Surgery Overview
Restrictive operations like gastric sleeve surgery make the stomach smaller and help people lose weight. With a smaller stomach, you will feel full a lot quicker than you are used to. This means that you will need to make big lifelong changes in how you eat-including smaller portion sizes and different foods-in order to lose weight.
This surgery can be done by making a large incision in the abdomen (an open procedure) or by making several small incisions and using small instruments and a camera to guide the surgery (laparoscopic approach). More than half of your stomach is removed, leaving a thin vertical sleeve, or tube, that is about the size of a banana. Surgical staples keep your new stomach closed. Because part of your stomach has been removed, this is not reversible.
Sometimes this surgery is part of a larger approach to weight loss done in several steps. If you need to lose a lot of weight before you have duodenal switch surgery
, gastric sleeve surgery may help you.
, gastric sleeve surgery may help you.How Is Sleeve Gastrectomy Performed?
We perform the sleeve 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.
If you’re interested in being a candidate for a gastric sleeve, you can watch our animated video about how the procedure works:
How Does Sleeve Gastrectomy Cause Weight Loss?
Sleeve gastrectomy is a restrictive procedure. It greatly reduces the size of your stomach and limits the amount of food that can be eaten at one time. It does not cause decreased absorption of nutrients or bypass your intestines. After eating a small amount of food, you will feel full very quickly and continue to feel full for several hours.
Sleeve gastrectomy may also cause a decrease in appetite. In addition to reducing the size of the stomach, sleeve gastrectomy may reduce the amount of “hunger hormone” produced by the stomach which may contribute to weight loss after this procedure.
WHAT ARE THE ADVANTAGES OF THE SLEEVE GASTRECTOMY?
Unlike the GASTRIC BAND procedure which requires adjustments every 4-6 weeks following surgery (until the perfect degree of restriction is reached – on average this means 4-5 adjustments), there are no adjustments required following SLEEVE GASTRECTOMY.
Because there is no prosthetic device involved with the SLEEVE GASTRECTOMY, the long term risks associated with this procedure are fewer than following GASTRIC BANDING.
Patients enjoy a fuller variety of foods than they may do following GASTRIC BANDING.
Patients will lose on average 70% of their excess weight following SLEEVE GASTRECTOMY. This weight loss tends to occur in the first 9-12 months following surgery.
For LAPAROSCOPIC SLEEVE GASTRECTOMY the Selection Criteria are as follows:
- Age between 18 and 65.
- BMI of 40, or
- BMI greater than 35 with at least with 1 major obesity related disease eg. Diabetes, Hypertension, Sleep Apnoea , arthritis.
- Acceptable operative risk
- Reasonable attempts at other weight loss techniques in the past
- A capacity to understand the risks and commitment associated with the surgery
- Dedicated to life-style change and follow up
WHAT ARE THE RISKS OF THE SLEEVE GASTRECTOMY?
Because the stomach itself has to be divided, there are some additional risks over Gastric Banding in the early post-operative period.
One problem is that gastric fluid may leak through the staple line. This usually occurs within the first few days after surgery, but may occur within 2 weeks following the procedure. This causes a serious infection around the outside of the Gastric Sleeve, and requires urgent surgery to remove the infection and control the leak. Recovery may take several weeks following this complication. The risk of this complication is around 1%, and is suspected if a patient develops fevers or abdominal pain in the early post operative period. Early treatment is the key to managing this problem successfully, so it is important to be on the watch for these symptoms and return back to the hospital without delay if concerns exist.
If you live outside Brisbane, Dr Hatzifotis will ask that you stay in Brisbane for a total of 2 weeks from the date of your surgery before returning home. This allows us to be able to help you in the event of a staple line leak.
Other complications that can occur include internal injuries, bleeding, blood clots in the leg veins or lungs, infections in the abdomen, chest or wounds, and allergic reactions to anaesthesia or medication. These problems are unusual, and may occur following any surgical procedure, and precautions are taken in all patients to reduce these risks to the absolute minimum.
There a very few long term problems following sleeve gastrectomy that have been reported to date. One uncommon problem that may occur is that the gastric sleeve may stretch leading to late weight regain. This may occur if a person regularly tries to eat more than the stomach can comfortably hold. It is important that a person having the sleeve gastrectomy respects their new smaller stomach and avoids overeating. As with all weightloss procedures, there is a need to complement the surgery with changes in eating behaviours, lifestyle, and exercise levels.
The chances of the sleeve stretching are greatly reduced when a patient works with their sleeve as a tool, maintains regular contact with their surgeon, and makes a genuine attempt to improve diet and lifestyle. However, in the event of a significant increase in the stomach capacity over time, there are a number of rescue procedures that have been proposed to make the stomach smaller again.
WHAT IS THE AFTERCARE FOLLOWING A SLEEVE GASTRECTOMY?
It does not require the same degree of follow up as with the GASTRIC BAND, and it does not require any adjustments once it has been created. Therefore it is a good option for people living in remote areas because it is a “set and forget” operation which requires little post op follow up. Dr Hatzifotis usually sees his patients 3 weeks after discharge from hospital, then every three months for the first year following surgery. After this, patients are then reviewed yearly. Patients who live outside of Brisbane can have theie follow up consultations performed over the telephone. Patients usually have a blood test performed 6-12 months after their surgery, and then yearly after this to monitor for any abnormalities or deficiencies of any vitamins or minerals. It is recommended that all patients take a daily multivitamin following Sleeve Gastrectomy surgery in order to reduce the chance of any vitamin or mineral deficiency.
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