Laparoscopic Sleeve Gastrectomy

About the Procedure

Gastric Sleeve or Laparoscopic Gastric Sleeve Surgery is performed as a weight-loss treatment for morbidly obese people by reducing the size of the stomach. This procedure can be accomplished as open surgery, although it is commonly thought of as laparoscopic. It differs from gastric bypass surgery in that it does not cut and re-attach any parts of the digestive tract. However, approximately 80% of the stomach is completely removed making it an irreversible procedure. A benefit of the gastric sleeve is that it doesn't contribute to insufficient nutrient absorption as do bypass surgeries. As a relatively new procedure, the available data on long-term weight loss or improvements in patients' health is too limited to accurately judge overall success.

A physician trained in bariatric surgery and laparoscopic techniques performs a gastric sleeve procedure in a hospital under general anesthesia. The stomach is accessed by creating several small incisions in the patient's mid-section and inserting long, thin tubes which have a video camera, a light, and surgical instruments attached at the end. While viewing the internal site on a video screen, the doctor shuts off a large section of the stomach using a stapling device along an imaginary line from the lower to upper end. The smaller section (about 20% of the original) is connected to the esophagus at the top and to the small intestines at the bottom, and has the appearance of a tube - or a sleeve. At the completion of the surgery, a drainage tube is inserted and the laparoscopic instruments are removed.

What to Know Before the Procedure

There are fewer risks with this procedure versus other weight-loss procedures because it is done laparoscopically; meaning no incisions. There is only a single line where the staples cut through the stomach, and no disconnections are created. As with any surgery done with general anesthesia, blood loss, infection, breathing problems, and pneumonia are possible. Gastric surgery adds such complications as irritation of the stomach lining and the leaking of stomach acid through the staples, which could lead to infection and the need for additional surgery. Depending on the patient's co-morbidities, additional complications or long term risks may apply.

In preparation for this surgery most physicians require smokers to quit at least a month before and encourage them to continue not smoking afterwards. Some surgeons put their gastric sleeve patients on a special diet for a week or two prior to the procedure. Pre-admission tests are usually done during the week before the operation and the doctor will inform the patient about fluid and food restrictions prior to the day of surgery.

What to Know After the Procedure

Gastric sleeve surgery takes about two hours. The hospital stay is one or two days depending on the ability to eat without pain or vomiting. The surgical area will be swollen and sore for a while and there may be small scars on the abdomen. Weight loss requires a continuing commitment to exercise and diet restrictions/requirements, especially for those patients for whom the sleeve is the first of two steps. Eating solid foods again is a process which begins with a liquid diet, followed by a diet of pureed foods, and finally, solids. As with similar surgeries, patients will see improvements in their blood pressure and cholesterol numbers, blood sugar levels, and sleep apnea.

If you Need to Travel Outside of your Local Hospital

This procedure is relatively new and there are not many surgeons who are experienced in it. If this option is selected after a discussion with a doctor who is familiar with the patient's case, then finding a surgeon to perform it will require research and interviews. Insurance companies are continually adding more gastric surgeries to their approval lists which may influence who can perform the operation. The cost of gastric sleeve surgery is near $10,000 with insurance coverage. With all of these concerns, patients may have no other option than to travel to have a gastric sleeve surgery performed.