Laparoscopic sleeve gastrectomy

 

Sleeve gastrectomy is now the commonest operation performed for obesity in Australia. The reduction in the volume of the stomach  induces a feeling of fullness with a greatly reduced  volume of food. 

 

 

 

I perform three major types of weight loss surgery, being the gastric band, the sleeve gastrectomy and the gastric bypass. The choice for most people lies between the sleeve gastrectomy and the gastric bypass. Studies comparing the two over five year time frames show very similar degrees of weight loss. Patients with Type II diabetes and those with gastric reflux have somewhat better results with the gastric bypass. However the sleeve gastrectomy, because of its reliable weight loss, can also achieve excellent improvement or even remission of diabetes.

 

• Sleeve gastrectomy in its present form has been performed for about 8 years, but has been around longer than that as the first part of an older two part operation

• Sleeve gastrectomy is almost always performed with keyhole surgery

• Patients commonly lose around 60% of their excess weight over 18 to 24 months

• Weight loss is more rapid than with gastric banding surgery

• Type II diabetics experience improvement in diabetes control with weight loss

• Many patients with Type II diabetes can be put into long-term remission

• Associated conditions such as high blood pressure and sleep apnoea often improve quickly

• Hospital stay is 3 to 4 days when performed with laparoscopic (keyhole) surgery

• Patients can be back at work in as little as two weeks

• Unlike gastric banding surgery, regular adjustments are not required

• You will be able to eat (small amounts of) most food types

• Long-term follow-up, as in all bariatric operations, is vital

• It is a permanent procedure and cannot be reversed

• It can be converted to a gastric bypass in certain situations

 

What is a Sleeve Gastrectomy?

It is a very simple procedure. The normal stomach holds about 1.5 litres of food. The size of the stomach is reduced by resecting the outer portion of the stomach. The resected part of the stomach is removed completely. The remaining “sleeve” of stomach holds only about 150 mls, thus the stomach capacity is reduced by 90%.

 

 

 

 

 

 

How Does it Work?

The effect of the sleeve gastrectomy is that you can eat a very small meal, feel full and satisfied and the hunger you would now feel from eating such a small meal does not occur.

By eating not more than a half cup of solid food your stomach will be full.  Food now sits at the top of the stomach. This activates nerves to the brain telling the brain the stomach is full and this causes the brain to turn off the hunger mechanism.

There is a second mechanism at work here although there remains some controversy over this. The main hunger hormone is known as ghrelin. The stomach that we resect secretes at least 60% of the body’s ghrelin. This may further reduce the hunger which would normally occur after eating very small meals.

Although the meals may be small, you can eat almost any food, just very small amounts. You will have no problem eating out.

What Are the Risks?

All operations carry risks. Risk will vary from person to person and must be thoroughly discussed with your surgeon before deciding to go ahead with the surgery.

When assessing the risks of surgery you must also consider and balance the risks of NOT having the surgery and remaining significantly overweight

 

Risks Common to All Types of Surgery

The following are the commonest of the complications but please note that this is not a comprehensive list of possible complications but does cover most events.

The Risk of the Anaesthetic.

Anaesthetic risks are extremely low because when you come to your operation any conditions which might increase your anaesthetic risk such as high blood pressure, diabetes or sleep apnoea will have been brought under control. All of our anaesthetists are experienced with dealing with the specific problems of patients with excess weight and have full access to all of the tests and information gathered during your preoperative assessment.

In any type of surgery the following risks can occur:-

Bleeding.

Although uncommon, bleeding can occur during an otherwise routine operation and could require blood transfusion and possibly abandoning the laparoscopic (keyhole) approach and require a major incision in the abdomen. Occasionally, after a routine operation, bleeding can commence some hours after an operation and require a return to the operating theatre.

Infections.

Again these are uncommon with laparoscopic surgery, but occasionally one of the small keyhole wounds can become infected and require antibiotics or drainage. Uncommonly, an infection inside the abdominal cavity or the chest can occur.

Damage to Other Organs.

Although uncommon, during laparoscopic surgery it is possible to inadvertently damage another organ such as the spleen or the bowel. Normally this can be diagnosed and repaired during the operation but very rarely this damage may not be obvious until some hours or even days after the procedure and will then require appropriate management.

Conversion to Open Operation.

Rarely, it is not possible to complete an operation with keyhole surgery and a full abdominal incision may be necessary. This is more likely to be the case if you have had previous surgery on your stomach such as a gastric band.

Blood Clots to the Legs or Lung (Pulmonary Embolus)

Blood clots to the legs or the lungs are a very serious complication. At LapSurgery we use the maximum protection against this occurring. Shortly before the operation you will be given a blood thinning injection and have stockings placed on your legs. As well is that a further device will be placed on your legs which keeps pumping blood through your legs whilst you’re asleep to minimise the chance of a clot forming whilst you are on the operating table.

Using these precautions and early mobilisation after the surgery that is possible with the keyhole operation, these complications have been extremely rare in our patients.

 

 

Complications Specific to the Sleeve Gastrectomy

Leakage – A Serious Complication

When we cut the stomach we use a stapling device to seal the stomach. A triple row of titanium staples seals the cut edges of the stomach. This produces a very secure closure of the cut edges of the stomach. However, right at the top edge of the stomach there can be a failure of the staples to seal fully. If this happens there will be a leakage of stomach contents into the abdominal cavity which can give rise to peritonitis. This can only occur in the first 10 days after the operation and occurs in about 1% of patients. If you have had previous stomach surgery such as a gastric band the leak rate is significantly higher and must be discussed thoroughly with your surgeon.

This is a very serious complication and could keep you in hospital for several weeks. Further operation may be required which may not be laparoscopic (keyhole) surgery.

The leak will eventually seal by itself or by other treatments and once this occurs the operation will work just as well as if the complication had not occurred.

 

Narrowing (Stenosis) of the Sleeve.

On occasions part of the sleeve will narrow and you may be unable to swallow foods properly. This is easily fixed in most cases by a simple gastroscopy and opening up the narrowed area with an inflatable balloon. This is painless and done just as a day case. Sometimes several dilatations may be required. In very rare cases it may not be possible to cure the problem and conversion to a gastric bypass may be necessary.

 

Dilatation (Stretching) of the Sleeve

This is uncommon and mostly seen at the upper end of the sleeve in patients who have previously had a gastric band. It occurs more often in pre-menopausal women. On occasions it can be trimmed but my preferred option is to convert to a gastric bypass.

 

Gastric Reflux (Heartburn)

Most patients will have some reflux in the first few months after a sleeve gastrectomy which can easily be controlled with acid lowering medications such as Nexium. A very small group of patients may experience very severe reflux not controlled by tablets. In this instance conversion to a gastric bypass may be necessary to stop the reflux.

 

Long Term Weight Gain

Unfortunately a small number of patients will either not lose the expected amount of weight or will at a later date put some of the weight back on. It is vital that you understand that the sleeve is a tool to help keep your weight down. It is not a procedure which can protect you forever from putting some of the weight back on. 

 

Risk of Vitmin B12 and Iron deficency

The stomach's small size may render it unable to allow you to absorb enough Iron or vit B12. You may need to have these supplemented by injections