laparoscopic sleeve gastrectomy ( lsg ) is now established as a stand - alone bariatric procedure for the morbidly obese population and is adopted worldwide [ 14 ] . lsg yielded excellent outcomes particularly when applied to the lower bmi population according to the current guidelines for bariatric surgery [ 5 , 6 ] . however , the expanding obesity epidemic consists mostly of relatively less obese patients ( bmi 30 < 35  kg / m ) who are not ( yet ) eligible for bariatric surgery [ 6 , 7 ] . hence , less invasive procedures and devices based upon gastric restriction and upon small intestinal exclusion , mimicking bariatric surgery , are rapidly being developed . even though short - term results of some of these techniques are promising , there is insufficient scientific data to support their clinical implementation today . the use of bariatric surgery for the mildly obese population ( bmi of 30 < 35  kg / m ) is currently under investigation , and preliminary studies have demonstrated beneficial and safe outcomes [ 911 ] . the aim of the present study is to investigate the operative outcome and short - term results of lsg for this population . the data for a consecutive series of mildly obese patients ( bmi 30 < 35  kg / m ) undergoing a lsg from may 2010 to may 2012 were collected prospectively . our eligibility criteria included patients with class i obesity ( bmi of 30 < 35  kg / m ) resistant to medical treatment and lasting for five years with or without comorbidities . patients with a history of a prior bariatric procedure were excluded . the risks , benefits , and long - term consequences of lsg were discussed in detail during the initial encounter with the surgeon and the dietician . preoperative work - up included blood tests , chest radiography , electrocardiogram , abdominal ultrasounds , psychiatric , and endocrinologic evaluations . followup data included weight loss parameters , change in comorbidity status , and patients satisfaction scoring ( body image and food tolerance ) . all data analysis was carried out using the spss version 15.0 for windows statistical package ( spss inc . , statistical analysis was conducted using student 's t test for continuous data and  test for population proportions , with a p value of .05 considered to be significant . the technique used for lsg is based on a 5-port approach : one 15  mm trocar inserted midline at the supraumbilical border ; one 12  mm trocar inserted 57  cm below the left costal margin on the midclavicular line ; and three 5  mm trocars ; one 57  cm below the right costal margin on the midclavicular line , one subxiphoid to retract the liver , and one at the lateral border of the left rectus . using the ligasure ( covidien ) vessel sealing device , the vessels of the gastric greater curvature are ligated starting from 6  cm proximal to the pylorus and proceeding to the angle of his where all the attachments of the fundus to the left crus are released . once this maneuver is completed , a 36-french ( f ) bougie is introduced by the anesthesiologist and passed down the esophagus , along the lesser curvature through the antrum , to calibrate the diameter of the gastric tube . the lsg is created by applying sequential firings of 60  mm endogia staplers ( covidien ) tightly abutting the bougie and extending from 6  cm orad to the pylorus to the angle of his . green ( 4.8  mm ) and blue ( 3.5  mm ) cartridges were used depending on the thickness of the stomach . intraoperative methylene blue test is performed in all patients to exclude a leak in the staple line . the specimen is retrieved via the 15  mm port , and the fascial defect is closed . early postoperative ambulation was strongly encouraged with patients getting out of bed the evening of the surgery . at discharge , patients were advised to take daily multivitamins as well as proton pomp inhibitor ( ppi ) prophylaxis for 1 month . followup appointments with the surgeon and the dietician were scheduled at 1 , 3 , 6 , and 12 months postoperatively , then twice a year . eighty - six percent of patients were young women , and 41 ( 33.6% ) of them underwent a previous cosmetic surgery including abdominoplasty in 28 and breast reduction surgery in 13 . intraoperative data : all cases were completed laparoscopically with an average operative time ( skin to skin ) of 58  15  min ( range 4095 ) . the mean number of sequential firings of 60  mm endogia staplers cartridges was 5  0.45 cartridges ( range 46 ) . all the patients were monitored in the recovery room and were then transferred to the wards . postoperative data are shown in table 2 : intra - abdominal bleeding requiring a blood transfusion occurred in 2 patients . one patient reported on postoperative day 2 acute pain originating from the left upper quadrant and radiating to the left shoulder . an abdominal ct scan ruled out a leakage but revealed a 4  cm splenic infarct located at the upper pole of the spleen ( figure 1 ) . an abdominal ct scan excluded an intra - abdominal etiology , and a thoracic ct scan revealed a left pneumonia requiring a readmission to the hospital and intravenous antibiotic therapy . no deaths occurred within 30 days of surgery , and the overall surgical morbidity was 2.4% . there were no leaks , abscesses , or strictures during the postoperative follow - up , and the rate of hemorrhage was 1.6% . the mean length of hospital stay was 43  4.5 hours ( range 3672 ) . ninety percent of weight loss occurred at 6 months and then stabilized after postoperative month 12 at an ewl value of 76% . the mean preoperative bmi decreased from 33.2  2 to 24.7  2 at 12 months . at that time substantial weight loss occurred in most patients with 96.8% achieving the 50% ewl at 1 year . none of the patients had a bmi drop below 20  kg / m or a serum albumin level below the normal range . lsg had a significant effect on resolution ( 70.5% ) or improvement ( 29.5% ) of comorbidities of patients who had achieved at least 6 months follow - up as shown in table 4 . on a satisfaction scale of 1 ( very poor ) to 5 ( excellent ) , the patient satisfaction scoring for 62 patients achieving at least one year of follow - up was 4.4  0.8 for body image and 4.2  0.6 for food tolerance . two ( 3.2% ) patients expressed a degree of dissatisfaction with the weight loss results . the procedure was well tolerated clinically , and the patients only encountered episodic emesis or mild reflux , occurring