Weight Loss Procedures
Laparoscopic Sleeve Gastrectomy
Sleeve Gastrectomy in female BMI 42 by Dr Craig Taylor OClinic
WHAT IS THE SLEEVE GASTRECTOMY?
The SLEEVE GASTRECTOMY, also known as the Gastric Sleeve, or Vertical Sleeve Gastrectomy(VSG) has been performed in Australia over the last 10 years, and has now become the most commonly performed Weight Loss procedure in Australia, the USA, and around the world. Currently in Queensland, approximately 80% of patients undergoing primary weight loss surgery are having Laparoscopic Sleeve Gastrectomy performed.
Sleeve Gastrectomy was originally designed as the first component of the more complicated and radical weight loss procedure called the DUODENAL SWITCH.
A SLEEVE GASTRECTOMY involves permanently removing the lateral 2/3 of the stomach with a stapling device. This reduces the size of the stomach from the size of a football to the size of banana. Another way of explaining the procedure is that it basically leaves a narrow stomach tube instead of a stomach sack. The holding capacity of the stomach is reduced from about 1.5 litres of food and liquid down to about 200mls.
The normal direction of food from the mouth into the stomach and then into the intestinal tract is not altered. There is no malabsorption to nutrients as there is with the GASTRIC BYPASS procedure. Despite being smaller, the stomach sleeve still functions like a normal stomach. Food and nutrients continue to enter and leave in the same way, acid continues to be made to assist in digestion, and essential vitamins and minerals such as B12, calcium, folate and iron can be absorbed in the normal way.
As a result of this much smaller stomach, patients feel full after eating much less food. Patients also feel less hungry between meals. Patients who have had a SLEEVE GASTRECTOMY eat approximately 1/4 of what they used to eat.
The one major advantage of the Sleeve Gastrectomy procedure over other weight loss procedures is that patients can eat a wider variety of foods. Most patients who have undergone Sleeve Gastrectomy surgery can eat all the foods they used to eat prior to their surgery, but in much smaller quantities, and feel full after this much smaller quantity of food for several hours.
The GASTRIC SLEEVE procedure is performed laparoscopically (keyhole surgery). However, unlike the GASTRIC BAND it is not reversible.
WHAT ARE THE ADVANTAGES OF THE SLEEVE GASTRECTOMY?
Unlike the GASTRIC BAND procedure which requires adjustments every 4-6 weeks following surgery (until the perfect degree of restriction is reached - on average this means 4-5 adjustments), there are no adjustments required following SLEEVE GASTRECTOMY.
Because there is no prosthetic device involved with the SLEEVE GASTRECTOMY, the long term risks associated with this procedure are fewer than following GASTRIC BANDING.
Patients enjoy a fuller variety of foods than they may do following GASTRIC BANDING.
Patients will lose on average 70% of their excess weight following SLEEVE GASTRECTOMY. This weight loss tends to occur in the first 9-12 months following surgery.
The procedure is performed laparoscopically through 5 small incision, so patients have less pain, fewer respiratory complications post operatively, and recover quickly.
It can be performed safely, with an overall complication rate of approximately 1% for primary procedures.
For LAPAROSCOPIC SLEEVE GASTRECTOMY the Selection Criteria are as follows:
- Age between 18 and 65. Under special circumstances, it may be occassionally performed on patients over 65 years of age.
- BMI of 40, or
- BMI greater than 35 with at least with 1 major obesity related disease eg. Diabetes, Hypertension, Sleep Apnoea , Fatty liver disease (under special circumstances it may be performed on certain patients with Type 2 Diabetes with a BMI 30-35).
- Acceptable operative risk - Dr Hatzifotis will determine this at your initial consulatation
- Reasonable attempts at other weight loss techniques in the past - such as diet, medications and exercise
- A capacity to understand the risks and commitment associated with the surgery
- Dedicated to life-style change and follow up
HOW MUCH WEIGHT WILL I LOSE WITH A SLEEVE GASTRECTOMY?
The amount of weight reduction is in the region of 70% of excess weight. This usually occurs over the first 9-12 months after Sleeve Gastrectomy. Patients can often lose most of their excess weight following Sleeve Gastrectomy surgery if they also adopt healthy eating habits and regular physical activity following their surgery. Certainly patients who adopt healthy eating behaviour with regular physical activity following surgery will usually lose more weight than patients who are less active and have unhealthy eating behaviours and unhealthy diets.
For example, if you have a height of 163cm and weigh 133kg, your BMI is 50.1, and your excess weight is 67kg - therefore, in this particular case following sleeve gastrectomy, you would be expected to lose 47kg on average. Some patients will lose more than this, and some patients will lose less than this weight.
HOW DOES IT WORK?
The Sleeve Gastrectomy appears to work in three distinct ways:
1. The major reduction in stomach capacity allows patients to become full and satisfied with a much smaller meal, providing portion control.
