Laparoscopic sleeve gastrectomy: a single-center experience with 1 568 cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Jionghuang ¹ , PU Xiaofan ¹ , CAI Xuyan ¹ , SHEN Hongdan ² , ZHENG Sufen ² ,  YU Weihua ¹

1. Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310009, P. R. China;
2. Department of Nursing, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310009, P. R. China;

Corresponding?author：

YU Weihua, Email: srrshwhy@zju.edu.cn

Keywords：

laparoscopic sleeve gastrectomy; bariatric and metabolic surgery; single-center experience

DOI：

10.7507/1007-9424.202508128

Video：

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Objective To evaluate the weight loss outcomes, metabolic disease remission, and complications profiles of laparoscopic sleeve gastrectomy (LSG) based on a large single-center cohort experience. Methods A retrospective observational study was conducted. Clinical data of patients who underwent LSG at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from June 2021 to June 2024 were collected based on predefined inclusion and exclusion criteria. The outcomes including percentage of total weight loss (%TWL), metabolic disease remission, and the incidence of postoperative complications were assessed. Results A total of 1 568 patients met the inclusion and exclusion criteria were finally included, including 304 males and 1 264 females. The age at surgery was (31.51±8.01）years old, and the body mass index was (37.26±4.18) kg/m². At 1 year after surgery, the %TWL was (32.84±6.38)%, and the complete remission rate of diabetes was 96.2% (304/316). Complications within 1 year after surgery: 1 (0.06%) case of postoperative bleeding, 2 (0.13%) cases of gastric leakage, 1 (0.06%) case of vitamin B1 deficiency, and 1 (0.06%) case of unilateral common peroneal nerve entrapment injury. The total complications rate was 0.32% (5/1 568). No mortality was observed. Conclusions LSG has significant short-term efficacy and higher safety in treatment of obesity and related metabolic diseases. In particular, experiences in aspects such as complications prevention and multidisciplinary follow-up management could provide references for centers in the early stage of development.

Citation： CHEN Jionghuang, PU Xiaofan, CAI Xuyan, SHEN Hongdan, ZHENG Sufen, YU Weihua. Laparoscopic sleeve gastrectomy: a single-center experience with 1 568 cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(9): 1107-1113. doi: 10.7507/1007-9424.202508128 Copy