after eating fast or overeating . lsg is now considered a definitive procedure for the treatment of morbid obesity and type 2 diabetes . lsg is increasingly performed worldwide and represents the bariatric procedure of choice in many countries [ 15 ] . the third international summit on the current status of sleeve gastrectomy that was held in december 2010 demonstrated that sleeve gastrectomy is successfully performed by laparoscopy in 99.7% , with high leaks rate of 1.3% , low leaks rate of 0.5% , and a mortality rate of 0.1% . more recently , lsg has been shown to be particularly safe and effective for the lower bmi ( 3543  kg / m ) population according to the current guidelines for bariatric surgery . however , the current era also demands effective therapies for the relatively moderate obese population . this population was shown to be also at increased risk from obesity - related conditions [ 11 , 12 , 14 ] . this encouraged the introduction of less invasive procedures mimicking the effects of conventional bariatric surgery on weight and comorbidities . hence , procedures influencing gastric function ( intragastric balloons , gastric plication , gastric pacing , and transoral gastric stapling ) and procedures bypassing a part of the small intestine ( endoluminal duodenojejunal sleeve and gastroduodenojejunal sleeve ) were developed . even though short - term results of some of these techniques are promising , there is insufficient scientific data to support their clinical implementation today . the use of bariatric surgery in patients with bmi of 30 < 35  kg / m is currently under investigation . apart from some scarce data concerning lsg in these patients , the current study of lsg in mildly obese patients is one of the few published series [ 11 , 13 , 15 ] . preliminary studies have demonstrated the benefits and safety of laparoscopic gastric banding ( lagb ) in this subgroup [ 9 , 10 , 16 , 17 ] . recently , an fda panel supported the use of lagb in the mildly obese population . they consider lagb as the least invasive and safest bariatric procedure .   however , lsg is safer than lagb in regards to long - term complications and more effective in term of quality of life and weight loss . lagb introduces a foreign body and may lead to long - term complications including band erosion or prolapse , requiring band replacement or removal . a recent study comparing quality of life after each procedure has shown that lsg had the highest scores as far as food tolerance and gastrointestinal quality of life . moreover , lagb does not decrease plasma ghrelin levels and may result in intolerance for restriction , excessive consumption of sweets , and insufficient weight loss or weight regain .   in the current series with low bmi , this was reflected by the short operative time and minimal intraoperative blood loss that compare favorably with other series in the literature [ 4 , 2123 ] . this positive correlation between bmi , operative time , and in addition , the complication rate was low , and recovery was fast as demonstrated by the short length of hospital stay . while intraoperative splenic upper pole discoloration is frequently observed during lsg , symptomatic splenic infarction occurring after lsg has been reported only once in a recent large series . in the present case , several studies have shown that lsg allows a reduction of the preoperative bmi by nearly from 7 to 10 points [ 4 , 23 , 24 ] . this finding is in concordance with our results showing that the mean preoperative bmi was reduced by 8.5 points and therefore dropped to the optimal bmi category of ( 20.024.9  kg / m ) . this bmi category has been shown to have the lowest all cause mortality risk and is rarely obtained when surgery is performed on patients with a preoperative higher bmi . in contrast with other studies , none of the patients suffered from excessive weight loss or denutrition . elevated ewl values could be explained by the low preoperative bmi values in our series . the comorbidities in the current study were characterized by a low incidence of metabolic syndrome when compared with series based on a higher preoperative bmi . the bulk of comorbidities in our case included chronic joint pain , depression , menstrual irregularities , and chronic headaches . the young age , the low incidence of metabolic syndrome , and the relative technical ease of the surgery contributed to the low morbidity in the studied population . body image had been significantly altered in our patients given the high rate of prior cosmetic surgery performed and depression . body image dissatisfaction played a major role in the decision for lsg and improved dramatically after surgery , as the majority of patients were satisfied with the final outcome . our pilot study showed that lsg performed for mildly obese patients has proved to be technically relatively easy , safe and brought up benefits in term of weight loss , comorbidities , and body image . however , it would be premature on the basis of this study to draw conclusions regarding long - terms benefits and harms of lsg for adults who are not yet morbidly obese .
background . data concerning laparoscopic sleeve gastrectomy ( lsg ) in mild obesity are under investigation . 
 aim / objective . 
 may 2010 to may 2012 , 122 consecutive patients with preoperative body mass index ( bmi ) of 33  2.5  kg / m2 ( range 3034.9 ) undergoing lsg were studied . 
 mean age was 33  10 years ( range 1560 ) , and 105 ( 86% ) were women . 
 mean preoperative weight was 91  9.7  kg ( range 66121 ) , and preoperative excess weight was 30  6.7  kg ( range 1943 ) . 
 comorbidities were detected in 44 ( 36% ) patients . 
 results . 
 mean operative time was 58  15  min ( range 4095 ) , and postoperative stay was 1.8  0.19 days ( range 1.53 ) . 
 there were no admissions to intensive care unit and no deaths within 30 days of surgery . 
 the rates of leaks and strictures were 0% , and of hemorrhage 1.6% . 
 at 12 months , bmi decreased to 24.7  2 , and the percentage of excess weight loss ( % ewl ) reached 76.5% . 
 none of the patients had a bmi below 20  kg / m2 . 
 comorbidities resolved in 70.5% or improved in 29.5% . 
 patient satisfaction scoring ( 15 ) at least 1 year after was 4.6  0.8 for body image and 4.4  0.6 for food tolerance . conclusion . 
 lsg for mildly obese patients has proved to be technically relatively easy , safe , and benefic in the short term .