Sleeve (Tube) Gastrectomy

Laparoscopic sleeve gastrectomy (LSG)

The Sleeve Gastrectomy is a new restrictive weight loss surgery procedure that causes weight loss by restricting food intake. This procedure is now the most common weight loss surgery performed in Australia. It is the procedure of choice for patients who are volume eaters and or have a history of eating disorders. For these groups of patients, sleeve gastrectomy is a life changing operation, it will help patients to lose weight and improve their health.

Losing weight lowers the risk of developing medical problems associated with obesity. For example, high blood pressure, diabetes, arthritis, sleep apnea and also self-confidence and self-esteem. Patient with diabetes less than 5 years almost has a 100 percent chance of being cured. Those who had diabetes for more than 5 years has up to 80% chance of being off their medications.

Sleeve gastrectomy procedure is performed laparoscopically, the concept is to makes your stomach smaller and should change the amount the patient can eat. Approximately 80% of the stomach is removed reducing a 2Litre stomach to 100mls to 150mls size. This part of the procedure is not reversible. The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the functions of the stomach while drastically reducing the volume. This surgery is an option for those patients that are morbidly obese with a BMI greater than 40kg/m2, or a BMI between 35-40 kg/m2 with significant comorbidities.

Studies have shown that the top fundus part of the stomach which produces the hunger hormone Grehlin is being removed during sleeve gastrectomy. A study by Karamanakos et al showed a markedly reduced level of ghrelin level in sleeve gastrectomy, are associated with greater suppression and excess weight loss compared with gastric bypass. This remove the hunger drive for the patient, however the effect will lessen in 6 to 9 months time. The average weight loss for this procedure is reported to be 60 to 80 % of the excess weight loss over 2 years. However, individual weight loss will vary based upon how well you follow the post-operative guidelines.

This operation have over taken gastric banding surgery as the most popular operation because the weight loss is more rapid, patient has less need for follow up, vomiting is rare and patient are not restricted to what they can consume. Most complications if it is to occur usually occur within the first two weeks, after which complications are rare. Staple line leaks is the most concerning and can be as high as 1-2%. The risk of stricture are 0.6% and post operative bleeding 1.2%. The surgery carry a mortality of less than 1%. Weight regain over time is not uncommon. Approximately 1 in 5 patient will have weight regain and 5 to 10 % of these patient may require further surgery.

The gastric sleeve has become a cornerstone for Dr. Clement Tsang’s practice because it has been proven in his hands to be a safe and effective operation, for those people who don’t want anatomic alteration of gastric bypass, nor a plastic insert, like lap band surgery. It has been known to cure Type II Diabetes at high rates and is also an excellent operation to achieve cure for high blood pressure and sleep apnea. Because of significant weight loss, patients will find tremendous relief from back pain, hip pain, knee pain, and foot pain allowing them to walk and exercise more.

If you are tired of the endless rounds of fad dieting and fruitless exercise regimens and think you may be ready for significant weight loss with a sleeve gastrectomy, or if you would like more information on all of the metabolic and weight loss surgery options at The Keyhole and Obesity Surgery Centre, contact us today.

We look forward to helping you start your weight loss journey today! Call 0292213919 to Schedule a Consultation.

Indications

  • Qualifications for bariatric surgery in most areas include:
    BMI ≥ 40, or more
  • BMI ≥35 and at least two obesity-related co-morbidities such as type II diabetes (T2DM), hypertension, sleep apnea and other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease.
  • Inability to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts.
  • Considering a Lap Band or Realize band, but are concerned about adjustments or having a surgical device internally
  • Concerned of vitamin deficiency associated with other weight loss surgery procedures

Advantages of the Sleeve Gastrectomy Weight Loss Surgery

  • The stomach is reduced in volume but tends to function normally so most food items can be consumed, though only in small amounts.
  • Eliminates the upper portion of the stomach that produces the hormones that stimulates hunger (Ghrelin), therefore hunger is often decreased temporarily for a few months.
  • No dumping syndrome because the pyloric valve is preserved.
  • Does not require adjustments
  • Does not induce malabsorption
  • Great procedure for Low BMI patients (30-40) with metabolic syndrome (HTN, diabetes type 2, etc.)
  • It is believed that the suppression of the gut hormones peptide tyrosine-tyrosine (PPY) and incretins, in addition to ghelin, has an immediate ameliorative impact on metabolic health problems such as hypertension, hyperlipidemia, gastro-esophageal reflux disease, and especially type 2 diabetes.
  • No foreign body or implanted devices.
  • Performed laparoscopically in virtually all patients.
  • Usually takes 1 hour to perform
  • Usually 2 nights in hospital
  • Minimizes the chance of an ulcer occurring by decreasing the amount of acid secreted.
  • By avoiding the intestinal bypass, the chance of intestinal obstruction (blockage), anemia, osteoporosis, protein deficiency and vitamin deficiency are greatly reduced.
  • No adjustment required or foreign body inserted (as in an adjustable gastric band) that may cause obstruction, slippage or erosion.
  • Disadvantages of the Vertical Gastrectomy Weight Loss Surgery
  • Because the stomach is removed, it is not reversible. It can though be converted to a Roux-En-Y Gastric Bypass in the future if necessary.
  • There is a potential for inadequate weight loss or weight regain. While this is true for all procedures, it is theoretically more possible with procedures that do not have an intestinal bypass.
  • Soft calories such as ice cream, milk shakes, can be consumed \ absorbed and these high calorie foods may slow weight loss.
  • This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur.
  • Dilation of the sleeve may occur, affecting weight loss

Following recovery, certain lifestyle changes and follow-up care occur; people who have gastric sleeve surgery must:

  •  Exercise regularly.
  • Learn behavior modification techniques.

