Laparoscopic Sleeve Gastrectomy

Introduction

Laparoscopic sleeve gastrectomy is a weight loss or 'bariatric' procedure which can help patients who are significantly obese* (laparoscopic surgery is commonly known as 'keyhole' or 'minimally invasive' surgery).

The difficulty with obesity - from a medical perspective - is its association with a range of serious metabolic conditions, including...

  • Diabetes.
  • High blood pressure.
  • Obstructive sleep apnoea.
  • High cholesterol / high triglycerides.
  • Infertility.
  • Polycystic ovarian syndrome.

Surgical approaches such as sleeve gastrectomy are generally only recommended where other non-surgical weight loss methods have not worked.

Laparoscopic sleeve gastrectomy involves the stomach being reduced to about 25% of its original size, by stapling and then surgical removal of a large portion of the stomach. The procedure permanently reduces the size of the stomach. Unlike some other bariatric procedures, it is not reversible.

Advantages

  • Limits the amount of food that is eaten at a meal.
  • Reduced hunger due to removal of the part of the stomach producing a hormone Grehlin.
  • Food passes through the digestive tract in the usual order, allowing vitamins and nutrients to be fully absorbed into the body.
  • No post-operative adjustments are required.
  • 70-80% Excess Weight Loss ('EWL') - the excess weight is the amount over the ideal body weight.

Disadvantages

  • Irreversible changes to anatomy.
  • Complications may include a leak from sleeve staple line (less than 1%) which would prolong hospital stay and may require further intervention.
  • There is a small risk with ongoing overeating of stretching the stomach and weight regain or reflux requiring further surgery.

Dietetic Requirements

A healthy, balanced eating plan is recommended with a focus on portion control. Consultation with the dietitian is essential.

Nutritional significance of this procedure is greater than Gastric Banding, with a greater risk of thiamine, iron, folate, B12, calcium and zinc deficiencies.

Ability to choose almost any foods, and regurgitation is rare (compared to other procedures).

At least a 6-12 monthly review of nutritional adequacy (including annual blood tests) is required to ensure maintenance of adequate nutritional health.

Indications

See the indications section for laparoscopic gastric banding<LINK> as substantially the same conditions apply for the procedures described here. This procedure is suitable for people with a BMI of 30 or higher.

Preoperative Instructions

After deciding to go ahead with surgery, patients see one of our dietitians and a preoperative plan is developed which may include a very low-calorie diet in the week leading up to surgery. This is not mandatory for all patients. Preoperative blood tests are performed. There is also an option to see a psychologist.

Procedure

The procedure is laparoscopic (keyhole) with 5 small incisions. The largest is 3 cm where the part of the stomach is removed. The operation takes about an hour.

The amount of stomach to be left is determined by a tube placed in the stomach and removed at the end of the procedure. This tube is called a bougie and is measured at size 34.

Before the tube is removed at the end of the procedure, blue dye is placed in the stomach as a test to ensure there is no leak from the staple line.

If the patient has had gastric banding previously, the operation is more difficult and takes longer.

Patient stay in hospital is about two days and about two weeks off work are required.

Postoperative Instructions

This is an essential part of this procedure. The dietitian will give written instructions for you to follow for the first 6 weeks. The dietitian and Dr Watson will see you at 3 to 4 weeks. The dietitian will see you several times in the first few months and Dr Watson will see you at 6 months and at one year and then every year.

Risks

As with any other surgery, bleeding and infection as well as general medical complications are possible but infrequent.

The main risk of this surgery is leakage from the staple line. Although not common (less than 1%), it can be a serious complication.

Reflux (heartburn / "indigestion") is a possible side effect after surgery and may require medication. This usually settles after 6 months.

Risks will be discussed in more detail by the surgeon at your consultation.

Treatment Alternatives

Read about other weight loss procedures, including:

Laparoscopic Gastric Banding

Laparoscopic Gastric Bypass

Intragastric Balloon

*obesity is most commonly measured as Body Mass Index (BMI) - this is the weight in kilograms divided by the height squared - for example a person weighing 120kg and 1.6m tall has a BMI of 47. Obesity is defined as a BMI reading over 30.


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