Laparoscopic Sleeve Gastrectomy

Introduction

The sleeve gastrectomy is a restrictive procedure and is also known as a vertical partial gastrectomy. In this operation 2/3 of the stomach will be removed, which gives the patient a sense of fullness with only a small amount of food. It also removes the upper part of the stomach, which secretes an enzyme called Ghrelin. This enzyme controls appetite. After removing the 2/3 of the stomach the valve at the outlet of the stomach remains and this provides for the normal process of the stomach emptying to continue and therefore allows the feeling of fullness.Dr Mark Daoud in theatreThe sleeve gastrectomy was originally discovered as a stage 1 for a 2-stage procedure in patients undergoing biliary pancreatic diversion, or sometimes before the Roux en Y gastric bypass in super obese patients. It now has been recognized as a stand-alone procedure. There is no connection made between the stomach and the small intestine in this procedure and there is no re-routing of the intestine. There is no malabsorption component; therefore, there is no dumping syndrome. The sleeve gastrectomy is believed to have an advantage over the adjustable gastric banding due to the removal of the part of the stomach that produces the hormone Ghrelin that controls the desire to eat. It has potential complication in the order of 0.5 to 1% compared to a 2-3% rate in a combined procedure.

This is a relatively new approach. It is the first component of the duodenal switch operation and involves removing the lateral two thirds of the stomach with a stapling device. It can be done laparoscopically (keyhole surgery) but is not reversible. It basically leaves a stomach tube instead of a stomach sack.

Sometimes it is offered to patients as part of a two stage Bypass operation particularly if they are super obese (BMI>60) because it allows good weight loss until the patient gets down to a safe weight and the more radical bypass can then be offered laparoscopically when they are at a safer weight.

The residual stomach capacity is about 200mls so a generous entree should be possible.

The weight loss seems to be a little better and more rapid than the lap band (60-70% EWL) over two years but it is not adjustable.

It might also be a good option if patients have a problem with their lap band requiring revision, have already lost a lot of weight and don't want a full bypass.

Indications

Obesity, morbid obesity.

Preoperative Instructions

There is a pre-operative dietary instruction, which will be provided verbally and in writing through our dietetic team. This will allow the fat stored in the liver to decrease, which allows the operation much easier, as the liver needs to be retracted to allow good exposure of the stomach and the adjoining part of the oesophagus. This also very important to rule out the presence of hiatus hernia and repair it if it is present. A step that is very fundamental to prevent the risk of sever reflux following sleeve gastrectomy.

Procedure

It involves removing the lateral two thirds of the stomach with a stapling device. It can be done laparoscopically (keyhole surgery) but is not reversible. It basically leaves a stomach tube instead of a stomach sack.

Postoperative Instructions

After bariatric surgery diet guidelines

Post bariatric surgery diet guidelines are fully discussed with patients during their comprehensive nutritional evaluation prior to surgery. Patients follow a Stage I diet for the first 4-6 week after surgery. This includes all foods that are soft, mushy and/or pureed consistencies. Examples for pureed foods are anything blended and smooth such as baby foods, fruitless yogurt, cottage cheese and hummus. Soft/mushy foods include chopped up ground meats such as turkey, veal, chicken or pork, soft, white, flaky fish that is baked, broiled or grilled, scrambled eggs and egg whites. Solid foods of all kinds should be completely avoided until weeks 4-6 or when the surgeon allows it.

This practice stresses the importance of good hydration, using non-carbonated, decaffeinated, sugar free beverages. We always promote good quality proteins to be consumed from day one after bariatric surgery. High sugar and high fat foods are limited and very specific guidelines are provided to help equip patients with a clear-cut way to determine which foods are healthy for them to eat. Fruits, vegetables, and high fibre foods are reintroduced after the first 3 months. 

Obesity Clinic Queensland team is fully dedicated to promoting high standards for nutritional health. That doesn’t mean that patients should not enjoy eating. Each patient is given the option to enrol in our indefinite bulk billed post-operative care. In choosing surgery to achieve significant and permanent weight loss your success will directly correspond to your commitment to embrace a new lifestyle change. 

Risks

Fewer patients develop complications after a sleeve gastrectomy than after gastric band or gastric bypass surgery. However, if complications do occur, they can potentially be difficult to fix.

In just one per cent of cases, a staple line leak occurs. Early detection and management is crucial for a fast and smooth recovery.  In some cases however, the recovery time can be lengthy. A leak will typically present in the first two weeks post surgery. After this time, there are few potential complications from sleeve gastrectomy.

Severe pre-existing reflux and heartburn may not be well controlled by this procedure. In some cases, a gastric bypass may control these severe symptoms more effectively.

In comparison to gastric band and bypass, sleeve gastrectomy is a relatively new procedure and therefore there is limited long-term data about weight loss maintenance. Published results up to 10 years after gastric sleeve surgery show that up to a third of people have some weight regain a few years after a weight loss operation. Weight regain after a sleeve gastrectomy is comparable with gastric bypass. Fortunately, after a gastric sleeve or bypass, the patient’s weight does not return to previous levels. This is not the case with patients who choose a gastric band, where if the restriction provided by a gastric band is removed; the patient typically regains the weight and sometimes more.

Hair loss

Surgeries and emotional stress can cause hair loss. Typically, there is a three-month delay between the event and the onset of hair loss. There may be another three-month delay prior to the return of noticeable hair re-growth. Therefore, the total hair loss and re-growth cycle can last 6 months.

For more information or to book a consultation, please contact us.