This operation has some resemblance to the old–fashioned so–called stomach stapling procedures of the 1980s and 1990s (the vertical banded gastroplasty) and has probably replaced them worldwide. It involves removing the outer part of the stomach, thus significantly reducing the capacity to store food and generate hunger signals. People who undergo this operation lose hunger quickly during a meal and find it hard to overeat. Their stomach is turned into a narrow tube with a volume at least 75 percent smaller than before. Their maximum meal size is reduced to less than one cup of food, but the restriction in the volume of food that can be eaten usually occurs without significant restriction of the types of food that can be eaten. Vomiting is less common than with the band, but reflux is more common. Although the side effects of this gastroplasty are far less than stomach stapling, the procedure is permanent, so any side effects might also be permanent.

Laparoscopic Gastric Plication

A band can also be placed at the top of the plicated (narrow) stomach.
The weight loss is quite rapid initially but weight regain occurs if patients do not change their eating habits. The sleeve gastrectomy can be used as a step on the path towards a gastric bypass (see below) for patients wanting to consider some of the benefits of the bypass (ease of weight loss, minimal vomiting) without the negatives (potential calcium, iron and vitamin B12 deficiency problems, and the small risk of blockages of the small bowel). If long–term weight loss is not sufficient, the sleeve can be converted laparoscopically to a bypass without undue difficulty. If someone has a permanent side effect from a sleeve gastrectomy, they may require a gastric bypass to address it.

 

Because part of the stomach is removed it is, therefore permanent. Any unwanted side effects would also be permanent unless treated.

Questions and other information about Sleeve (Tube) Gastrectomy

  • What should i do before Gastric Sleeve Surgery

    Before gastric sleeve resection or any bariatric surgery, smoking increases the risk for infections, pneumonia, blood clots, slow healing and other life-threatening complications after surgery. Ideally, you should permanently quit smoking, but even if you don’t you must quit for at least one month before and one month after bariatric surgery.
    Some surgeons require patients to go on special diets in the week(s) before the procedure. On average most patient will be on optifast shakes for 2 weeks, patient who have a higher BMI may need to go in it for longer than 2 weeks.

  • What should I expect after Gastric Sleeve Surgery

    A non-reversible procedure, gastric sleeve surgery is performed under general anesthesia and takes about one hours.

    Afterward you will probably stay in the hospital for one or two days; recovery from gastric sleeve surgery may last a few weeks.

    Most patient will return to office work in 7 to 10 days.
    Most patient will have pain in the wound, chest and sometimes left shoulder.
    Following surgery, you will need to become re-accustomed to eating solid foods. Normally this starts with 2-3 weeks on a liquid-only diet, two weeks of pureed foods and then soft food.
    As far as weight loss goes, most people who have gastric sleeve surgery lose 50 to 80 percent of their excess body weight over the first six months to one year after surgery.
    Studies have shown that after the gastric sleeve resection procedure people show improvement in diabetes, high blood pressure, high cholesterol and sleep apnea within one to two years. These improvements are comparable with those seen after other weight loss surgeries.
    As this is a relatively new procedure, limited data is available on long-term weight loss (beyond five years after surgery) or overall health improvements.

  • Who is gastric sleeve surgery for?
    • Patients who are looking for a less invasive procedure to the gastric bypass.
    • Age groups usually include patients from ages 18-65.
    • Weight loss for IVF
    • Treatment of medical condition such as diabetes, hypertension, and sleep apnoea in patients with morbid obesity with BMI greater than 30
    • Morbidly obese with polycystic ovarian syndrome.
    • Revisional surgery for failed gastric band
  • What are some of the benifits?
    • Can be less expensive than other procedures
    • Less potential for complications
    • Great weight loss results
    • Capable of delivering good long term results
    • No more dieting
    • Portions control
    • May eliminate or relieve symptoms of many health conditions (e.g. diabetes).
  • Medical conditions that prevent them from having gastric bypass surgery Procedure

    What Are The Risks Of Laparoscopic Sleeve Gastrectomy?

    There are risks that are common to any laparoscopic procedure such as bleeding, infection, injury to other organs, or the need to convert to an open procedure. There is also a small risk of a leak from the staple line used to divide the stomach. These problems are rare and major complications occur less than 1% of the time.

    Overall, the operative risks associated with LSG are slightly higher than those seen with the laparoscopic adjustable band but lower than the risks associated with gastric bypass.

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the Society of American Gastrointestinal and Endoscopic Surgeons