The Laparoscopic Sleeve gastrectomy (LSG) is the most common bariatric surgery performed worldwide, including Qatar and Lebanon. The idea of the LSG is to reduce the capacity of the stomach by around 70-80% leaving the rest of the digestive system intact. Around 70-0% 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 LSG first and then few months later complete the DS, at which time the patient would have lost weight and the operation would be easier. To everyone’s surprise the LSG alone led to substantial and sustained weight loss and that led to the adoption of the LSG as a recognized primary bariatric operation.
Long-term results with the LSG are equivalent to the gastric bypass with weight loss around 30% of the total weight at one year. Most patients experience mild weight regain, but on average maintain 20-25% total weight loss on long-term follow-up. The vast majority of patients experience improvement or resolution of obesity related co-morbidities.
Immediate serious risks following LSG occur in 1% 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 0.1% in experienced bariatric surgical centers such as ours.
Long-term side effects include acid reflux in around 20-40% of patients, gallstones and loose skin. 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.
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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