopically in four patients (one DS and three gastric bypasses). Conclusions: The LSG, as an isolated restrictive procedure, demonstrated substantial and durable weight loss, together with good QoL, in most of the patients studied. BOSS 7090