LAPAROSCOPIC SLEEVE GASTRECTOMY

What is Laparoscopic Sleeve Gastrectomy?

During sleeve gastrectomy, the stomach is stapled and divided vertically. This procedure requires specially designed surgical staplers, using the keyhole or laparoscopic method. By doing this, about 2/3 or 60% of the stomach will be removed. The remaining stomach is now in the shape of a long narrow tube resembling a shirt sleeve. The much smaller size of the stomach restricts the amount of food the stomach can hold at a time. The appetite for food is also reduced.

Why Laparoscopic Sleeve Gastrectomy?

The results of this procedure are very good. About 60% of excess weight will be lost over one or two years. More importantly, this can be maintained for at least five to ten years with close-followup with the doctor. Complications such as leak of the staple line or bleeding are very low.

What to expect?

Before the procedure

  • A gastroscopy is done to ensure the stomach does not have any disease.
  • A full medical work-up including an ultrasound of the liver and gallbladder is done.
  • Fasting is required 8 hours prior to your procedure.
  • All regular medications will be stopped unless absolutely necessary under a doctors supervision.
  • Be prepared to have an average hospital stay following the procedure in between 2-3 days.

On the day of the procedure

  • The procedure does involve stapling of the stomach. There will be 5 very small wounds to complete
    the laparoscopic or keyhole procedure.
  • Your surgeon will advise you on the specific details.

After the procedure

  • This procedure is not reversible.
  • You will be allowed to drink fluids and eat within the next 24 hours. However, allow your appetite to
    guide you. Fluid diet is required for the first week.
  • If you experience nausea, stay with clear liquids until it resolves.
  • Resume your normal diet after about a week and after the first review with your doctor.
  • The amount of food consumed will be small and has to be taken slowly.
  • Your doctor will advise on the type of food to be consumed, and encourage you to embark on an
    exercise regime after a month.

Why Laparoscopic Sleeve Gastrectomy?
Laparoscopic sleeve gastrectomy is a safe and effective procedure where patients can expect to lose around 60 to 80 per cent of their excess body weight and sustain it in the long term.
Furthermore, studies have shown that laparoscopic sleeve gastrectomy causes many obesity-related diseases to resolve or improve following surgery, leading to improvement in an individual’s quality of life.

Excellent and sustained weight loss

Laparoscopic sleeve gastrectomy helps patients to lose weight more rapidly over a significantly shorter time. In many cases, rapid weight loss occurs in the first six months after the procedure and around 70 per cent of their excess weight within one year after the surgery. Studies have found that 60 per cent of this excess weight loss is maintained in the next five years.

Improving or resolving obesity-related diseases

Not only does laparoscopic sleeve gastrectomy help you in weight loss that is significant and sustained, this surgery has been proven to improve or resolve multiple comorbitides linked to obesity. Studies have shown that more than 75 per cent of patients undergoing laparoscopic sleeve gastrectomy will have significant improvement or resolution in many major conditions such
as Type II Diabetes, hyperlipidemia, hypertension, obstructive sleep apnea, high cholesterol and gastroesophageal reflux disease. Within one year, patients report 80 per cent resolution for Type II Diabetes, 75 per cent for hyperlipidemia, 83 per cent for hypertension, and 91 per cent for gastroesophageal reflux disease. The effect is especially notable in Type II Diabetics, who experience incredible improvement in diabetes control with weight loss and the majority of patients with Type II diabetes go into long term remission. This is a result of the weight loss achieved through bariatric surgery.

High rate of satisfaction and improvement in quality of life

Following laparoscopic sleeve gastrectomy, patients benefit from this surgery and go on to lead longer, healthier lives. Within three months after laparoscopic sleeve gastrectomy, patients report greater satisfaction due to improved health, better self-image and increased social activity as a
result of weight loss. 93 per cent of patients have experienced an improved quality of life due to weight loss and better management of obesity-related conditions such as Type II Diabetes and hypertension.

Extremely low risk of complications

It is noteworthy that laparoscopic sleeve gastrectomy is a simple procedure as it does not involve rerouting or reconnection of your intestines. Thus this procedure has very low rate of complications and quick recovery times. Surgical risk with a laparoscopic sleeve gastrectomy are extremely
uncommon and affect less than one per cent of all patients undergoing the procedure. There is also less risk of developing vitamin or mineral deficiencies as the food you eat follow a normal
digestive route with no change in your gastrointestinal tract.

Laparoscopic sleeve gastrectomy is also virtually scarless as your surgeon makes several small incisions instead of a large one. As opposed to traditional open surgery, laparoscopic sleeve gastrectomy causes you to experience less pain, less risk of wound infection, shorter hospital stay
and a faster recovery and return to normal activities.

Am I suitable for laparoscopic sleeve gastrectomy?

Laparoscopic sleeve gastrectomy is recommended if you are severely overweight, having either a

  • Body Mass Index (BMI) of over 40
  • BMI between 35 and 40 with health conditions such as Type II diabetes, metabolic syndrome,
    heart disease or sleep apnea

This surgery is advised especially if you have attempted conventional methods of weight loss such as diet and exercise but are unsuccessful in losing significant weight loss in the long run.

What will life be like after laparoscopic sleeve gastrectomy?
Laparoscopic sleeve gastrectomy helps you with lifelong changes in your diet and lifestyle.

For the first week after the surgery, you may be placed on a liquid diet and another two weeks of eating soft and pureed foods. You will likely be able to consume solid food in small portions thereafter. This food plan is crucial to ensure that your staple lines heal well after laparoscopic sleeve gastrectomy so that the sleeve will be kept in place.

When you are able to resume eating solid foods, you will be able to eat all foods, but in much smaller quantities. You will feel full and satisfied more quickly after consuming a small portion of food, as the volume of food the pouch can hold is greatly reduced. Your stomach may be full by eating as little as half a cup of solid food and this food fills you for the next few hours. This reduces the amount of food that you can eat at a time. You will also eat more slowly. At the same time, as laparoscopic sleeve gastrectomy resects your fundus, the main part of your stomach which produces ghrelin which is known as the ‘hunger hormone’, decreased levels of gherkin leads to a reduced appetite and greater satiety. This also helps you lose weight easily without having to make an intentional effort unlike dieting. This means you can still consume most of your favourite foods without having to worry about dumping syndrome, in which you will experience abdominal discomfort and other symptoms. You may take some time getting used to these changes and they should be permanent. This is what ensures rapid and reliable weight loss.

Your doctor or nutritionist will advise you to take multivitamins and Vitamin B tablets daily and help you make healthy food choices.

You may be advised to start an exercise routine as soon as you obtain the green light from your surgeon. Regular exercise works hand-in- hand with a healthy diet to ensure sustained weight loss and prevent weight regain.

Unlike certain types of bariatric surgery, on-going adjustments do not need to be made. However,regular follow up with your surgeon or dietician is necessary to ensure the pace of weight loss is appropriate and your intake is contains adequate nutrition.