Sleeve Gastrectomy
leeve gastrectomy as a laparoscopic procedure. 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 laparoscopic sleeve gastrectomy (LSG), about 75% of the
stomach is removed leaving a narrow gastric “tube” or “sleeve”. No
intestines are removed or bypassed during the sleeve gastrectomy. The
LSG takes one to two hours to complete.
Who Do We Offer Laparoscopic Sleeve Gastrectomy?
This procedure is primarily used as part of a staged approach to
surgical weight loss. Patients who have a very high body mass index
(BMI) or who are at risk for undergoing anesthesia or a longer procedure
due to heart or lung problems may benefit from this staged approach.
Sometimes the decision to proceed with a two-stage approach is made
before surgery due to these known risk factors. In other patients, the
decision to perform sleeve gastrectomy (instead of gastric bypass) is
made during the operation. Reasons for making this decision
intraoperatively include an excessively large liver or extensive scar
tissue that would make the gastric bypass procedure too long or unsafe.
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 and the risk of anesthesia is much
lower (and the liver has decreased in size). Though this approach
involves two procedures, we believe it is safe and effective for
selected patients.
Laparoscopic sleeve gastrectomy can also be used as a primary
procedure. There is relatively little data regarding the use of LSG as a
stand-alone procedure in patients with lower BMI’s and it should be
considered an investigational procedure in this patient group. We are
offering this procedure to diabetic patients with a BMI between 30 and
40 as a part of a clinical trial that will better define the short and
long-term benefits of LSG in this group of patients.
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.
What Are The benefits Of Laparoscopic Sleeve Gastrectomy?
Depending on their pre-operative weight, patients can expect to lose
between 40% to 70% of their excess body weight in the first year after
surgery.
Many obesity-related comorbidities improve or resolve after bariatric
surgery. Diabetes, hypertension, obstructive sleep apnea and abnormal
cholesterol levels are improved or cured in more than 75% of patients
undergoing LSG. Though long-term studies are not yet available, the
weight loss that occurs after LSG results in dramatic improvement in
these medical conditions in the first year after surgery.
Is Laparoscopic Sleeve Gastrectomy A Good Choice For Me?
Your surgeon may talk to you about LSG as an option if you have a BMI
over 60 or significant medical problems that increase your risk for
undergoing anesthesia or gastric bypass. Laparoscopic sleeve gastrectomy
may also be offered as part of a clinical investigation if you have a
lower BMI and diabetes.
Ref: http://my.clevelandclinic.org/services/bariatric-and-metabolic-institute/weightloss-options/gastric-sleeve
