Laparoscopic Sleeve Gastrectomy
Sleeve Gastrectomy (SG) is offered to low BMI and low risk patients as an alternative to laparoscopic banding of the stomach. It generates weight loss by restricting the amount of food (and therefore calories) that can be eaten by removing 85% or more of the stomach without bypassing the intestines or causing any gastrointestinal malabsorption.
Gastric Tubing Surgery
It is a purely restrictive operation. It is currently indicated as an alternative to the Laparoscopic gastric banding procedure for low weight individuals and as a safe option for higher weight individuals.
This procedure generates weight loss solely through gastric restriction (reduced stomach volume). The stomach is restricted by stapling and dividing it vertically and removing more than 85% of the stomach. This part of the procedure is not reversible.
The stomach that remains is shaped like a very slim banana and measures about 3 ounces (100cc).The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the functions of the stomach while drastically reducing the volume.
By comparison, in a Roux-en-Y gastric bypass, the stomach is divided, not removed, and the pylorus (outlet valve) is excluded. The Roux-en-Y gastric bypass stomach can be reconnected (reversed) if necessary. Note that there is no intestinal bypass with this procedure, only stomach reduction. The lack of an intestinal bypass avoids potentially costly, long term complications such as marginal ulcers, vitamin deficiencies and intestinal obstructions.
Rather than creating a pouch with a silastic gastric band, the SG removes the majority of the stomach. The portion of the stomach which isremoved is responsible for secreting Ghrelin, which is a hormone that is responsible for appetite and hunger. By removing this portion of the stomach, the level of Ghrelin is reduced to near zero, causing loss of or a reduction in appetite. Currently, it is not known if Ghrelin levels increase again after one to two years. Patients do report that some hunger and cravings do slowly return. An excellent study by Dr. Himpens in Belgium demonstrated that the cravings in SG patient 3 years after surgery are much less than the gastric band patients and this probably accounts for the superior weight loss.
The removed section of the stomach is the portion that “stretches” the most. The long vertical tube shaped stomach that remains is the portion least likely to expand over time and it creates significant resistance to volumes of food. The smaller the diameter and the longer the channel the greater the resistance, so not only is the appetite is reduced but very small amounts of food generate early and lasting satiety (fullness).
This procedure does not involve the insertion of silastic band around the stomach and hence the problems associated with infection, erosion are eliminated.
The sleeve gastrectomy is a reasonable alternative to a Roux en Y Gastric Bypass for a number of reasons:
- Because there is no intestinal bypass, the risk of malabsorptive complications such as vitamin deficiency and protein deficiency is minimal.
- There is no risk of marginal ulcer which occurs in over 2% of Roux en Y Gastric Bypass patients.
- The pylorus is preserved so dumping syndrome does not occur or is minimal.
- There is no intestinal obstruction since there is no intestinal bypass.
- It is relatively easy to modify to an alternative procedure should weight loss be inadequate or weight regain occur.
The limited two year and 6 year weight loss data available to date is superior to current Banding and comparable to Gastric Bypass weight loss data (see Lee, Jossart, Cirangle Surgical Endoscopy 2007).
Laparoscopic sleeve gastrectomy
Includes the following services:
- Up to 5 day stay at the hospital where surgery is performed
- Life Long follow up care
- Preoperative evaluations
- Operating room costs
- Anaesthetist’s fees
- Physician’s review
- Surgeon’s fees