Laparoscopic Sleeve Gastrectomy
Sleeve gastrectomy is a relatively new surgical option offered by the Hickory Surgical Clinic to treat morbid obesity. Just as the Gastric Bypass and the Adjustable Gastric Band procedures work primarily by restricting the stomach, the Sleeve Gastrectomy also works by reducing the capacity of the stomach.
When we perform a Sleeve Gastrectomy, we re-shape the stomach by removing (excising) a portion of the stomach to create a long, tubular stomach pouch that is shaped like a sleeve. As a result, patients who have undergone this operation should expect a sense of fullness and satiety with very small meals.The result is that fewer calories are consumed over the course of the day, which in the long run leads to weight loss that can be maintained for life.
History
The sleeve gastrectomy was originally developed as the restrictive component of another weight loss operation called the "duodenal switch" (DS) procedure. In 1997, surgeons started using the sleeve gastrectomy alone as a "first stage" operation in certain high risk patients. In this manner, patients with very high BMI could undergo a relatively safer laparoscopic procedure, in order to allow for a safer "second stage" operation after achieving some initial weight loss.Laparoscopic sleeve gastrectomy is still used for this purpose in certain cases today. However, in recent years this procedure has become increasingly popular as a "single stage" operation even in patients with a lower BMI.
Minimally Invasive Approach
In our program, sleeve gastrectomy procedures are nearly always performed with a minimally invasive laparoscopic technique. This means that instead of a large incision, the operation can usually be completed through 4-6 small incisions in the abdomen. We use a video camera (called a "laparoscope") to view the inside of the abdominal cavity, and surgical staplers to divide the tissues and make the new connections.The advantages of laparoscopic surgery include better cosmetic results, fewer wound-related complications, and a faster recovery with quicker return to work and other activities.
In appropriate cases, we often find that we can insert all the instruments we need through a single incision (where the stomach remnant is extracted). In certain cases this incision can be partially concealed in the umbilicus (bellybutton). This technique, called "single-incision laparoscopic surgery" or SILS, may offer some cosmetic benefits; the procedure is exactly the same on the inside.
Surgical Technique
The laparoscopic sleeve gastrectomy has only a single basic step: reduce the size of the stomach by creating a thin vertical "sleeve" using a stapling device. Watch the technique in the following video:How Does the Sleeve Gastrectomy Work?
Like the Adjustable Gastric Band, the sleeve gastrectomy is a purely restrictive procedure. Like the Gastric Bypass, the stomach pouch is created using a surgical stapler. However, when we shape the stomach pouch in this way, food can travel through the stomach and into the intestine without the need for re-routing the intestine as we do with a Gastric Bypass. This can provide a significant advantage for super-morbidly obese patients, or for patients in whom Roux-en-Y intestinal surgery is too risky or is contraindicated. Also, the sleeve-shaped pouch provides its restrictive effect without requiring the implantation of a device like the Gastric Band — and without the need for adjustments. Thus, the Sleeve Gastrectomy offers some advantages over both the Gastric Bypass and the Band.There are some potential disadvantages to consider. With a Sleeve Gastrectomy, patients do not experience dumping syndrome as they do with a Gastric Bypass. This eliminates the “negative feedback” effect that gastric bypass patients feel when they make poor food choices. Also, while short-term studies on weight loss with the Sleeve Gastrectomy look promising so far, a long-term track record has not yet been as firmly established as with the gastric bypass or adjustable gastric band. Finally, some insurance companies (including Medicare) may not cover this procedure.
What are the Risks of the Sleeve Gastrectomy?
There are risks associated with any major surgical procedure, including pain, bleeding, infection, heart or lung complications, blood clots (deep vein thrombosis or pulmonary embolism), injury to adjacent organs, drug reactions, anesthesia complications, and death. Some laparoscopic procedures require conversion to a traditional "open" approach with a larger incision.Some risks that are specific to the sleeve gastrectomy procedure include:
|
|
What are the Results of the Sleeve Gastrectomy?
After the sleeve gastrectomy operation, patients typically experience progressive weight loss for the first 12 to 18 months. Patients may lose up to 50-70% of their excess weight in the first two years. While short-term studies on weight loss with the Sleeve Gastrectomy look promising, a long-term track record has not yet been as firmly established as with the gastric bypass or adjustable gastric band.Sustained weight loss is not the only benefit of the sleeve gastrectomy. Numerous studies have shown improvement or complete resolution of many of the co-morbidities that are commonly associated with obesity.
Making a Choice
Is surgery the right choice? If so, which procedure? How does laparoscopic sleeve gastrectomy compare to other choices like the laparoscopic gastric bypass or the laparoscopic adjustable gastric band? Browse our site for more information, or call us with any questions.If you feel that you or someone you love might benefit from weight loss surgery, or if you would like any additional information, please contact us at 828-327-9178. Or click here to see how to get started in our program.
