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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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