What is Laparoscopic Sleeve Gastrectomy Surgery?
Laparoscopic Sleeve Gastrectomy, otherwise known as Gastric Sleeve is a relatively new entrant into the field of bariatric surgeries. It is a simpler operation than gastric bypass or duodenal switch, and does not rely on implants, adjustments or fills. It requires removal of the left side of the stomach but does not involve any rearrangement of intestines. The remaining stomach is sealed with staples.
This procedure can successfully be used on its own but is also used as the first stage of bariatric surgery for super - obesity, where the body mass index is so high that more radical surgeries would be too risky. It can be followed by either duodenal switch or gastric bypass to achieve the weight loss advantages of restricting food absorption.
In patients who undergo Laparoscopic Sleeve Gastrectomy 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).
In other cases, 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.
THE PROCEDURE
The Laparoscopic Sleeve Gastrectomy procedure is performed through 5 small incisions. The outer margin of the stomach is removed to restrict food intake, leaving a “sleeve” of stomach, roughly the size and shape of a banana. The pylorus also remains intact- the muscle that controls emptying of food from the stomach into the intestine.
During the Laparoscopic Sleeve Gastrectomy (LSG), about 75% of the stomach is removed however; no intestines are removed or bypassed during the procedure.
Surgery takes between 45 minutes to an hour to complete. Our surgeon will perform a "leak test" in the operating room before he completes the operation.
Having the Laparoscopic Sleeve Gastrectomy usually involves just an overnight stay in the hospital and there is normally no need for a drain or nasogastric tube.
Laparoscopic Sleeve Gastrectomy Advantages
The reduction of the size of the stomach, to about 60 cc in volume results in a powerful restrictive weight loss. As a result, patients feel full after a very small amount of food, and therefore lose weight because they eat less, and they are happy eating less. 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 illnesses 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.
This operation is the only bariatric procedure that has no malabsorption (as the RNY and DS do) and no foreign body issues (as the Lap Band does). There is a very low risk at the time of surgery, relative to the RNY and the DS, and an extremely low risk of needing another operation in the future.
There are also significant effects on the hunger mechanisms that make the weight loss seen with the Sleeve Gastrectomy even better than would be seen just with a small stomach pouch. Hunger is favorably affected because there is a reduced capacity to produce Ghrelin, a substance that plays a role in how you feel and relieve hunger.
Also very important is the fact that it preserves the pylorus, the valve that regulates emptying of the stomach. This acts as "nature’s band" and allows food to hold up in the stomach for a while, making the person feel full while the food trickles out. Coupled with the fact that there is no rearrangement of the bowel, it also means dumping and marginal ulcers are not a problem. The normal satiety mechanism is therefore enhanced.
PREPARATION FOR SURGERY
Before traveling to Cyprus, as part of your Gastric Band surgery preparation you will complete a detailed bariatric specific questionnaire, which will allow our doctors to determine your eligibility for Gastric Band surgery. If you are not ready to make lifestyle changes, you will not be considered eligible for the procedure.
To help you adjust to your new lifestyle, we advise you to empty your home of all edible “temptations”, creating a suitable environment for your return, post operatively.
Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.
After hospital admission, you will receive psychological advice. This will help you adhere to a healthier lifestyle. Without changing your lifestyle, the surgery will not be a success. You will also receive nutritional counseling before (and after) your surgery, by our specialists.
RECOVERY AFTER SURGERY
Following surgery, most patients make a full recovery within one month. You are able to return to work, resume some lifting and less strenuous activity, in most cases, in about two weeks post operatively.
Laparoscopic 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. After eating a small amount of food, you will feel full very quickly and continue to feel full for several hours. Laparoscopic Sleeve Gastrectomy may also cause a decrease in appetite.
Daily light exercise such as walking should begin about one month after surgery.
LIFE AFTER SURGERY
Following your recovery diet you will slowly begin to introduce new foods in increasing quantities until about 6 months after surgery when your new bariatric diet will be in full swing. All weight loss surgery procedures require a complete change in diet for your procedure to continue to be effective and Laparoscopic Sleeve Gastrectomy is no different.
Assuming you follow the diet and exercise guidelines of our surgical team, all indications are that weight loss and health improvement following Sleeve Gastrectomy surgery may be permanent. However, some patients are likely to experience weight regain as a result of your stomach stretching over time.
Post-Surgery Nutrition
After surgery, you will need a new nutrition plan. Our surgeon and/or dietitian can help you learn about and get used to the changes in lifestyle and eating habits you need to make. It is very important to follow the eating and drinking instructions beginning immediately after the operation.
In the first few weeks after your surgery, you will be on a liquid diet since only thin liquids will be tolerated by your stomach at that time. As you heal, you will gradually progress to pureed foods (three to four weeks post-op) and then soft foods (five weeks post-op). Finally, you will be able to eat solid foods.
When you are at the stage to eat solid foods without problems, you will need to pay close attention to your diet.
You will also need to learn to eat slowly and chew your food very thoroughly.
It is recommended that you eat only three small meals a day and make sure that these meals contain adequate nutrients. Foods that have a concentrated supply of calories with little nutritional value, such as milkshakes, syrups, jam, and pastries, should be avoided as much as possible.
Exercise Plan
Exercise is very important and incorporating regular physical activity into your daily routine is as important as following your nutrition plan.
Often Weight Loss Surgery patients have been inactive due to decreased activity tolerance, psychological constraints and in some cases, physical disabilities. After Laparoscopic Sleeve Gastrectomy aerobic activities, particularly walking and swimming are generally best tolerated. Your surgeon will advise you on which activity is right for you.