Gastric Sleeve Surgery

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How Is Sleeve Gastrectomy Performed?

We  perform the sleeve gastrectomy as a laparoscopic procedure. This  involves making five or six small incisions in the abdomen and  performing the procedure using a video camera (laparoscope) and long  instruments that are placed through these small incisions.

During  the laparoscopic sleeve gastrectomy (LSG), about 75% of the stomach is  removed leaving a narrow gastric “tube” or “sleeve”. No intestines are  removed or bypassed during the sleeve gastrectomy. The LSG takes one to  two hours to complete.

How Does Sleeve Gastrectomy Cause Weight Loss?

Sleeve  gastrectomy is a restrictive procedure. It greatly reduces the size of  your stomach and limits the amount of food that can be eaten at one  time. It does not cause decreased absorption of nutrients or bypass your  intestines. After eating a small amount of food, you will feel full  very quickly and continue to feel full for several hours.

Sleeve  gastrectomy may also cause a decrease in appetite. In addition to  reducing the size of the stomach, sleeve gastrectomy may reduce the  amount of "hunger hormone" produced by the stomach which may contribute  to weight loss after this procedure.

Who Do We Offer Laparoscopic Sleeve Gastrectomy?

This  procedure is primarily used as part of a staged approach to surgical  weight loss. Patients who have a very high body mass index (BMI) or who  are at risk for undergoing anesthesia or a longer procedure due to heart  or lung problems may benefit from this staged approach. Sometimes the  decision to proceed with a two-stage approach is made before surgery due  to these known risk factors. In other patients, the decision to perform  sleeve gastrectomy (instead of gastric bypass) is made during the  operation. Reasons for making this decision intraoperatively include an  excessively large liver or extensive scar tissue that would make the  gastric bypass procedure too long or unsafe.

In  patients who undergo LSG as a first stage procedure, the second stage  (gastric bypass) is performed 12 to 18 months later after significant  weight loss has occurred and the risk of anesthesia is much lower (and  the liver has decreased in size). Though this approach involves two  procedures, we believe it is safe and effective for selected patients.

Laparoscopic  sleeve gastrectomy can also be used as a primary procedure. There is  relatively little data regarding the use of LSG as a stand-alone  procedure in patients with lower BMI’s and it should be considered an  investigational procedure in this patient group. 

What Are The Risks Of Laparoscopic Sleeve Gastrectomy?

There  are risks that are common to any laparoscopic procedure such as  bleeding, infection, injury to other organs, or the need to convert to  an open procedure. There is also a small risk of a leak from the staple  line used to divide the stomach. These problems are rare and major  complications occur less than 1% of the time.

Overall,  the operative risks associated with LSG are slightly higher than those  seen with the laparoscopic adjustable band but lower than the risks  associated with gastric bypass.

What Are The Benefits Of Laparoscopic Sleeve Gastrectomy?

Depending  on their pre-operative weight, patients can expect to lose between 40%  to 70% of their excess body weight in the first year after surgery.

Many  obesity-related comorbidities improve or resolve after bariatric  surgery. Diabetes, hypertension, obstructive sleep apnea and abnormal  cholesterol levels are improved or cured in more than 75% of patients  undergoing LSG. Though long-term studies are not yet available, the  weight loss that occurs after LSG results in dramatic improvement in  these medical conditions in the first year after surgery.