Chinese standardized surgical guideline for symmetrical three-port laparoscopic sleeve gastrectomy (2023 edition)_West China Medical Journal

Authors：

 Obesity and Diabetes Active Health Professional Committee of China Association for Promotion of Health Science and Technology

Corresponding author：

Obesity and Diabetes Active Health Professional Committee of China Association for Promotion of Health Science and Technology, Email: Huyangxi2046@163.com

Keywords：

Bariatric and metabolic surgery; symmetrical three-port laparoscopic sleeve gastrectomy; obesity; surgical procedures; guideline

DOI：

10.7507/1002-0179.202309120

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Laparoscopic sleeve gastrectomy (LSG) is an effective and lasting method for treating obesity, type 2 diabetes and other obesity related metabolic diseases. The symmetrical three-port LSG has been proven to be a simple, safe, and effective surgical procedure. However, China still lacks standardized surgical operation guidelines for this method. This guideline provides a detailed description of the various steps and key details of the symmetrical three-port LSG, aiming to standardize and normalize the symmetrical three-port LSG in the bariatric and metabolic field in China, and to provide standardized surgical procedures for clinical surgeons in this field.

Citation： Obesity and Diabetes Active Health Professional Committee of China Association for Promotion of Health Science and Technology. Chinese standardized surgical guideline for symmetrical three-port laparoscopic sleeve gastrectomy (2023 edition). West China Medical Journal, 2023, 38(12): 1785-1791. doi: 10.7507/1002-0179.202309120 Copy

1.	Chooi YC, Ding C, Magkos F. The epidemiology of obesity. Metabolism, 2019, 92: 6-10.
2.	Després JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature, 2006, 444(7121): 881-887.
3.	Al-Sulaiti H, Diboun I, Agha MV, et al. Metabolic signature of obesity-associated insulin resistance and type 2 diabetes. J Transl Med, 2019, 17(1): 348.
4.	Saxton SN, Clark BJ, Withers SB, et al. Mechanistic links between obesity, diabetes, and blood pressure: role of perivascular adipose tissue. Physiol Rev, 2019, 99(4): 1701-1763.
5.	Mirabelli M, Chiefari E, Arcidiacono B, et al. Mediterranean diet nutrients to turn the tide against insulin resistance and related diseases. Nutrients, 2020, 12(4): 1066.
6.	Vekic J, Zeljkovic A, Stefanovic A, et al. Obesity and dyslipidemia. Metabolism, 2019, 92: 71-81.
7.	Muscogiuri G, Barrea L, Annunziata G, et al. Obesity and sleep disturbance: the chicken or the egg?. Crit Rev Food Sci Nutr, 2019, 59(13): 2158-2165.
8.	Sheka AC, Adeyi O, Thompson J, et al. Nonalcoholic steatohepatitis: a review. JAMA, 2020, 323(12): 1175-1183.
9.	Lemieux I, Després JP. Metabolic syndrome: past, present and future. Nutrients, 2020, 12(11): 3501.
10.	NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet, 2016, 387(10026): 1377-1396.
11.	Caballero B. Humans against obesity: who will win?. Adv Nutr, 2019, 10(Suppl 1): S4-S9.
12.	Perdomo CM, Cohen RV, Sumithran P, et al. Contemporary medical, device, and surgical therapies for obesity in adults. Lancet, 2023, 401(10382): 1116-1130.
13.	Hanipah ZN, Schauer PR. Bariatric surgery as a long-term treatment for type 2 diabetes/metabolic syndrome. Annu Rev Med, 2020, 71: 1-15.
