Gastric Sleeve

What is Laparoscopic Sleeve Gastrectomy?

Laparoscopic Sleeve Gastrectomy (LSG) , commonly known as gastric sleeve is a minimally invasive weight loss surgery that reduces the stomach size by 75-80%, transforming it into a narrow, 'sleeve-like' shape. The procedure is a restrictive weight loss surgery to treat extremely obese patients with a high BMI. It encourages weight loss by restricting the stomach size, so it holds only a limited amount of food. This helps patients to eat less and achieve significant and long-term weight loss without hampering the normal digestive process. It is the most popular and commonly done weight loss surgery performed for the treatment of obesity due to its effectiveness, lower risk compared to gastric bypass, and metabolic health benefits.

Sometimes sleeve gastrectomy is carried out as the first stage of a two-stage operation in extremely obese patients with a BMI of 45-50 or more. This is done to achieve a considerable amount of weight loss, so it is safer for the patient to undergo a second bariatric surgery if needed.

How is Gastric Sleeve Surgery Performed?

Laparoscopic Sleeve Gastrectomy is performed under general anaesthesia and typically takes 60-90minutes. Here's a step-by-step guide:

1. Small incisions, big impact - The Surgeon makes 4-5 tiny skin incisions in your abdomen.

2. High-definition precision - A laparoscope ( tiny camera) is inserted for a clear view of the stomach.

3. Reshaping the stomach - A 'Bougie' which is a thin flexible tube is inserted into the stomach to act as a guide for the surgeon to create a small, narrow stomach during the procedure

4. Sealing for safety - The stomach is stapled and sealed at the same time using a specialised key hole stapler to prevent leaks

5. Final Steps - Surgical instruments are removed, and incisions are closed with absorbable sutures.

Benefits of Minimally Invasive Approach

Faster recovery - 1-2 nights stay in hospital
Less pain and scarring
Lower risks of complications

Advantages of Sleeve Gastrectomy Surgery

Reduced stomach volume increases the feeling of fullness
Stomach functions normally allowing most foods to be eaten, just in smaller amounts
Stomach portion that produces a hunger-stimulating hormone (Ghrelin) is removed.
Unlikely to have dumping syndrome due to the pyloric portion of the stomach is left intact
No intestinal bypass and its associated risks
Can be performed via keyhole surgery (laparoscopic surgery)
Simpler procedure than gastric bypass
Safer first stage procedure of two-stage surgery for super morbidly obese
Shorter operative time than gastric bypass surgeries
Shorter hospital stay than gastric bypass surgeries
No foreign bodies used such as in gastric band surgery

Disadvantages of Sleeve Gastrectomy Surgery

Irreversible
Can lead to new reflux symptoms
Potential for dilation of the sleeved stomach leading to weight regain

Post-operative Care after Sleeve Gastrectomy

Your doctor will prescribe pain-relieving medications to keep you comfortable following the procedure.
You will be advised to take medication to reduce the amount of acid produced by your stomach.
Avoid strenuous exercises and lifting heavy weights until approved by your surgeon
For the first month after the procedure, eat only small amounts of soft foods
Sip water throughout the day to prevent dehydration.
Eat a highly nutritious diet rich in proteins with low-fat content.
Your dietitian will tailor a new diet regimen for you to follow.

Risks and Complications after Sleeve Gastrectomy

As with any surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place. Most patients do not have complications after sleeve gastrectomy surgery; however, complications can occur and depend on the patient's health status.

Complications can be medical (general) or specific to sleeve gastrectomy.

Medical complications include those of the anaesthesia and your general well-being. Almost any medical condition can occur, so this list is not complete. Complications include:

Allergic reaction to medications
Blood loss requiring transfusion with its low risk of disease transmission
Heart attack, strokes, kidney failure, pneumonia, bladder infections
Complications from anaesthesia
Serious medical problems can lead to ongoing health concerns, prolonged hospitalization, or rarely death.

Specific complications for sleeve gastrectomy surgery include:
- DVT Deep vein thrombosis (blood clot in the deep leg veins) or Pulmonary Embolism (Blood Clots in Lungs)
- Damage to adjacent organs
- Leakage of digestive contents from the staple line can lead to serious infection and sepsis