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2.	中國醫師協會外科醫師分會肥胖和代謝病外科專家工作組, 中國醫師協會外科醫師分會肥胖代謝外科綜合管理專家工作組, 中國肥胖代謝外科研究協作組. 中國肥胖代謝外科數據庫: 2023年度報告. 中華肥胖與代謝病電子雜志, 2024, 10(2): 73-83.
3.	中華醫學會外科學分會甲狀腺及代謝外科學組, 中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會. 中國肥胖及2型糖尿病外科治療指南(2019版). 中國實用外科雜志, 2019, 39(4): 301-306.
4.	朱利勇, 高祥, 李鵬洲, 等. 腹腔鏡袖狀胃切除術規范化操作要點. 中華消化外科雜志, 2024, 23(8): 1044-1048.
5.	中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會. 腹腔鏡袖狀胃切除術操作指南(2018版). 中華肥胖與代謝病電子雜志, 2018, 4(4): 196-201.
6.	駱鵬, 陳國俊, 陳炯煌, 等. 右側微創三孔法腹腔鏡袖狀胃切除術治療肥胖癥的應用價值. 中華消化外科雜志, 2022, 21(11): 1461-1466.
7.	《緩解型糖尿病中國專家共識》編寫專家委員會. 緩解2型糖尿病中國專家共識. 中國全科醫學, 2021, 24(32): 4037-4048.
8.	Yamaguchi T, Tani M, Kasama K, et al. Reference values for weight loss during 1 year after sleeve gastrectomy: a multicenter retrospective study in Japan. Obes Surg, 2022, 32(8): 2672-2681.
9.	Drai C, Chierici A, Schiavo L, et al. Long-term results of sleeve gastrectomy and Roux-en-Y gastric bypass in individuals older than 60 years with morbid obesity. Obes Surg, 2023, 33(12): 3850-3859.
10.	Lee WJ, Almulaifi A, Tsou JJ, et al. Laparoscopic sleeve gastrectomy for type 2 diabetes mellitus: predicting the success by ABCD score. Surg Obes Relat Dis, 2015, 11(5): 991-996.
11.	Lin S, Guan W, Yang N, et al. Short-term outcomes of sleeve gastrectomy plus jejunojejunal bypass: a retrospective comparative study with sleeve gastrectomy and Roux-en-Y gastric bypass in Chinese patients with BMI ≥35 kg/m². Obes Surg, 2019, 29(4): 1352-1359.
12.	Tranchart H, Rebibo L, Gaillard M, et al. Short-term outcomes of single-port versus conventional laparoscopic sleeve gastrectomy: a propensity score matched analysis. Surg Endosc, 2020, 34(9): 3978-3985.
13.	Wu D, Wang L, Jiang T. Efficacy comparison of laparoscopic sleeve gastrectomy in type 2 diabetes patients with a BMI 30–34.9 kg/m² versus BMI < 30 kg/m². Surg Endosc, 2021, 35(4): 1544-1550.
14.	Sha Y, Huang X, Ke P, et al. Laparoscopic Roux-en-Y gastric bypass versus sleeve gastrectomy for type 2 diabetes mellitus in nonseverely obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Surg, 2020, 30(5): 1660-1670.
15.	梁輝, 管蔚, 林士波, 等. 單中心1 139例減重代謝手術經驗總結. 中國實用外科雜志, 2019, 39(4): 343-345.
16.	De Angelis F, Abdelgawad M, Rizzello M, et al. Perioperative hemorrhagic complications after laparoscopic sleeve gastrectomy: four-year experience of a bariatric center of excellence. Surg Endosc, 2017, 31(9): 3547-3551.
17.	Sakran N, Raziel A, Goitein O, et al. Laparoscopic sleeve gastrectomy for morbid obesity in 3 003 patients: results at a high-volume bariatric center. Obes Surg, 2016, 26(9): 2045-2050.
18.	Highet A, Johnson EH, Bonham AJ, et al. Cost-effectiveness of staple line reinforcement in laparoscopic sleeve gastrectomy. Ann Surg, 2023, 277(1): 121-126.
19.	Aboueisha MA, Freeman M, Allotey JK, et al. Battle of the buttress: 5-year propensity-matched analysis of staple-line reinforcement techniques from the MBSAQIP database. Surg Endosc, 2023, 37(4): 3090-3102.
20.	Abu-Ghanem Y, Meydan C, Segev L, et al. Gastric wall thickness and the choice of linear staples in laparoscopic sleeve gastrectomy: challenging conventional concepts. Obes Surg, 2017, 27(3): 837-843.
21.	Kitaghenda FK, Shu C, Wang J, et al. Measurement of gastric wall thickness after laparoscopic sleeve gastrectomy: obesity comorbidities and gastric wall in Chinese patients with obesity. Updates Surg, 2023, 75(5): 1235-1242.
22.	Barski K, Binda A, Kudlicka E, et al. Gastric wall thickness and stapling in laparoscopic sleeve gastrectomy—a literature review. Wideochir Inne Tech Maloinwazyjne, 2018, 13(1): 122-127.
23.	Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, et al. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12 000 cases. Surg Obes Relat Dis, 2012, 8(1): 8-19.
24.	Choi YY, Bae J, Hur KY, et al. Reinforcing the staple line during laparoscopic sleeve gastrectomy: does it have advantages? A meta-analysis. Obes Surg, 2012, 22(8): 1206-1213.
