Sleeve

Laparoscopic Sleeve Gastrectomy (LSG)


The Laparoscopic Sleeve gastrectomy is a relatively new operation that has gained popularity around 2005 and has become the fastest growing bariatric operation. The idea of the sleeve is to reduce the capacity of the stomach by around 70% leaving the rest of the digestive system intact. Around 70% of the stomach on the left side is removed and the remaining part of the stomach now looks like a tube or a “banana”.

The sleeve gastrectomy started as a part of an operation called the duodenal switch (DS). The DS operation includes bypassing a large segment of the intestines to decrease the absorption of calories and fat. It is one of the most difficult operations to be performed laparoscopically. Surgeons who attempted this operation in the 90’s faced a lot of difficulties and so they divided the operation into two phases. They would start with the laparoscopic sleeve gastrectomy first and then few months later complete the duodenal switch, at which time the patient would have lost weight and the operation would be easier. To everyone’s surprise the sleeve gastrectomy alone led to substantial and sustained weight loss and that led to the adoption of the sleeve gastrectomy as a recognized primary bariatric operation.

Results
Long-term results with the SG are not available since the LSG is a relatively new operation. However, results at 5 years closely resemble those of the RYGB with percent excess weight loss of 50-70% and improvement or resolution of obesity related co-morbidities.

Risks and Side Effects
Immediate serious risks following LSG occur in 2% of patients and include the risk of deep vein thrombosis (blood clots), pulmonary embolus (PE), leak and deep abdominal infection, bleeding. Most will appear within the first few days. Some of these complications are best managed with early re-operation. Leaks from the staple line can sometimes be managed without an operation using stents but many patients who develop a leak will be best treated by converting the operation into a bypass. The risk of death is less than 0.3% in experienced bariatric surgical centers such as ours.

Long-term side effects include acid reflux in around 20% of patients. As with all bariatric operations, some patients will regain weight with time. It appears that weight gain is related to re-expansion of the stomach. Vitamin B-12 levels should be monitored regularly to prevent deficiency.

Life after the LSG
The average operation takes about 60 minutes and the average stay in the hospital is around 2 days. The phases of diet include clear fluids for ten days, thick fluids for ten days and soft food for ten days. Thereafter food intake becomes normal. Most patients return to work within 10 days of the operation and resume exercise three weeks later.

Long-term commitment to healthy eating habits and regular activity are important to guarantee the success of the operation.

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