Obesity has emerged as one of the most pressing global health challenges, contributing to comorbidities such as diabetes, hypertension, cardiovascular disease, sleep apnea, and reduced life expectancy. When conservative measures like diet, exercise, and medication fail, bariatric surgery becomes a highly effective solution. Among the various bariatric procedures, laparoscopic sleeve gastrectomy (LSG) has gained tremendous popularity due to its simplicity, safety profile, and favorable outcomes.

The addition of endoscopic calibration during sleeve gastrectomy further enhances surgical precision, reduces complications, and ensures a standardized gastric sleeve size for optimal weight loss results.

Understanding Laparoscopic Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy involves the removal of approximately 70–80% of the stomach, leaving behind a narrow, tubular gastric pouch resembling a “banana.” This restrictive procedure reduces the stomach’s volume, leading to early satiety and reduced calorie intake. Additionally, the resection of the gastric fundus decreases ghrelin secretion, a hormone that stimulates appetite, thereby assisting long-term weight management.

Key Benefits of LSG:

Effective weight loss (average of 60–70% excess weight loss in 1–2 years)

Improvement or resolution of obesity-related comorbidities

No intestinal bypass, thus avoiding malabsorption issues

Relatively shorter operative time compared to gastric bypass

Lower risk of long-term complications like dumping syndrome

Role of Endoscopic Calibration

While LSG has become a standard bariatric procedure, the size and uniformity of the gastric sleeve are critical for outcomes. If the sleeve is too narrow, patients may develop strictures, dysphagia, or leaks. If it is too wide, inadequate weight loss or weight regain can occur.

Endoscopic calibration involves the use of a flexible endoscope to guide the resection process, ensuring:

Uniform Sleeve Size: Standardized sleeve creation with precise lumen diameter.

Leak Testing: Real-time identification of staple line integrity and immediate detection of air leaks.

Enhanced Safety: Prevents over-resection or under-resection, reducing postoperative complications.

Direct Visualization: Offers clear anatomical guidance, especially in difficult cases.

This technique adds a layer of precision beyond the traditional use of bougies (calibration tubes).

Surgical Technique
Patient Preparation

Comprehensive preoperative evaluation includes BMI assessment, metabolic profile, and counseling.

The patient is placed under general anesthesia in a supine, reverse Trendelenburg position.

Laparoscopic Access

Typically, 4–5 ports are inserted for the laparoscope and working instruments.

The liver is retracted to expose the stomach adequately.

Gastric Mobilization

Dissection begins along the greater curvature, with division of short gastric vessels up to the left crus.

The stomach is fully mobilized, including the fundus, to ensure complete resection.

Endoscopic Calibration

A flexible endoscope is introduced orally by the endoscopist.

The endoscope serves as a calibration guide to determine the ideal sleeve diameter.

Unlike rigid bougies, the endoscope allows dynamic visualization and avoids undue narrowing.

Sleeve Creation

Sequential stapling is performed alongside the endoscope, beginning 4–6 cm from the pylorus and progressing toward the angle of His.

The staple line is reinforced with buttressing material or oversewing to reduce leak risk.

Leak Test

The endoscope is used for air insufflation under saline irrigation to detect any staple line leaks.

This step ensures immediate intraoperative correction if needed.

Completion

Hemostasis is confirmed, drains may be placed selectively, and ports are closed.

Postoperative Care

Hospital Stay: 2–3 days on average.

Diet Progression: Patients start on clear liquids, gradually transitioning to pureed, soft, and finally regular foods over 4–6 weeks.

Activity: Early mobilization is encouraged to prevent thrombosis.

Supplements: Multivitamins, calcium, and vitamin D are typically prescribed.

Follow-up: Regular monitoring for nutritional status and weight trajectory.

Outcomes and Benefits

When combined with endoscopic calibration, LSG offers several distinct advantages:

Reduced Complications: Lower risk of leaks and strictures.

Standardized Results: Consistent sleeve size ensures predictable weight loss.

Enhanced Safety: Real-time inspection of gastric anatomy and staple line integrity.

Durable Weight Loss: Long-term studies demonstrate sustained weight reduction and comorbidity resolution.

Challenges and Considerations

Requires coordination between surgeon and endoscopist.

Slightly longer operative time compared to traditional LSG.

Cost may be higher due to endoscopic equipment use.

Not suitable for patients with severe gastroesophageal reflux disease (GERD), as sleeve gastrectomy can worsen reflux.

Conclusion

Laparoscopic sleeve gastrectomy with endoscopic calibration represents a significant advancement in bariatric surgery. By combining the effectiveness of LSG with the precision of endoscopic guidance, this approach minimizes complications and maximizes long-term weight loss outcomes.

At specialized centers like World Laparoscopy Hospital, this procedure is performed with cutting-edge laparoscopic and endoscopic expertise, ensuring the highest standards of patient care and safety. For individuals struggling with morbid obesity, this innovative surgical option offers renewed hope for a healthier, more active, and fulfilling life.