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4th INTERNATIONAL CONSENSUS SUMMIT FOR SLEEVE GASTRECTOMY I: The Utilization of Sleeve Gastrectomy Changes in the Framework of Bariatric Surgery by NINH T. NGUYEN, MD, and ALANA GEBHART, BA Bariatric Times. 2013;10(5 Suppl A):A4–A6 AUTHOR AFFILIATIONS: Dr. Nguyen and Ms. Gebhart are from Department of Surgery, University of California, Irvine Medical Center, Orange, California ADDRESS FOR CORRESPONDENCE: Ninh T. Nguyen, MD, Department of Surgery, 333 City Bldg. West, Suite 850, Orange, CA 92868; Phone: (714) 456-8598; Fax: (714) 456-6027; E-mail: ninhn@uci.edu FUNDING AND DISCLOSURES: No funding was provided. The information contained in this article was based on the clinical database provided by the University HealthSystem Consortium. KEY POINTS • There has been a change in the makeup of bariatric surgery since the introduction of laparoscopic sleeve gastrectomy in 2010 as a primary bariatric operation for the treatment of severe obesity. • We found a dramatic increase in utilization of laparoscopic sleeve gastrectomy, surpassing that of laparoscopic adjustable gastric banding with a concurrent reduction in utilization of laparoscopic gastric bypass. • Perioperative outcome for sleeve gastrectomy is between that of laparoscopic gastric banding and gastric bypass. S ince its introduction in 1994, laparoscopic Roux-en-Y gastric bypass (RYGB) has become the most commonly performed bariatric operation in the United States.1,2 In 2001, laparoscopic adjustable gastric banding (LAGB) was approved by the United States Food and Drug Administration (FDA) for clinical use in the United States. Our group previously reported an increase in utilization of laparoscopic adjustable gastric banding, from seven percent in 2004 to 23 percent in 2007.3 Compared A4 to laparoscopic gastric bypass, laparoscopic gastric banding has been shown to be associated with improved short-term morbidity, but lower weight loss at short- and medium-term followup.4 Laparoscopic sleeve gastrectomy (LSG) is a relatively new bariatric procedure that is gaining popularity in the United States. The LSG originated as a part of the duodenal switch (DS) operation. As a stand-alone procedure, the sleeve gastrectomy was first reported by Gagner et al in 2003 when it was performed as a two-stage procedure for high-risk patients undergoing laparoscopic gastric bypass.5 In their description, the first stage consisted of a LSG, which was later converted to a laparoscopic gastric bypass at a mean time interval of 11 months.5 Recent studies have shown that LSG is safe and effective, resulting in weight loss somewhere between that of gastric banding and gastric bypass.6–8 The American Society for Metabolic and Bariatric Surgery (ASMBS) now recognizes LSG as an acceptable option as a primary bariatric procedure.9,10 Using the University HealthSystem Consortium database, we analyzed a total of 60,738 patients who underwent Bariatric Times • May 2013 • Supplement A bariatric surgery for the treatment of morbid obesity between the fourth quarter of 2008 to the third quarter of 2012. We found that the use of LSG increased from 0.9 to 36.3 percent while the use of LAGB decreased from 23.8 to 4.1 percent. There was also a concurrent decrease in the use of laparoscopic gastric bypass from 66.8 to 56.4 percent and open gastric bypass from 8.6 to 3.2 percent (Figure 1).11 We also found an increase in the number of institutions performing LSG in the last four quarters, which is comparable to the number of institutions performing laparoscopic gastric bypass (Figure 2). The number of institutions performing laparoscopic gastric bypass, laparoscopic gastric banding, and open gastric bypass remained stable over the study period. The landscape of bariatric surgery has changed immensely over the past two decades. In the late 1990s and early 2000s, we observed an exponential increase in the number of bariatric operations being performed in the United States.2 The makeup of bariatric surgery at that time comprised mostly open gastric bypass. In 2002, using data from the Nationwide Inpatient Sample database, Nguyen et al estimated that only 18