Laparoscopic Sleeve Gastrectomy

How is Sleeve Gastrectomy Performed?

The majority of sleeve gastrectomies performed today are completed laparoscopically. This involves making five or six small incisions in the abdomen and performing the procedure using a video camera (laparoscope) and long instruments that are placed through these small incisions.

During the sleeve gastrectomy, about 75 percent of the stomach is removed leaving a narrow gastric tube or “sleeve”. No intestines are removed or bypassed during the sleeve gastrectomy. This procedure takes one to two hours to complete. This short operative time is an important advantage for patients with severe heart or lung disease.

How Does the Sleeve Gastrectomy Cause Weight-Loss?

Sleeve gastrectomy is a restrictive procedure. It greatly reduces the size of the stomach and limits the amount of food that can be eaten at one time. It does not cause decreased absorption of nutrients or bypass the intestines. After this surgery, patients feel full after eating very small amounts of food. Sleeve gastrectomy may also cause a decrease in appetite. In addition to reducing the size of the stomach, the procedure reduces the amount of the “hunger hormone,” ghrelin, produced by the stomach. The duration of this effect is not clear yet, but most patients have significantly decreased hunger after the operation.

Who Should Have a Sleeve Gastrectomy?

This operation has been used successfully for many different types of bariatric patients.  Since it is a relatively new procedure, there is no data regarding weight-loss, complications or weight regain beyond three years. This procedure is sometimes used as part of a staged approach for high-risk patients. Patients who have a very high body mass index (BMI) or severe heart or lung disease may benefit from a shorter, lower risk operation such as the sleeve gastrectomy as a first stage procedure. Sometimes, the decision to proceed with the sleeve gastrectomy is made in the operating room due to an excessively large liver or extensive scar tissue to the intestines that make gastric bypass impossible.

In patients who undergo LSG as a first stage procedure, the second stage (gastric bypass) is performed 12 to 18 months later after significant weight-loss has occurred, the liver has decreased in size and the risk of anesthesia is much lower. Though this approach involves two procedures, we believe it a safe and effective strategy for selected high-risk patients.

LSG is also being used as a primary weight-loss procedure in lower BMI patients. Because this is a more recent application of this procedure, it is currently being performed as part of an investigational protocol for this lower BMI patient group.

How Much Weight-loss Occurs after LSG?

Several studies have documented excellent weight-loss up to three years after In higher BMI patients who undergo LSG as a first stage procedure, the average patient will lose 40 – 50 percent of their excess weight in the first two years after the procedure. This typically equates to about 125 pounds of weight-loss for patients with a BMI greater than 60.

Patients with lower BMI’s who undergo LSG will lose a larger proportion of their excess weight (60 – 80 percent) within three years of the surgery. Weight-loss after LSG has been directly compared to Laparoscopic Adjustable Gastric Banding (LAGB). In a randomized trial comparing LSG to LAGB, LSG resulted in better weight-loss at three years (66 percent versus 48 percent excess weight-loss). Additionally, more than 75 percent of patients will have significant improvement or resolution of major obesity-related co-morbidities such as diabetes, hypertension, sleep apnea and hyperlipidemia following sleeve gastrectomy.

What are the Risks of Sleeve Gastrectomy?

The risk of major post-operative complications after LSG is 5-10 percent, which is less than the risk associated with gastric bypass or malabsorptive procedures such as duodenal switch. This is primarily because the small intestine is not divided and reconnected during LSG as it is during the bypass procedures. This lower risk and shorter operative time is the main reason we use it as a staging procedure for high-risk patients.

Complications that can occur after LSG include a leak from the sleeve resulting in an infection or abscess, deep venous thrombosis or pulmonary embolism, narrowing of the sleeve (stricture) requiring endoscopic dilation and bleeding. Major complications requiring reoperation are uncommon after sleeve gastrectomy and occur in less than 5 percent of patients.

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