LAPAROSCOPIC SLEEVE GASTRECTOMY

With the Surgical Obesity Service, the sleeve gastrectomy procedure is usually performed laparoscopically (i.e. keyhole surgery with a telescope); however in some cases it may be necessary to perform an open procedure. This restrictive operation to achieve weight-loss has become popular as a way to safely reduce the weight of superobese patients down to a point where it is safer to do a definitive bypass operation. There is a small series reporting significant weight re-gain after 5 years if patients didn't proceed on to the next operation, but in other series, the sleeve seems to be all that is needed. Longer followup is needed to clearly define the place of sleeve gastrectomy amongst obesity operations.

In this operation, the stomach is completely divided with a stapler along the right hand side, leaving a long thin tube down to a normal piece of stomach. The remaining stomach is removed through a 15 mm cut. This reduces the size of the stomach down to 20% of its normal size.

The small stomach creates a sense of fullness early so that only a small amount of food can be taken in at any sitting.

When performed laparoscopically, most patients stay in hospital 3 nights and are back at work in two weeks.

Advantages:

• Technically easy to perform.
• There are no joins to leak.
• Because the duodenum is not bypassed, there is no need for iron supplementation long term. For patients who are well motivated, this may be all the operation that is needed to achieve weight-loss.

Disadvantages

• No long term large series have been reported so long term results are uncertain
• Some patients may still need a further operation if weight loss is insufficient
• May not produce the instant cure of diabetes that occurs with the bypass
• Costs just as much as a bypass

Risks:

The risks are similar to the bypass:

• Leakage from staple lines
• Pulmonary embolus (blood clots from the legs to the lungs)
• Bleeding
• Late formation of gallstones

However, the risk of internal hernia and leakage from a join are absent.

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