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Laparoscopic Sleeve
Gastrectomy ...
A
New addition to Bariatric Surgery ...
Severely and morbidly obese patients seeking to
loose weight successfully and keep their weight down have little option today than
to seek a surgical weight loss solution. There is little doubt that the gastric
bypass has proven to be the most successful of surgical interventions in the area
of Bariatric surgery.
However this surgical solution is not without risks and it can be seen through statistics
that the risks to the patient increase substantially when they candidate has a BMI
of over 55.
The Laparoscopic Sleeve Gastrectomy is a solution that carries a low surgical risk
factor and enables the patient to loose up to 80% of their excess body weight.
About 80 % of the bariatric procedures performed are gastric bypass
procedures. The other 20 percent are comprised of restrictive procedures, such as
the laparoscopic adjustable gastric band. The Laparoscopic Sleeve Gastrectomy (LSG),
a relative newcomer to bariatric surgery, is growing in popularity.
The Sleeve Gastrectomy originated as the restrictive part of the duodenal switch
operation. In the last several years, though, it has been used by some surgeons
as a staging procedure prior to a gastric bypass or duodenal switch in very high
risk patients. It has also been used as a primary, stand-alone procedure by some
surgeons.
How
is Sleeve Gastrectomy Performed?
The majority of Sleeve Gastrectomies performed today are completed
laparoscopically.
During the Sleeve Gastrectomy, a portion of the stomach is removed leaving
a narrow gastric tube or “sleeve”.
No intestines are removed or bypassed during the Sleeve Gastrectomy. This
procedure takes less than an hour to complete.
This short operative time is an important advantage for patients with severe
heart or lung disease. |
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How
Does the Sleeve Gastrectomy Cause Weight-Loss?
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. Patients have significantly decreased hunger after
the operation.
Who
Should Have a Sleeve Gastrectomy?
This operation has been used successfully for many different types
of bariatric patients. This procedure is often used as part of a staged approach
for high-risk patients. Patients who have a very high body mass index (BMI) or severe
heart or lung disease may benefit from a shorter, lower risk operation such as the
Sleeve Gastrectomy as a first stage procedure. Sometimes, the decision to proceed
with the Sleeve Gastrectomy is made in the operating room due to an excessively
large liver or extensive scar tissue to the intestines that make gastric bypass
impossible.
In patients who undergo LSG as a first stage procedure, the second stage (gastric
bypass) can be performed 2 to 3 years later after significant weight-loss has occurred,
the liver has decreased in size and the risk of anaesthesia is much lower. Though
this approach involves two procedures, we believe it a safe and effective strategy
for selected high-risk patients.
How
Much Weight-loss Occurs after LSG?
The average patient will lose 40 – 50 percent of their excess
weight in the first two years after the procedure. Eventually the patient will lose
a larger proportion of their excess weight (60 – 80 percent) within three
years of the surgery.
More than 75 percent of patients will have significant improvement of major obesity-related
co-morbidities such as diabetes, hypertension, sleep apnea and hyperlipidemia following
Sleeve Gastrectomy.
What
are the Risks of Sleeve Gastrectomy?
The risk of major post-operative complications after LSG is 5 %
- 10 % on one in 20 persons. This is a significant figure because the candidates
are high risk to start with. The risks of such candidates which is associated with
gastric bypass or malabsorptive procedures such as duodenal switch would be far
higher perhaps as high as 50%. This is primarily because the small intestine is
not divided and reconnected during LSG as it is during the bypass procedures. This
lower risk and shorter operative time is the main reason we use it as a staging
procedure for high-risk patients.
Complications that can occur after LSG include a leak from the sleeve, resulting
in an infection or abscess, deep venous thrombosis or pulmonary embolism, narrowing
of the sleeve (stricture) requiring endoscopic dilation and bleeding. Major complications
requiring reoperation are uncommon after Sleeve Gastrectomy and occur in less than
3 % of patients.
Is
LSG a Good Choice for Me?
You should first know the risks and benefits of Sleeve Gastrectomy,
adjustable gastric banding and gastric bypass. For high-risk patients and patients
with very high BMI’s, we discuss LSG as a first-stage procedure prior to gastric
bypass. Ultimately, the decision regarding which procedure to perform is based on
each patient’s operative risk and their expectations and goals for surgical
weight-loss.
Sleeve
Gastrectomy may be performed for the following reasons:
- Body Mass Index is greater than 55
- Severe comorbidities (cardiac, pulmonary,
liver disease)
- Advanced age
- Inflammatory bowel disease (Crohn’s
disease)
- Need to continue specific medications (anti-inflammatory
medicines,
transplant medications)
- Need for continued surveillance of the
stomach (that couldn’t be
evaluated after a gastric bypass)
- Severely enlarged liver found during the
operation
- Severe adhesions (scarring) to the bowel
found during the operation
- Any combination of the above that significantly
increases the patient’s risk
The Sleeve Gastrectom Program..
Day 1 |
Arrival + Consultation with Dr Stefaan de Clercq + Nutritionist, Blood
tests, pres surgery tests including an enedoscipic examination of the stomach.
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Day 2 |
Surgery
+ overnight stay in hospital |
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Day 3 |
Overnight
stay in hospital |
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Day 4 |
Stay
in Hotel |
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Day 5 |
Stay
in Hotel + our nurse will visit you in your hotel |
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Day 6 |
Stay
in Hotel |
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Day 7 |
Stay
in Hotel |
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Day 8 |
Post
operative check & departure
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- Contact us to set a target date for treatment
- We will confirm the date is available
- Let us know your travel details
- We send your confirmation & invoice
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