Laparoscopic sleeve gastrectomy: an innovative new tool in the battle against the obesity epidemic in Canada

According to the most recent estimates from the 2004 Canadian Community Health Survey, 59% of the adult population is overweight (i.e., body mass index [BMI] ≥ 25) and 1 in [...]
Obesity can be considered to be one of the most important chronic diseases facing Canadians of all ages. Whereas patients with a very high body mass index may have the most to gain from procedures such as Roux-en-Y gastric bypass or biliopancreatic diversion/duodenal switch, the increased risk of postoperative complications often makes them poor surgical candidates. As a result, several 'bridging' procedures have been proposed to impart clinically effective weight loss and reduce the risk of complications and improve outcomes in the definitive weight-loss procedure. In this article, we provide a review of the evidence in support of laparoscopic sleeve gastrectomy as an innovative new surgical procedure used as a bridging procedure in patients with severe obesity and discuss new findings for its possible role as a definitive procedure for some individuals with less severe obesity. Finally, we comment on a possible approach to introduce this innovative new procedure to Canadian bariatric centres. On peut considerer l'obesite comme l'une des plus importantes maladies chroniques auxquelles les Canadiens de tous ages font face. Si les Canadiens dont l'indice de masse corporelle est tres eleve sont ceux qui pourraient le plus beneficier des avantages d'interventions telles que la derivation gastrique Roux en Y ou la diversion biliopancreatique avec commutation duodenale, en fait, le risque accru de complications operatoires fait d'eux de mauvais candidats a la chirurgie. C'est pourquoi on a propose plusieurs solutions de transition pour obtenir une perte de poids cliniquement efficace et ainsi reduire le risque de complications et ameliorer l'issue de l'intervention bariatrique definitive le temps venu. Dans le present article, nous presentons un apercu des preuves favorables a la gastrectomie laparoscopique en manchon comme intervention chirurgicale novatrice en guise de solution interimaire chez les patients atteints d'obesite morbide et nous presentons les resultats recents qui temoignent de son role possible a titre d'intervention definitive dans certains cas d'obesite moins prononcee. En terminant, nous commentons une demarche envisageable pour faire adopter cette intervention novatrice dans les centres bariatriques canadiens.