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Sleeve Gastrectomy

The laparoscopic sleeve gastrectomy is a bariatric procedure in which the surgeon removes approximately 85% of the stomach, shaping the remaining stomach into a tube or “sleeve”.

It can be used as a first stage operation prior to a gastric bypass or as a definite procedure. The new, smaller stomach is about the size of a banana. It limits the amount of food you can eat by making you feel full after eating small amounts of food.

Hospital Stay: Hospital Stay: 3 days
Duration: Duration: 1.5 hrs
Cost Estimate: Cost Estimate: 5600 USD - 10800 USD These are indicative prices in Indian Hospitals

Weight-loss surgery may be an option if you are very obese and have not been able to lose weight through diet and exercise.

Vertical sleeve gastrectomy is not a quick fix for obesity. It will greatly change your lifestyle. You must eat healthy foods, control portion sizes of what you eat, and exercise after this surgery. If you do not follow these measures, you may have complications from the surgery and poor weight loss.

This procedure may be recommended if you have:

  • A body mass index (BMI) of 40 or more. Someone with a BMI of 40 or more is at least 100 pounds over their recommended weight. A normal BMI is between 18.5 and 25.
  • A BMI of 35 or more and a serious medical condition that might improve with weight loss. Some of these conditions are sleep apnea, type 2 diabetes, and heart disease.

Vertical sleeve gastrectomy has most often been done on patients who are too heavy to safely have other types of weight-loss surgery. Some patients may eventually need a second weight-loss surgery.

This procedure cannot be reversed once it has been done.

The surgery is usually done using a tiny camera that is placed in your belly. This type of surgery is called laparoscopy. The camera is called a laparoscope. It allows your surgeon to see inside your belly.

In this surgery:

  • Your surgeon will make 2 to 5 small cuts in your abdomen.
  • The surgeon will pass the laparoscope and the instruments needed to perform the surgery through these openings.
  • The camera is connected to a video monitor in the operating room. Your surgeon will look at the monitor to see inside your belly.
  • Your surgeon will insert thin surgical instruments through the other openings.

Your surgeon will remove most of your stomach.

  • The remaining portions of your stomach are joined together using surgical staples. This creates a long vertical tube or banana-shaped stomach.
  • The surgery does not involve cutting or changing the sphincter muscles that allow food to enter or leave the stomach
  • The surgery may take only 60 to 90 minutes if your surgeon has done many of these procedures.

When you eat after having this surgery, the small pouch will fill quickly. You will feel full after eating a very small amount of food.

Weight-loss surgery may increase your risk of gallstones. Your doctor may recommend having a cholecystectomy (surgery to remove the gallbladder) before your surgery or at the same time.

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.

Advantages
  • For those who do not wish to have a gastric bypass
  • No foreign objects are implanted, as with the Lap Band.
  • Better weight loss than the Lap Band.
  • For those that need nonsteroidal anti-inflammatories (NSAID’s) this surgery is preferred over the gastric bypass, as there is a lower risk of an ulcer.
  • Decreased appetite
  • Prolonged sense of fullness after small meals
  • Decreases cravings for sweets
  • Laparoscopic procedure is minimally invasive
Disadvantages
  • This is the only truly non-reversible bariatric surgery, as a portion of the stomach is actually removed from your body. (The gastric bypass is technically reversible, although reversing it, comes with many risks.)
  • Weight loss may not be as good as a gastric bypass.
  • Long term data does not exist with the Sleeve, as it does with other bariatric surgeries.
  • There is a slightly higher risk of a leak following a Sleeve gastrectomy than with a gastric bypass.
  • Requires patient to follow recommendations for diet, vitamin intake, and clinical follow-up to avoid nutritional deficiencies.

A sleeve gastrectomy is a life changing operation. It is used to help people who are severely obese (BMI 40+ or BMI 35+ with other health conditions) to lose weight and improve their health. Losing weight should help to lower the risk of developing medical problems associated with obesity (e.g. high blood pressure, diabetes, arthritis, breathing problems and asthma).
The sleeve gastrectomy makes your stomach smaller and should change the amount you can eat at your meals, which will help you to lose weight. It is not a reversible procedure. Usually people considering a sleeve gastrectomy will have already tried many non-surgical options available to help them to lose weight

The surgery is usually done laparoscopically, commonly known as keyhole surgery. This means that you will be up and about soon after surgery and should make a speedy recovery. Although you will have some pain after surgery this is usually easily controlled by taking pain killers regularly.
The operation involves removing approximately 75 per cent of your stomach, leaving behind a narrow tube (sleeve) which becomes your new stomach. After the surgery food will follow the normal route into the smaller stomach and then on into the small intestine.
The operation also alters some of the hormone signals from the stomach and intestine to parts of the brain that control body weight.
Following this operation, many patients report that they feel less like eating and feel fuller sooner and for longer after a meal. As the size of your stomach has been reduced, the size of your meals will need to be reduced to be appropriate for your new small stomach. Your reduced portion size combined with low fat, low sugar choices will help you to lose weight. A sleeve gastrectomy is permanent and is not a reversible procedure. You may need to take vitamin supplements after the operation.

During the laparoscopic gastric sleeve the nerves of the stomach and the outlet valve (pylorus) are not altered, preserving the function of the stomach. Other advantages:

  • The rest of the gastrointestinal tract anatomy is not altered, so the food ingested follows the normal course. This results in less chance of developing lack of vitamins and minerals and eliminates dumping syndrome.
  • The procedure decreases significantly the hunger by removing the part of the stomach that produces the main stimulating hormones.
  • Minimize the chance of developing ulcers.
  • Fewer office visits that the Lap Band, since there is no need for band size adjustments.

In the laparoscopic sleeve gastrectomy the stomach is divided along its vertical length in order to create a slender pouch. The excess stomach is removed. The purpose is to limit the amount of food ingested at any give time (restrictive operation), without altering the normal absorption of the vitamins and minerals.

The procedure is particularly indicated for patients who are at high medical risk for bypass procedures, have very high BMI, or complex surgical history. Patients interested in the gastric banding procedure may also want to consider the sleeve gastrectomy to avoid the potential risks of a foreign body.

You can expect to lose between 50 and 70 per cent of your excess weight in the first 12 to 18 months following surgery. The amount of weight you are able to lose and keep off after surgery will depend also on the lifestyle changes that you make, such as increasing the amount of exercise you take and eating a healthy diet. It is important to remember that the operation will not stop from you from craving certain foods or eating what you fancy.

As with all major surgery, sleeve gastrectomy has some risks. These risks vary according to your age and any other illnesses you may have.

Complications that can occur soon after surgery:

  • Wound infection: This can be treated with a course of antibiotics.
  • Bleeding: You will be monitored carefully for signs of bleeding; a few patients will need a blood transfusion. Usually this will not be a problem but in the worst case scenario the surgeon will take you back to theatre and stop the bleeding (may involve an ‘open’ operation where the stomach has to be opened up with an incision).
  • Embolism

Long term problems are uncommon but can include:

  • Hernias of the abdominal wall.
  • Narrowing of the new stomach which can cause problems with eating and drinking. This will usually settle on its own although sometimes it will need to be stretched under a local anaesthetic.
  • Hair loss or thinning in the first six months; this will re-grow.

It is important for you to know that the procedure recommended is based on your specific medical history and dietary history.
Other options we offer include:

  • Gastric Band.
  • Gastric Bypass.
  • Intensive Weight Control Programme (non-surgical pathway).

Please feel free to discuss your options with your surgeon

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.

You should discuss all of the available surgical procedures with your surgeon and determine which procedure is best for you.

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