Sleeve Gastrectomy
The laparoscopic sleeve gastrectomy is a relatively new procedure that is quickly becoming very popular. The operation can be performed as a one off for patients who don’t have much weight to lose, or is commonly performed as part of a staged operation to allow severely obese people to reduce their weight to a level at which it is safe to perform a regular gastric bypass. It is the only weight loss surgery that has no risk of complications related to malabsorption (like with gastric bypass surgery) and no risk of complications related to the presence of a foreign body (as with lap band surgery).
The procedure
The sleeve gastrectomy operation is done by using 5 small incisions, is performed under general anaesthetic and takes about an hour to complete. Staples are used to divide the stomach in two forming a long thin tube down the right hand side. The excess stomach tissue is then removed through a small incision leaving a tube-shaped stomach approximately 20% of its original size.
A major advantage of the surgery is the fact that the pylorus (the part of the stomach which controls the flow of food into the small intestine) is kept intact allowing effective regulation of gastric emptying making patient’s feel full as food is slowly delivered to the small intestine.
After your surgery
If performed laparoscopically patients usually spend 3 nights in hospital and can return to work in 2 – 3 weeks. If open surgery is required you will spend an extra night or two in hospital and need an extra week or two to recover before returning to everyday activities.
As with other weight loss surgeries your diet will consist purely of liquids for the first few days. After being discharged pureed foods can be introduced into your diet and eventually soft solid foods can be reintroduced after about three weeks.
During your recovery period any prescribed medications should be crushed up and added to food to improve absorption and walking as much as possible is encouraged. Strenuous activity is likely to be uncomfortable during the first month following surgery and should be avoided.
Long term outcome
The overall outcome of the procedure is the reduction of stomach capacity to about 20% of what is was before the operation. Patients therefore require smaller portions of food to satisfy their appetites and as a result patients happily eat less, consume less calories, and lose weight. There is no need to take iron supplements long term as is required with gastric bypass surgery - the duodendum, the first part of the small intestine, is left intact preventing problems with malabsorption. Patients typically lose 55%-65% of excess body weight after the first year and provided patients are well motivated further surgery is not required.
Risks
The risks involved are similar to those related to gastric bypass surgery. In very rare cases pulmonary emboli may form which can potentially be very dangerous, however unlike gastric bypass surgery there are no connections from which leakage can occur. Leakage from staple lines may occur in a small number of cases. Other less serious risks include infection and bleeding and the development of gallstones may occur later as a result of surgery.