25.	Wang Z, Dai X, Xie H, et al. The efficacy of staple line reinforcement during laparoscopic sleeve gastrectomy: a meta-analysis of randomized controlled trials. Int J Surg, 2016, 25: 145-152.
26.	Berger ER, Clements RH, Morton JM, et al. The impact of different surgical techniques on outcomes in laparoscopic sleeve gastrectomies: the first report from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). Ann Surg, 2016, 264(3): 464-473.
27.	Shikora SA, Mahoney CB. Clinical benefit of gastric staple line reinforcement (SLR) in gastrointestinal surgery: a meta-analysis. Obes Surg, 2015, 25(7): 1133-1141.
28.	Jing W, Huang Y, Feng J, et al. The clinical effectiveness of staple line reinforcement with different matrix used in surgery. Front Bioeng Biotechnol, 2023, 11: 1178619. doi: 10.3389/fbioe.2023.1178619.
29.	Di Lorenzo N, Antoniou SA, Batterham RL, et al. Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP. Surg Endosc, 2020, 34(6): 2332-2358.
30.	Karaman K, Aziret M, Ercan M, et al. A preventive strategy for staple line bleeding in morbidly obese patients undergoing sleeve gastrectomy. J Laparoendosc Adv Surg Tech A, 2017, 27(10): 1015-1021.
31.	Janik MR, Wal?dziak M, Br?goszewski J, et al. Prediction model for hemorrhagic complications after laparoscopic sleeve gastrectomy: development of SLEEVE BLEED calculator. Obes Surg, 2017, 27(4): 968-972.
32.	Albanopoulos K, Alevizos L, Linardoutsos D, et al. Routine abdominal drains after laparoscopic sleeve gastrectomy: a retrospective review of 353 patients. Obes Surg, 2011, 21(6): 687-691.
33.	Doumouras AG, Maeda A, Jackson TD. The role of routine abdominal drainage after bariatric surgery: a metabolic and bariatric surgery accreditation and quality improvement program study. Surg Obes Relat Dis, 2017, 13(12): 1997-2003.
34.	Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4 888 patients. Surg Endosc, 2012, 26(6): 1509-1515.
35.	Stroh C, K?ckerling F, Volker L, et al. Results of more than 11 800 sleeve gastrectomies: data analysis of the German bariatric surgery registry. Ann Surg, 2016, 263(5): 949-955.
36.	Husain F, Jeong IH, Spight D, et al. Risk factors for early postoperative complications after bariatric surgery. Ann Surg Treat Res, 2018, 95(2): 100-110.
37.	Chang PC, Chen KH, Jhou HJ, et al. Promising effects of 33 to 36 Fr. bougie calibration for laparoscopic sleeve gastrectomy: a systematic review and network meta-analysis. Sci Rep, 2021, 11(1): 15217. doi: 10.1038/s41598-021-94716-1.
38.	Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9 991 cases. Ann Surg, 2013, 257(2): 231-237.
39.	Gagner M, Kemmeter P. Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surg Endosc, 2020, 34(1): 396-407.
40.	Chen YS, Loh EW, Shen SC, et al. Efficacy of fibrin sealant in reducing complication risk after bariatric surgery: a systematic review and meta-analysis. Obes Surg, 2021, 31(3): 1158-1167.
41.	Yolsuriyanwong K, Ingviya T, Kongkamol C, et al. Effects of intraoperative leak testing on postoperative leak-related outcomes after primary bariatric surgery: an analysis of the MBSAQIP database. Surg Obes Relat Dis, 2019, 15(9): 1530-1540.
42.	Jung JJ, Jackson T, Gordon L, et al. Intraoperative leak test is associated with lower postoperative bleed rate in primary sleeve gastrectomy: a propensity matched analysis of primary and revision bariatric surgery using the MBSAQIP database. Surg Endosc, 2022, 36(1): 753-763.
43.	Chivot C, Rebibo L, Robert B, et al. Value of routine upper gastrointestinal swallow study after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis, 2017, 13(5): 758-765.
44.	Vitello DJ, Vitello JM, Beach-Bachmann J, et al. Value of routine gastrografin upper gastrointestinal study after sleeve gastrectomy. JAMA Surg, 2019, 154(2): 181-182.
45.	Sethi M, Magrath M, Somoza E, et al. The utility of radiological upper gastrointestinal series and clinical indicators in detecting leaks after laparoscopic sleeve gastrectomy: a case-controlled study. Surg Endosc, 2016, 30(6): 2266-2275.
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1. 國家衛生健康委食品安全標準與監測評估司, 中國疾病預防控制中心營養與健康所, 成人肥胖食養指南編寫專家組, 等. 成人肥胖食養指南(2024年版). 衛生研究, 2024, 53(3): 347-351.
