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Laparoscopic Sleeve Gastrectomy

OVERVIEW

This procedure involves surgery on the stomach only and does not involve the intestine. In this procedure, the stomach is reduced permanently to about 20% of its original size, by surgical removal of a large portion of the stomach along the greater curvature. The result is a sleeve or banana like structure. The newer smaller stomach restricts food intake by allowing only a small amount of food to be consumed in a single sitting. It provides quicker satiety (sense of fullness) and decreased appetite because of removal of fundus that produces hunger hormone Ghrelin.

Why it's done

Sleeve gastrectomy is done to help you lose excess weight and reduce your risk of potentially life-threatening weight-related health problems, including:

  • YGastroesophageal reflux disease
  • Heart disease
  • High blood pressure
  • High cholestero
  • Obstructive sleep apnea
  • Type 2 diabetes
  • Stroke
  • Infertility
  • Sleeve gastrectomy is typically done only after you've tried to lose weight by improving your diet and exercise habits.

    In general, sleeve gastrectomy surgery could be an option for you if:


  • Your body mass index (BMI) is 40 or higher (extreme obesity).
  • Your BMI is 35 to 39.9 (obesity), and you have a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea. In some cases, you may qualify for certain types of weight-loss surgery if your BMI is 30 to 34 and you have serious weight-related health problems.

You must also be willing to make permanent changes to lead a healthier lifestyle. You may be required to participate in long-term follow-up plans that include monitoring your nutrition, your lifestyle and behavior, and your medical conditions.

Check with your health insurance plan or your regional Medicare or Medicaid office to find out if your policy covers weight-loss surgery.

Risks

As with any major surgery, sleeve gastrectomy poses potential health risks, both in the short term and long term.

Laparoscopic Sleeve Gastrectomy Disadvantages and Risks

One of the most important features about recovery and efficacy of laparoscopic sleeve gastrectomy is postoperative follow-up. In order to accomplish successful weight loss, adopting a healthy diet and partaking in exercise as well as following the physician’s indications is critically important. Laparoscopic sleeve gastrectomy has a lower risk of complications than a gastric bypass, but higher than a laparoscopic adjustable band.

Main complications that can occur during the procedure include bleeding, infection, injuries to the other organs, or the surgery may need to convert the procedure to an open procedure. In addition, following the surgery, there is also the risk of leak from the staple line, which is a problem that tends to occur in less than one percent of the cases.


Risks associated with the sleeve gastrectomy can include:


  • Excessive bleeding
  • Infection
  • Adverse reactions to anesthesia.
  • Blood clots
  • Lung or breathing problems
  • Leaks from the cut edge of the stomach
  • Longer term risks and complications of sleeve gastrectomy surgery can include:


  • Gastrointestinal obstruction
  • Hernias
  • Gastroesophageal reflux.
  • Low blood sugar (hypoglycemia).
  • Malnutrition
  • Vomiting

Very rarely, complications of sleeve gastrectomy can be fatal.

How you prepare:


If you qualify for sleeve gastrectomy, your health care team gives you instructions on how to prepare for surgery. You may need to have various lab tests and exams before surgery.


Food and medications

Before your surgery, give your doctor a list of all medicines, vitamins, minerals, and herbal or dietary supplements you take. You may have restrictions on eating and drinking and which medications you can take.

If you take blood-thinning medications, talk with your doctor before your surgery. Because these medications affect clotting and bleeding, your blood-thinning medication routine may need to be changed.

If you have diabetes, talk with the doctor who manages your insulin or other diabetes medications for specific instructions on taking or adjusting them after surgery.

Other precautions:


You'll be required to start a physical activity program.

You'll be required to stop any tobacco use 12 weeks before surgery and may be tested for nicotine prior to your surgery.

You may also need to prepare by planning ahead for your recovery after surgery. For instance, arrange for help at home if you think you'll need it. People who have a sleeve gastrectomy are typically off work for four weeks.

What you can expect:


You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.

Before the procedure


Before you go to the operating room, you will change into a gown and will be asked several questions by both doctors and nurses. In the operating room, you are given a general anesthetic before your surgery begins. The anesthetic is medicine that keeps you asleep and comfortable during surgery.

During the procedure


The specifics of your surgery depend on your individual situation and the hospital's or doctor's practices. Some sleeve gastrectomies are done with traditional large (open) incisions in the abdomen. But sleeve gastrectomy is typically performed laparoscopically, which involves inserting small instruments through multiple small incisions in the upper abdomen.

The surgeon then creates a narrow sleeve by stapling the stomach vertically and removing the larger, curved part of the stomach.Surgery usually takes one to two hours. After surgery, you awaken in a recovery room, where medical staff monitors you for any complications.

After the Procedure

After sleeve gastrectomy, your diet begins with sugar-free, noncarbonated liquids for the first seven days, then progresses to pureed foods for three weeks, and finally to regular foods approximately four weeks after your surgery. You will be required to take a multivitamin twice a day, a calcium supplement once a day, and a vitamin B-12 injection once a month for life.

You'll have frequent medical checkups to monitor your health in the first several months after weight-loss surgery. You may need laboratory testing, bloodwork and various exams.

You may experience changes as your body reacts to the rapid weight loss in the first three to six months after sleeve gastrectomy, including:

  • Body aches
  • Feeling tired, as if you have the flu
  • Feeling cold
  • Dry skin
  • Hair thinning and hair loss
  • Mood changes

Results

Sleeve gastrectomy can provide long-term weight loss. The amount of weight you lose depends on your change in lifestyle habits. It is possible to lose approximately 60 percent, or even more, of your excess weight within two years.

In addition to weight loss, sleeve gastrectomy may improve or resolve conditions related to being overweight, including:

  • Heart disease
  • High blood pressure
  • High cholesterol
  • Obstructive sleep apnea
  • Type 2 diabetes
  • Stroke
  • Infertility

Sleeve gastrectomy surgery can also improve your ability to perform routine daily activities, and can help improve your quality of life.