Does Sleeve Shape Make a Difference in Outcomes?
Adel Alhaj Saleh
Michal R. Janik
Rami R. Mustafa
Adil H. Khan
Seyed Mohammad Kalantar Motamedi
Published online: 8 January 2018
Springer Science+Business Media, LLC, part of Springer Nature 2018
Introduction Sleeve gastrectomy (SG) is one of the most common procedures performed for weight loss. Many seek the Bperfect
sleeve^ with the notion that the type of calibrating device affects sleeve shape, and this in turn will affect outcomes and
complications. Two major concerns after SG are amount of weight loss and acid reflux. Our aim was to determine if the various
calibration methods could impact sleeve shape and thereby allow for better outcomes of weight loss and reflux.
Methods A retrospective chart review was performed of 210 patients who underwent SG and had postoperative upper gastro-
intestinal (UGI) study from 2011 to 2015 in a single center by a single (fellowship-trained) bariatric surgeon. Data regarding
demographics, calibrating devices and clinical outcomes at 1 year (weight loss and de novo acid reflux) were collected. UGIs
were reviewed by two radiologists blinded to the clinical outcomes. Sleeve shape was classified according to a previously
described classification as tubular, dumbbell, upper pouch, or lower pouch. The types of calibrating devices used to guide the
sleeve size intraoperatively were endoscopy, large-bore orogastric tube, and fenestrated suction tube.
Results One hundred ninety-nine patients met inclusion criteria (11 had no esophagram). Demographics revealed age
45.76 ± 10.6 years, BMI 47 ± 8.6 kg/m
, and 82% female. Calibration devices used were endoscopic guidance (7.6%),
large bore orogastric tube (41.4%), and fenestrated suction tube (50.5%). Sleeve shape was reported as 32.6% tubular,
20.6% dumbbell, 39.2% lower pouch, and 7.5% upper pouch (100% interrater reliability). No correlation was seen with
type of calibration used. Of patients, 62.0% had > 50% excess weight loss at 1 year. Twenty-three percent of patients
remained on PPI at 1 year (of which 43.3% did not have reflux preoperatively). The lower pouch shape showed a trend
toward less reflux and more weight loss.
Conclusion This study showed no clear association between uniformity of sleeve shape and the type of calibration device used.
The study showed a trend toward decreased reflux and improved weight loss with the lower pouch shape, regardless of
Keywords Sleeve gastrectomy
Obesity is a worldwide public health concern, as obesity has
doubled since 1980 with 1.5 billion adults considered obese in
2008 . In the USA, 34% of adults over 20 years of age are
overweight, 34% are obese, and 6% are extremely obese .
Obesity is directly associated with increased risk of diabetes,
hypertension, and other chronic diseases, and places a huge
burden on public health.
Over the past 20 years, bariatric surgery has become a
well-accepted solution to this public health concern.
Although the gastric bypass used to be the most common-
ly performed procedure for weight loss, now the sleeve
* Adel Alhaj Saleh
* Leena Khaitan
Department of Surgery/ Bariatric Division, University Hospitals,
Cleveland Medical Center, Case Western Reserve University School
of Medicine, 11100 Euclid Avenue, Cleveland, OH 44121, USA
Department of Surgery, Texas Tech University Health Sciences
Center, School of Medicine, Lubbock, TX, USA
Department of General, Oncologic, Metabolic and Thoracic Surgery,
Military Institute of Medicine, Szaserów, 04-141 Warszawa, Poland
Obesity Surgery (2018) 28:1731–1737