2. 中國醫師協會外科醫師分會肥胖和代謝病外科專家工作組, 中國醫師協會外科醫師分會肥胖代謝外科綜合管理專家工作組, 中國肥胖代謝外科研究協作組. 中國肥胖代謝外科數據庫: 2023年度報告. 中華肥胖與代謝病電子雜志, 2024, 10(2): 73-83.
3. 中華醫學會外科學分會甲狀腺及代謝外科學組, 中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會. 中國肥胖及2型糖尿病外科治療指南(2019版). 中國實用外科雜志, 2019, 39(4): 301-306.
4. 朱利勇, 高祥, 李鵬洲, 等. 腹腔鏡袖狀胃切除術規范化操作要點. 中華消化外科雜志, 2024, 23(8): 1044-1048.
5. 中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會. 腹腔鏡袖狀胃切除術操作指南(2018版). 中華肥胖與代謝病電子雜志, 2018, 4(4): 196-201.
6. 駱鵬, 陳國俊, 陳炯煌, 等. 右側微創三孔法腹腔鏡袖狀胃切除術治療肥胖癥的應用價值. 中華消化外科雜志, 2022, 21(11): 1461-1466.
7. 《緩解型糖尿病中國專家共識》編寫專家委員會. 緩解2型糖尿病中國專家共識. 中國全科醫學, 2021, 24(32): 4037-4048.
8. Yamaguchi T, Tani M, Kasama K, et al. Reference values for weight loss during 1 year after sleeve gastrectomy: a multicenter retrospective study in Japan. Obes Surg, 2022, 32(8): 2672-2681.
9. Drai C, Chierici A, Schiavo L, et al. Long-term results of sleeve gastrectomy and Roux-en-Y gastric bypass in individuals older than 60 years with morbid obesity. Obes Surg, 2023, 33(12): 3850-3859.
10. Lee WJ, Almulaifi A, Tsou JJ, et al. Laparoscopic sleeve gastrectomy for type 2 diabetes mellitus: predicting the success by ABCD score. Surg Obes Relat Dis, 2015, 11(5): 991-996.
11. Lin S, Guan W, Yang N, et al. Short-term outcomes of sleeve gastrectomy plus jejunojejunal bypass: a retrospective comparative study with sleeve gastrectomy and Roux-en-Y gastric bypass in Chinese patients with BMI ≥35 kg/m². Obes Surg, 2019, 29(4): 1352-1359.
12. Tranchart H, Rebibo L, Gaillard M, et al. Short-term outcomes of single-port versus conventional laparoscopic sleeve gastrectomy: a propensity score matched analysis. Surg Endosc, 2020, 34(9): 3978-3985.
13. Wu D, Wang L, Jiang T. Efficacy comparison of laparoscopic sleeve gastrectomy in type 2 diabetes patients with a BMI 30–34.9 kg/m² versus BMI < 30 kg/m². Surg Endosc, 2021, 35(4): 1544-1550.
14. Sha Y, Huang X, Ke P, et al. Laparoscopic Roux-en-Y gastric bypass versus sleeve gastrectomy for type 2 diabetes mellitus in nonseverely obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Surg, 2020, 30(5): 1660-1670.
15. 梁輝, 管蔚, 林士波, 等. 單中心1 139例減重代謝手術經驗總結. 中國實用外科雜志, 2019, 39(4): 343-345.
16. De Angelis F, Abdelgawad M, Rizzello M, et al. Perioperative hemorrhagic complications after laparoscopic sleeve gastrectomy: four-year experience of a bariatric center of excellence. Surg Endosc, 2017, 31(9): 3547-3551.
17. Sakran N, Raziel A, Goitein O, et al. Laparoscopic sleeve gastrectomy for morbid obesity in 3 003 patients: results at a high-volume bariatric center. Obes Surg, 2016, 26(9): 2045-2050.
18. Highet A, Johnson EH, Bonham AJ, et al. Cost-effectiveness of staple line reinforcement in laparoscopic sleeve gastrectomy. Ann Surg, 2023, 277(1): 121-126.
19. Aboueisha MA, Freeman M, Allotey JK, et al. Battle of the buttress: 5-year propensity-matched analysis of staple-line reinforcement techniques from the MBSAQIP database. Surg Endosc, 2023, 37(4): 3090-3102.
20. Abu-Ghanem Y, Meydan C, Segev L, et al. Gastric wall thickness and the choice of linear staples in laparoscopic sleeve gastrectomy: challenging conventional concepts. Obes Surg, 2017, 27(3): 837-843.
21. Kitaghenda FK, Shu C, Wang J, et al. Measurement of gastric wall thickness after laparoscopic sleeve gastrectomy: obesity comorbidities and gastric wall in Chinese patients with obesity. Updates Surg, 2023, 75(5): 1235-1242.
22. Barski K, Binda A, Kudlicka E, et al. Gastric wall thickness and stapling in laparoscopic sleeve gastrectomy—a literature review. Wideochir Inne Tech Maloinwazyjne, 2018, 13(1): 122-127.
23. Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, et al. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12 000 cases. Surg Obes Relat Dis, 2012, 8(1): 8-19.
24. Choi YY, Bae J, Hur KY, et al. Reinforcing the staple line during laparoscopic sleeve gastrectomy: does it have advantages? A meta-analysis. Obes Surg, 2012, 22(8): 1206-1213.
25. Wang Z, Dai X, Xie H, et al. The efficacy of staple line reinforcement during laparoscopic sleeve gastrectomy: a meta-analysis of randomized controlled trials. Int J Surg, 2016, 25: 145-152.
