Laparoscopic Sleeve Gastrectomy

A sleeve gastrectomy is the removal of the left side of the stomach. This is usually performed as part of a surgery for weight loss.

Removing your stomach doesn’t take away your ability to digest liquids and foods. However, you may need to make several lifestyle changes after the procedure.

What is the purpose of Sleeve Gastrectomy?

This type of gastrectomy is used to treat obesity. By making the stomach smaller, it fills more quickly. This may help you eat less. However, gastrectomy is only an appropriate obesity treatment when other options have failed. Less invasive treatments include:

  • diet
  • exercise
  • medication
  • counseling

Sleeve Gastrectomy May be Performed for the Following Reasons:

  • Body Mass Index is greater than 60
  • Severe comorbidities (cardiac, pulmonary, liver disease)
  • Advanced age
  • Inflammatory bowel disease (Crohn’s disease)
  • Need to continue specific medications (anti-inflammatory medicines, transplant medications)
  • Need for continued surveillance of the stomach (that couldn’t be evaluated after a gastric bypass)
  • Severely enlarged liver found during the operation
  • Severe adhesions (scarring) to the bowel found during the operation
  • Any combination of the above that significantly increases the patient’s risk

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 narrowgastric tube or “sleeve” (pictured right). 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?

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.

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 re-operation are uncommon after sleeve gastrectomy and occur in less than 5 percent of patients.

What is expect after the surgery?

Lifestyle Changes

Once you go home, you may have to adjust your eating habits. Some changes may include:

  • eating smaller meals throughout the day
  • avoiding high fiber foods
  • eating foods rich in calcium, iron, and vitamins C and D
  • taking vitamin supplements

Recovery from a gastrectomy can take a long time. Eventually, your stomach and small intestine will stretch. Then, you’ll be able to consume more fiber and eat larger meals. You’ll need to have regular blood tests after the procedure to make sure that you’re getting enough vitamins and minerals.