What is laparoscopic sleeve gastrectomy?
Laparoscopic sleeve gastrectomy is a restrictive procedure that is performed via 5 small key-hole incisions on your upper abdomen. During the procedure 70-80% of the stomach is removed leaving a new small tube-shaped stomach that has the capacity of approximately half a cup or 125mls. Sleeve gastrectomy works by creating a restriction on portion size, this is opposed to gastric bypass surgery that also incorporates a malabsorptive component to weight loss. After sleeve gastrectomy a balanced diet is consumed only in much smaller quantities. If this strict portion control was attempted without surgery hunger would sabotage long-term success. Sleeve gastrectomy works by removing the Ghrelin producing cells of the stomach which greatly reduces appetite and allows satiety to be quickly achieved.
How is sleeve gastrectomy performed?
Is sleeve gastrectomy safe?
Sleeve gastrectomy was first performed in America in the late 1980’s to reduce weight in patients going for gastric bypass who were to obese for the operation to be completed safely. It has since gained widespread popularity due to its safety profile and reliable outcomes. Sleeve gastrectomy has a lower risk of bleeding, leak and subsequent re-operation compared to gastric bypass. It is also safer from a nutritional point of view as bypass causes malabsorption of nutrients with deficiencies in Calcium, Iron and Vitamin B12 commonly seen.
The safest approach is to have your operation performed by a specialist bariatric surgeon who is contributing to our national peer reviewed data registry. A detailed explanation of the risks of surgery should be outlined in your initial appointments including strategies to prevent and treat known complications. Post-operative care is paramount with support from dieticians, physiotherapists and psychologists leading to improved long-term success, many surgeons now offer these services as in-house after care packages.
How effective Is sleeve gastrectomy?
Many long-term studies show an excess weight loss of around 60% at 5 years after sleeve surgery (excess weight is how many kilograms you are over your ideal body weight, ie if you had BMI 25). Patients also see improvement in diabetes, hypertension, dyslipidemia, obstructive sleep apnea and degenerative joint disease1. Life after sleeve gastrectomy includes the benefits of moving more freely, improved sleep, improved mood and increased energy.
As sleeve surgery has been shown to reverse diabetes a plan should be established with your surgeon, GP and endocrinologist to reduce medication as your weight decreases. Bariatric surgery improves fertility with high rates of reversal of polycystic ovarian syndrome (PCOS). A safer pregnancy is experienced with a reduced risk of pre-eclampsia, gestational diabetes, induced labour, post-partum haemorrhage, c-section and epidural complications. Guidelines recommend that you should not fall pregnant within 12 months after surgery as premature birth and low-birth weights have been reported.
What to expect after sleeve gastrectomy
The first two weeks after surgery involve a liquid diet while the long wound in the stomach heals and swelling subsides. In weeks 3 and 4 a soft diet is consumed, these food stages allow comfortable progression back to solids at one month post-op. Shoulder tip gas pain is common after laparoscopic surgery and will subside within 48 hours, key-hole wounds should not be painful when managed with simple analgesia such as paracetamol. Nausea can be an issue in the days after surgery and you will be provided with a script for anti-emetics to allow adequate hydration.
For those with desk jobs recovery time is usually 2 weeks before returning to work while those with physical jobs may need 3-4 weeks off. Exercise is built up gradually with short walks in week 3 after surgery, week 5 is the earliest for a cardio workout as you need to ensure you can consume enough calories, week 6 is the earliest for resistance training in order to avoid a hernia.
Surgery is not an ‘easy way out’ of obesity but many patients who have achieved success will confirm that the process is entirely worth it, please contact us if you would like to speak with one of our patients or staff.