14.	Arterburn DE, Telem DA, Kushner RF, et al. Benefits and risks of bariatric surgery in adults: a review. JAMA, 2020, 324(9): 879-887.
15.	Ruiz-Cota P, Bacardí-Gascón M, Jiménez-Cruz A. Long-term outcomes of metabolic and bariatric surgery in adolescents with severe obesity with a follow-up of at least 5 years: a systematic review. Surg Obes Relat Dis, 2019, 15(1): 133-144.
16.	孙永胜, 孟化. 减重代谢手术治疗肥胖型 2 型糖尿病的研究进展. 现代消化及介入诊疗, 2019(2): 1536-1537.
17.	Kremen AJ, Linner JH, Nelson CH. An experimental evaluation of the nutritional importance of proximal and distal small intestine. Ann Surg, 1954, 140(3): 439-448.
18.	Griffen WO Jr, Bivins BA, Bell RM. The decline and fall of the jejunoileal bypass. Surg Gynecol Obstet, 1983, 157(4): 301-308.
19.	Mason EE, Ito C. Gastric bypass. Ann Surg, 1969, 170(3): 329-339.
20.	Han Y, Jia Y, Wang H, et al. Comparative analysis of weight loss and resolution of comorbidities between laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass: a systematic review and meta-analysis based on 18 studies. Int J Surg, 2020, 76: 101-110.
21.	高磊, 胡扬喜, 胡德升, 等. 对称 3 孔法腹腔镜袖状胃切除术的临床应用价值. 中华消化外科杂志, 2019, 18(9): 854-858.
22.	Chhabra KR, Telem DA, Chao GF, et al. Comparative safety of sleeve gastrectomy and gastric bypass: an instrumental variables approach. Ann Surg, 2022, 275(3): 539-545.
23.	Ali M, El Chaar M, Ghiassi S, et al. American Society for Metabolic and Bariatric Surgery updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis, 2017, 13(10): 1652-1657.
24.	中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 中国肥胖及 2 型糖尿病外科治疗指南(2019 版). 中国实用外科杂志, 2019, 39(4): 301-306.
25.	Grönroos S, Helmiö M, Juuti A, et al. Effect of laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass on weight loss and quality of life at 7 years in patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA Surg, 2021, 156(2): 137-146.
26.	Climaco K, Ahnfeldt E. Laparoscopic vertical sleeve gastrectomy. Surg Clin North Am, 2021, 101(2): 177-188.
27.	中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 腹腔镜袖状胃切除术操作指南(2018 版). 中华肥胖与代谢病电子杂志, 2018, 4(4): 196-201.
28.	刘洋, 刘欢妹, 魏丹, 等. 三孔法腹腔镜胃袖状切除术治疗肥胖症的临床疗效. 中华消化外科杂志, 2017, 16(6): 566-570.
29.	董星, 胡扬喜, 李英, 等. 三孔法腹腔镜胃袖状切除术治疗极重度肥胖合并心肌病的应用体会. 腹腔镜外科杂志, 2021, 26(7): 489-492.
30.	牛牧天, 孟化, 胡扬喜, 等. 对称三孔法腹腔镜袖状胃切除术治疗原发性高血压的疗效分析. 腹腔镜外科杂志, 2022, 27(2): 90-95.
31.	纪浩洋, 刘宇萌, 张洁, 等. 对称三孔法腹腔镜袖状胃切除术治疗 2 型糖尿病的疗效分析. 中华普通外科杂志, 2020, 35(7): 569-570.
32.	Zhou B, Cao X, Wang Z, et al. Symmetric three-port laparoscopic Roux-en-Y gastric bypass: a novel technique that is safe, effective, and feasible. Surg Today, 2023, 53(6): 702-708.
33.	中华医学会外科学分会. 腹腔镜胃外科手术缝合技术与缝合材料选择中国专家共识(2021 版). 中国实用外科杂志, 2021, 41(5): 495-503.
34.	Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA. 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.
35.	中国研究型医院学会糖尿病与肥胖外科专业委员会. 减重与代谢外科加速康复外科原则中国专家共识(2021 版). 中华消化外科杂志, 2021, 20(8): 841-845.
36.	中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 精准肥胖代谢外科手术中国专家共识(2022 版). 中华消化外科杂志, 2022, 21(10): 1302-1312.
37.	Zhou B, Ji H, Liu Y, et al. ERAS reduces postoperative hospital stay and complications after bariatric surgery: a retrospective cohort study. Medicine (Baltimore), 2021, 100(47): e27831.
38.	刘洋, 孟化. 代谢手术相关并发症的诊治和预防. 中华肥胖与代谢病电子杂志, 2016, 2(4): 201-204.

