Sleeve Gastrectomy


 

Laparoscopic Sleeve Gastrectomy Surgery

The Sleeve Gastrectomy is a surgery performed solely on the stomach. There is no rerouting of the intestines like with the gastric bypass. The sleeve is created with a surgical stapler along the inside curve of the stomach.

The valve at the outlet of the stomach remains, which provides for the normal process of stomach-emptying to continue, which allows for the feeling of fullness.

Sleeve Gastrectomy has also been called Partial Gastrectomy, Vertical Sleeve Gastrectomy, and Gastric Sleeve. It is a laparoscopic procedure and basically consists of making a stomach that looks like a pouch (large stretchy bag) into a long tube; therefore the name “sleeve.” The Sleeve Gastrectomy removes 2/3 to 3/4 of the stomach, which provides for quicker satiety (sense of fullness) and decreased appetite. The “sleeve” is a smaller stomach pouch which then restricts food intake by allowing only a small amount of food to be eaten at one time. After the separation of the stomach into a smaller tube, the remainder of the stomach is permanently removed (see photo). The stomach is converted from a “bag” into a narrow tube with stapling techniques.

The valve at the outlet of the stomach remains; it is not changed so that this allows for the normal process of stomach emptying to continue which allows for the feeling of fullness. If you eat too quickly, take large bites of food, drink fluids with meals/snacks, eat dry, tough, or sticky foods, vomiting or discomfort can occur.

After the new stomach is created the remaining stomach is removed. External incisions can be closed with sutures, steri-strips, or staples. The sleeve gastrectomy is typically performed in less than an hour. The majority of the outer portion of the stomach is removed leaving a small tubular stomach behind (see photo). Often, most patients feel less hungry and are less interested in carbohydrates, and patients lose weight* despite usually not feeling hungry!

Common side effects early on include nausea and feeling full. If you eat too quickly or too much you may throw up, which is defeating the purpose of the surgery. Average meal should be one cup of food or less over the course of 30 minutes five times daily spaced 3-4 hours apart. Average weight loss depends on several factors, the most important being the compliance of the patient in regards to their diet. Other factors include the weight a patient started at, incorporating exercise and being more active, avoiding calorie-laden beverages, and complying with medical therapy for other ailments. Average national weight loss is between 50-70% of your excess weight. Patients in my practice that follow our guidelines with proper follow up are expected to reach their pre-operative weight loss goals as discussed in our office.The Laparoscopic Vertical Sleeve Gastrectomy (VSG), like the adjustable gastric band, is a restrictive procedure that limits the amount of food that a patient can eat. The VSG is primarily used as a staging procedure in patients with very severe obesity. However, it is becoming increasingly used as the only surgery in selected patients. The procedure takes about one hour to perform. Hospital stay is typically two days and recovery time one week. Weight loss varies greatly from 25-60% excess weight loss. 20 to 30 percent of patients require a secondary procedure once their initial weight loss plateaus.

The sleeve gastrectomy is an operation in which the left side of the stomach is surgically removed (results in the permanent removal or about 80% of your anatomic stomach). This results in a new stomach which is roughly the size and shape of a banana. Since this operation does not involve any "rerouting" or reconnecting the intestines, it is a much simpler operation than the gastric bypass, both anatomically and physiologically. The long staple line can and historically has resulted in a significant possibility of “intestinal or gastric leakage” which can be life threatening. When these leaks occur, they are very difficult to manage and can result in 6 months or more of re-operations, disability, infection, and worse (on occasion). Because of the ease of the operation from a surgical perspective and the anticipated lower operative times and potential complications than the gastric bypass, this operation has recently enjoyed a dramatic increase in frequency. There are several very significant problems with this operation. First and foremost, this operation seemed to evolve from the anticipated lower morbidity and mortality that the gastric bypass. In fact, even upon review of the BOLD outcome data base, there are similar complications and outcomes which compare similarly to the gastric bypass (the mortality and morbidity/or rate of complications are very similar for both). There also is no good long term out come data from the Lap Sleeve; and we anticipate that the long term weight loss data will deteriorate over time and a second operation is very likely. Unlike the Lap-Band® procedure, the sleeve gastrectomy does not require the implantation of an artificial device inside the abdomen.

Patients who should consider this procedure include:

1. Those who are concerned about the potential long term side effects of an
intestinal bypass such as intestinal obstruction, ulcers, anemia, osteoporosis, protein deficiency and vitamin deficiency.
2. Those who are considering a Lap-Band® but are concerned about a foreign body inside the abdomen.

3. Those who have medical problems that prevent them from having weight loss surgery such as anemia, crohn's disease, extensive prior surgery, and other complex medical conditions.

4. People who need to take anti-inflammatory medications may also want to consider this. Usually, these medications need to be avoided after a gastric bypass because the risk of ulcer is higher.

It might also be a good option if patients have a problem with their lap band requiring revision, have already lost a lot of weight and don't want a full bypass. The weight loss seems to be a little better and more rapid than the lap band (60 - 70% EWL) over two years. There is still no long-term data.

What advantages does it have?

1. It does not require disconnecting or reconnecting the intestines (no dumping syndrome).

2. There is no significant malabsorption of nutrients therefore avoiding anemia, osteoporosis, protein deficiency and vitamin deficiency.

3. Only surgery that substantially removes the "hunger hormone" Ghrelin.

4. It is a technically a much simpler operation than the gastric bypass or the duodenal switch.

5. There is no foreign body inside of you.

6. It does not need adjustments or fills (adjustable band patients must come back for fills).

7. Preserves the pylorus (most patients should not get dumping syndrome).

8. It may be a safer operation for patients with a body mass index (BMI) more than 60. It may be used as the first stage of a 2-stage operation. Gastric Sleeve Procedure

Patients with Lap-Band® complications

If you are a patient with a previous Lap-Band® procedure and your experiencing problems such as reflux, esophagitis, band erosion, band slippage, port site infection you may be a candidate for "revision" surgery. This means removing the Lap-band® System and performing a VSG (Gastric Sleeve) procedure. Patients in this category are very concerned about regaining their already lost weight and they will greatly benefit with the gastric sleeve procedure. At this point the Gastric Sleeve will not only let them maintain their weight, but will let them continue losing more weight.

 

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