26. Berger ER, Clements RH, Morton JM, et al. The impact of different surgical techniques on outcomes in laparoscopic sleeve gastrectomies: the first report from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). Ann Surg, 2016, 264(3): 464-473.
27. Shikora SA, Mahoney CB. Clinical benefit of gastric staple line reinforcement (SLR) in gastrointestinal surgery: a meta-analysis. Obes Surg, 2015, 25(7): 1133-1141.
28. Jing W, Huang Y, Feng J, et al. The clinical effectiveness of staple line reinforcement with different matrix used in surgery. Front Bioeng Biotechnol, 2023, 11: 1178619. doi: 10.3389/fbioe.2023.1178619.
29. Di Lorenzo N, Antoniou SA, Batterham RL, et al. Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP. Surg Endosc, 2020, 34(6): 2332-2358.
30. Karaman K, Aziret M, Ercan M, et al. A preventive strategy for staple line bleeding in morbidly obese patients undergoing sleeve gastrectomy. J Laparoendosc Adv Surg Tech A, 2017, 27(10): 1015-1021.
31. Janik MR, Wal?dziak M, Br?goszewski J, et al. Prediction model for hemorrhagic complications after laparoscopic sleeve gastrectomy: development of SLEEVE BLEED calculator. Obes Surg, 2017, 27(4): 968-972.
32. Albanopoulos K, Alevizos L, Linardoutsos D, et al. Routine abdominal drains after laparoscopic sleeve gastrectomy: a retrospective review of 353 patients. Obes Surg, 2011, 21(6): 687-691.
33. Doumouras AG, Maeda A, Jackson TD. The role of routine abdominal drainage after bariatric surgery: a metabolic and bariatric surgery accreditation and quality improvement program study. Surg Obes Relat Dis, 2017, 13(12): 1997-2003.
34. Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4 888 patients. Surg Endosc, 2012, 26(6): 1509-1515.
35. Stroh C, K?ckerling F, Volker L, et al. Results of more than 11 800 sleeve gastrectomies: data analysis of the German bariatric surgery registry. Ann Surg, 2016, 263(5): 949-955.
36. Husain F, Jeong IH, Spight D, et al. Risk factors for early postoperative complications after bariatric surgery. Ann Surg Treat Res, 2018, 95(2): 100-110.
37. Chang PC, Chen KH, Jhou HJ, et al. Promising effects of 33 to 36 Fr. bougie calibration for laparoscopic sleeve gastrectomy: a systematic review and network meta-analysis. Sci Rep, 2021, 11(1): 15217. doi: 10.1038/s41598-021-94716-1.
38. Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9 991 cases. Ann Surg, 2013, 257(2): 231-237.
39. Gagner M, Kemmeter P. Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surg Endosc, 2020, 34(1): 396-407.
40. Chen YS, Loh EW, Shen SC, et al. Efficacy of fibrin sealant in reducing complication risk after bariatric surgery: a systematic review and meta-analysis. Obes Surg, 2021, 31(3): 1158-1167.
41. Yolsuriyanwong K, Ingviya T, Kongkamol C, et al. Effects of intraoperative leak testing on postoperative leak-related outcomes after primary bariatric surgery: an analysis of the MBSAQIP database. Surg Obes Relat Dis, 2019, 15(9): 1530-1540.
42. Jung JJ, Jackson T, Gordon L, et al. Intraoperative leak test is associated with lower postoperative bleed rate in primary sleeve gastrectomy: a propensity matched analysis of primary and revision bariatric surgery using the MBSAQIP database. Surg Endosc, 2022, 36(1): 753-763.
43. Chivot C, Rebibo L, Robert B, et al. Value of routine upper gastrointestinal swallow study after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis, 2017, 13(5): 758-765.
44. Vitello DJ, Vitello JM, Beach-Bachmann J, et al. Value of routine gastrografin upper gastrointestinal study after sleeve gastrectomy. JAMA Surg, 2019, 154(2): 181-182.
45. Sethi M, Magrath M, Somoza E, et al. The utility of radiological upper gastrointestinal series and clinical indicators in detecting leaks after laparoscopic sleeve gastrectomy: a case-controlled study. Surg Endosc, 2016, 30(6): 2266-2275.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Laparoscopic sleeve gastrectomy: a single-center experience with 1 568 cases

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