1. Chooi YC, Ding C, Magkos F. The epidemiology of obesity. Metabolism, 2019, 92: 6-10.
2. Després JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature, 2006, 444(7121): 881-887.
3. Al-Sulaiti H, Diboun I, Agha MV, et al. Metabolic signature of obesity-associated insulin resistance and type 2 diabetes. J Transl Med, 2019, 17(1): 348.
4. Saxton SN, Clark BJ, Withers SB, et al. Mechanistic links between obesity, diabetes, and blood pressure: role of perivascular adipose tissue. Physiol Rev, 2019, 99(4): 1701-1763.
5. Mirabelli M, Chiefari E, Arcidiacono B, et al. Mediterranean diet nutrients to turn the tide against insulin resistance and related diseases. Nutrients, 2020, 12(4): 1066.
6. Vekic J, Zeljkovic A, Stefanovic A, et al. Obesity and dyslipidemia. Metabolism, 2019, 92: 71-81.
7. Muscogiuri G, Barrea L, Annunziata G, et al. Obesity and sleep disturbance: the chicken or the egg?. Crit Rev Food Sci Nutr, 2019, 59(13): 2158-2165.
8. Sheka AC, Adeyi O, Thompson J, et al. Nonalcoholic steatohepatitis: a review. JAMA, 2020, 323(12): 1175-1183.
9. Lemieux I, Després JP. Metabolic syndrome: past, present and future. Nutrients, 2020, 12(11): 3501.
10. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet, 2016, 387(10026): 1377-1396.
11. Caballero B. Humans against obesity: who will win?. Adv Nutr, 2019, 10(Suppl 1): S4-S9.
12. Perdomo CM, Cohen RV, Sumithran P, et al. Contemporary medical, device, and surgical therapies for obesity in adults. Lancet, 2023, 401(10382): 1116-1130.
13. Hanipah ZN, Schauer PR. Bariatric surgery as a long-term treatment for type 2 diabetes/metabolic syndrome. Annu Rev Med, 2020, 71: 1-15.
14. Arterburn DE, Telem DA, Kushner RF, et al. Benefits and risks of bariatric surgery in adults: a review. JAMA, 2020, 324(9): 879-887.
15. Ruiz-Cota P, Bacardí-Gascón M, Jiménez-Cruz A. Long-term outcomes of metabolic and bariatric surgery in adolescents with severe obesity with a follow-up of at least 5 years: a systematic review. Surg Obes Relat Dis, 2019, 15(1): 133-144.
16. 孙永胜, 孟化. 减重代谢手术治疗肥胖型 2 型糖尿病的研究进展. 现代消化及介入诊疗, 2019(2): 1536-1537.
17. Kremen AJ, Linner JH, Nelson CH. An experimental evaluation of the nutritional importance of proximal and distal small intestine. Ann Surg, 1954, 140(3): 439-448.
18. Griffen WO Jr, Bivins BA, Bell RM. The decline and fall of the jejunoileal bypass. Surg Gynecol Obstet, 1983, 157(4): 301-308.
19. Mason EE, Ito C. Gastric bypass. Ann Surg, 1969, 170(3): 329-339.
20. Han Y, Jia Y, Wang H, et al. Comparative analysis of weight loss and resolution of comorbidities between laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass: a systematic review and meta-analysis based on 18 studies. Int J Surg, 2020, 76: 101-110.
21. 高磊, 胡扬喜, 胡德升, 等. 对称 3 孔法腹腔镜袖状胃切除术的临床应用价值. 中华消化外科杂志, 2019, 18(9): 854-858.
22. Chhabra KR, Telem DA, Chao GF, et al. Comparative safety of sleeve gastrectomy and gastric bypass: an instrumental variables approach. Ann Surg, 2022, 275(3): 539-545.
23. Ali M, El Chaar M, Ghiassi S, et al. American Society for Metabolic and Bariatric Surgery updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis, 2017, 13(10): 1652-1657.
24. 中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 中国肥胖及 2 型糖尿病外科治疗指南(2019 版). 中国实用外科杂志, 2019, 39(4): 301-306.
25. Grönroos S, Helmiö M, Juuti A, et al. Effect of laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass on weight loss and quality of life at 7 years in patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA Surg, 2021, 156(2): 137-146.
26. Climaco K, Ahnfeldt E. Laparoscopic vertical sleeve gastrectomy. Surg Clin North Am, 2021, 101(2): 177-188.
27. 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 腹腔镜袖状胃切除术操作指南(2018 版). 中华肥胖与代谢病电子杂志, 2018, 4(4): 196-201.
28. 刘洋, 刘欢妹, 魏丹, 等. 三孔法腹腔镜胃袖状切除术治疗肥胖症的临床疗效. 中华消化外科杂志, 2017, 16(6): 566-570.
29. 董星, 胡扬喜, 李英, 等. 三孔法腹腔镜胃袖状切除术治疗极重度肥胖合并心肌病的应用体会. 腹腔镜外科杂志, 2021, 26(7): 489-492.
30. 牛牧天, 孟化, 胡扬喜, 等. 对称三孔法腹腔镜袖状胃切除术治疗原发性高血压的疗效分析. 腹腔镜外科杂志, 2022, 27(2): 90-95.
31. 纪浩洋, 刘宇萌, 张洁, 等. 对称三孔法腹腔镜袖状胃切除术治疗 2 型糖尿病的疗效分析. 中华普通外科杂志, 2020, 35(7): 569-570.
32. Zhou B, Cao X, Wang Z, et al. Symmetric three-port laparoscopic Roux-en-Y gastric bypass: a novel technique that is safe, effective, and feasible. Surg Today, 2023, 53(6): 702-708.
33. 中华医学会外科学分会. 腹腔镜胃外科手术缝合技术与缝合材料选择中国专家共识(2021 版). 中国实用外科杂志, 2021, 41(5): 495-503.
34. Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA. 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.
35. 中国研究型医院学会糖尿病与肥胖外科专业委员会. 减重与代谢外科加速康复外科原则中国专家共识(2021 版). 中华消化外科杂志, 2021, 20(8): 841-845.
36. 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 精准肥胖代谢外科手术中国专家共识(2022 版). 中华消化外科杂志, 2022, 21(10): 1302-1312.
37. Zhou B, Ji H, Liu Y, et al. ERAS reduces postoperative hospital stay and complications after bariatric surgery: a retrospective cohort study. Medicine (Baltimore), 2021, 100(47): e27831.
38. 刘洋, 孟化. 代谢手术相关并发症的诊治和预防. 中华肥胖与代谢病电子杂志, 2016, 2(4): 201-204.

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Chinese standardized surgical guideline for symmetrical three-port laparoscopic sleeve gastrectomy (2023 edition)

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