Sleeve Gastrectomy

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Sleeve Gastrectomy

The Laparoscopic Sleeve Gastrectomy (LSG) – often called the sleeve – is performed by removing approximately 80 percent of the stomach, longitudinally. The left stomach portion is a tubular pouch resembling a banana.

The Procedure

This procedure works by several mechanisms.

First, the new stomach pouch holds a considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food (and thus calories) that can be consumed.

The greater impact, however, seems to be the effect the surgery has on gut hormones that impact a number of factors including hunger, satiety, and blood sugar control.

Short term studies show that the sleeve is as effective as the roux-en-Y gastric bypass in terms of weight loss and improvement or remission of diabetes. There is also evidence that suggest the sleeve, similar to the gastric bypass, is effective in improving type 2 diabetes independent of the weight loss. The complication rates of the sleeve fall between those of the adjustable gastric band and the roux-en-y gastric bypass.

Advantages

1. Restricts the amount of food the stomach can hold
2. Induces rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass. Weight loss of >50% for 3-5+ year data, and weight loss comparable to that of the bypass with maintenance of >50%
3. Requires no foreign objects (AGB), and no bypass or re-routing of the food stream (RYGB)
4. Involves a relatively short hospital stay of approximately 2 days
5. Causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve satiety

Disadvantages

1. Is a non-reversible procedure
2. Has the potential for long-term vitamin deficiencies
3. Has a higher early complication rate than the AGB

Fig-Sleeve Gastrectomy

How is Sleeve Gastrectomy Performed?
The sleeve gastrectomy is performed laparoscopically. This involves making five or six small incisions in the abdomen for placement of a video camera known as a laproscope and long instruments to perform camera guided gastrectomy.

During the sleeve gastrectomy, about 75-80 percent of the stomach is removed leaving a narrow gastric tube or “sleeve”. This procedure takes one to two hours to complete. This short operative time is an important advantage for patients with severe heart or lung disease.

Am I a good candidate for Sleeve Gastrectomy?

Sleeve Gastrectomy has been used successfully for many different types of bariatric patients. It is a relatively new procedure, this procedure is mostly used as part of a staged approach for high-risk patients. Patients who have a very high body mass index (BMI) or severe heart or lung disease may benefit from a shorter, lower risk operation such as the sleeve gastrectomy as a first stage procedure. Sometimes, the decision to proceed with the sleeve gastrectomy is made in the operating room due to an excessively large liver or extensive scar tissue to the intestines that make gastric bypass impossible.

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, the liver has decreased in size and the risk of anesthesia is much lower. Though this approach involves two procedures, we believe it a safe and effective strategy for selected high-risk patients.

LSG is also being used as a primary weight-loss procedure in lower BMI patients.

How Much Weight-loss can be achieved with LSG?
Several studies have documented excellent weight-loss up to three years after LSG. In higher BMI patients who undergo LSG as a first stage procedure, the average patient will lose 40 – 50 percent of their excess weight in the first two years after the procedure. This typically equates to about 125 pounds of weight-loss for patients with a BMI greater than 60.

Patients with lower BMI’s who undergo LSG will lose a larger proportion of their excess weight (60 – 80 percent) within three years of the surgery. Weight-loss after LSG has been directly compared to Laparoscopic Adjustable Gastric Banding (LAGB). In a randomized trial comparing LSG to LAGB, LSG resulted in better weight-loss at three years (66 percent versus 48 percent excess weight-loss). Additionally, more than 75 percent of patients will have significant improvement or resolution of major obesity-related co-morbidities such as diabetes, hypertension, sleep apnea and hyperlipidemia following sleeve gastrectomy.

Published Studies on LSG

Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg 2005; 15(7):1024-9.
Baltasar A, Serra C, Perez N, et al. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg 2005; 15(8):1124-8.
Lee CM, Cirangle PT, Jossart GH. Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc 2007.
Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc 2006; 20(6):859-63.
Moon Han S, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg 2005; 15(10):1469-75.
Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg 2006; 16(11):1450-6.
Hamoui N, Anthone GJ, Kaufman HS, Crookes PF. Sleeve gastrectomy in the high-risk patient. Obes Surg 2006; 16(11):1445-9.
Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg 2006; 16(9):1138-44.

What are the major risks associated with Sleeve Gastrectomy?
The risk of major post-operative complications after LSG is 5-10 percent, which is less than the risk associated with gastric bypass or malabsorptive procedures such as duodenal switch. This is primarily because the small intestine is not divided and reconnected during LSG as it is during the bypass procedures. This lower risk and shorter operative time is the main reason we use it as a staging procedure for high-risk patients.

Complications that can occur after LSG include a leak from the sleeve resulting in an infection or abscess, deep venous thrombosis or pulmonary embolism, narrowing of the sleeve (stricture) requiring endoscopic dilation and bleeding. Major complications requiring re-operation are uncommon after sleeve gastrectomy and occur in less than 5 percent of patients.[/vc_column_text][/vc_column][/vc_row]