2. Levels of the hunger hormone Ghrelin are reduced by 50-65%, as the removed part of the stomach is rich in cells that make that hormone. Patients consistently report feeling less hungry between their meals as a result of this.
3. There appears to be a change in the way that fatty foods are handled by the digestive track- patients frequently report losing their taste for foods high in fat and sugar such as fried food, chocolate and soft drink, which seem to make them feel more bloated, unsettled, or queezy. Dietitians like this aspect of the Sleeve as it helps patients adopt healthier eating habits.
WHAT ARE THE RISKS OF THE SLEEVE GASTRECTOMY?
Because the stomach itself has to be divided and stapled, and the new smaller stomach is held together with 3 rows of staples, the new stomach is fragile in the first 4-6 weeks while it is healing.
One uncommon problem is that gastric fluid may leak through the staple line. This may occurs within the first few days after surgery, but may occur within 4-5 weeks following the procedure. This causes a serious infection around the outside of the Gastric Sleeve, and may requires urgent surgery to remove the infection and control the leak. Recovery may take several weeks following this complication. The risk of this complication in Dr Hatzifotis's patients in less than 1%. The risk of developing this complication is primarily dependant on the surgeon's technique and precision in performing this procedure. It is also dependant on the ability of the patient to adhere to their specific post operative diet and post operative instructions in the first 4-6 weeks.
A leak is suspected if a patient develops fevers or abdominal pain in the early post operative period. Early treatment is the key to managing this problem successfully, so it is important to be on the watch for these symptoms and return back to the hospital without delay if concerns exist.
If you live outside Brisbane, Dr Hatzifotis will ask that you stay in Brisbane for a total of 2 weeks from the date of your surgery before returning home. This allows us to be able to help you quickly in the event of a staple line leak.
Other complications that can occur include internal injuries to nearby organs such as the spleen, bleeding, blood clots in the leg veins, lungs or abdomen, infections in the abdomen, chest or wounds, and allergic reactions to anaesthesia or medication. These problems are unusual, and may occur following any surgical procedure, and precautions are taken in all patients to reduce these risks to the absolute minimum.
There a very few long term problems following sleeve gastrectomy that have been reported to date. One uncommon problem that may occur is that the gastric sleeve may stretch leading to late weight regain. This may occur if a person regularly tries to eat more than the stomach can comfortably hold. It is important that a person having the sleeve gastrectomy respects their new smaller stomach and avoids overeating. As with all weightloss procedures, there is a need to complement the surgery with changes in eating behaviours, lifestyle, and exercise levels.
The chances of the sleeve stretching are greatly reduced when a patient works with their sleeve as a tool, maintains regular contact with their surgeon, and makes a genuine attempt to improve diet and lifestyle. However, in the event of a significant increase in the stomach capacity over time, there are a number of rescue procedures, such as a GASTRIC BYPASS that may be performed to help patients with ongoing weight loss.
Gastro-oesophageal reflux may occur in 5-10% of patients following sleeve gastrectomy. The symptoms of this may only last a few months after surgery, but less commonly can continue long term. Medications such as Nexium or Somac, are easily available and may be prescribed to alleviate the symptoms or gastro-oesophageal reflux if it exists. The reasons for developing gastro-oesophageal reflux following sleeve gastrectomy surgery are varied, but measures can be taken during your surgery to reduce the incidence of developing this post operatively. Some patients infact, find that their gastro-oesophageal reflux improves after sleeve gastrectomy surgery.
Finally, the incidence of developing any vitamin or mineral deficiencies after sleeve gastrectomy surgery is low. It is less common than after gastric bypass or mini-gastric bypass surgery. Dr Hatzifotis recommends all patient take a daily multivitamin and calcium supplement following surgery to reduce the chance of this problem occurring. Your vitamin and mineral levels will be checked before surgery and 6months, 12months, and annually following surgery to detect these problems should they exist.
WHAT IS THE AFTERCARE FOLLOWING A SLEEVE GASTRECTOMY?
Sleeve gastrectomy does not require the same degree of follow up as with the GASTRIC BAND, and it does not require any adjustments once it has been created. Therefore it is a good option for people living in remote areas because it is a "set and forget" operation.
Dr Hatzifotis usually sees his patients 3 weeks after discharge from hospital, then every three months for the first year following surgery. After this, patients are then reviewed yearly. Patients who live outside of Brisbane can have their follow up consultations performed over the telephone.
Patients usually have a blood test performed 6 and 12 months after their surgery, and then yearly after this to monitor for any abnormalities or deficiencies of any vitamins or minerals. It is recommended that all patients take a daily multivitamin and calcium supplement following Sleeve Gastrectomy surgery in order to reduce the chance of any vitamin or mineral deficiencies.