What is Sleeve Gastrectomy?
The concept of weight loss through sleeve gastrectomy was first described by Marceau in 1993, as a component of biliopancreatic diversion. Over the time, the method underwent various changes, and now it is been widely used as an effective treatment to lose weight. The Laparoscopic Sleeve Gastrectomy is a relatively new operation, in which the outer margin of the stomach is removed to limit food intake and leaving behind just a sleeve of stomach, roughly the size of a banana. After this operation, the size of the stomach is reduced and a person can feel fuller after intaking lesser calories and eating less. The operation also involves removing the portion of the stomach, which releases a hormone and make person feel hungry.
Process of Laparoscopic Sleeve Gastrectomy
To gain access to the abdominal cavity, four to five small incisions are made on the abdominal wall. Trocars are used to penetrate into the skin incisions to access abdominal cavity. Trocars, are nothing but surgical instruments that act as passageways. The stomach is then filled with carbon dioxide gas to lift the abdominal cavity and separate it from the small intestines and other organs. The surgeon takes the help of the laparoscope to view the inner abdominal cavity. The next step is to position your liver. The liver sits directly over your esophagus and portion of the stomach. Your surgeon would use retractor to put your liver off your stomach so that he can clearly get a view of the sleeve gastrectomy.
The tissues that attach stomach to the omentum is then separated to make the area under the stomach visible. The surgeon, after then continues to cut and seal the blood vessels that lie on the side of the stomach, which is also known by the name greater curvature. The pylorus of the stomach is then identified and an ultrasonic scalpel is then used to enter the stomach via omentum. The dissection of the stomach is started from the greater curvature of the stomach to make it free from the omentum and short gastric blood vessels. To transect the stomach, an endoscopic linear cutting stapler is used, which stays to the left and lateral to the endoscope. The transected stomach, is then completely made free and is removed from the peritoneum through the left flank port incision.
The transected stomach is then stapled along the length of the stomach by the bougie that creates a narrow partition. This line can also be covered with some material that reduces the risk of bleeding. The resected stomach is then placed in a specimen bag and extracted through the trocar site. The remaining portion of your stomach would be equal to the size of a banana. After Surgery Observations After you have undergone a surgery, you will be made to undergo a gastrograffin swallow study to evaluate for leaks. Some patients experience delayed passage of the contrast, which occurs due edema in the gastric remnant. However, the delayed passage of contrast resolves itself after several days of discharge. In addition to gastrografin swallow, if a patient feels the pain is under control, he is discharged after giving strict dietary instructions. Patients may require visiting a surgeon once in 3 months, 6 months and 1 year post surgery and then yearly thereafter.
Risks Associated With Laparoscopic Sleeve Gastrectomy
As with every kind of surgery, there are several risks associated, Laparoscopic Sleeve Gastrectomy is no different. Patients do carry a risk of infection, bleeding, injury to other organs, which may require open surgery. There is also a risk of leak from the staple line that divide the stomach.
Advantages of Laparoscopic Sleeve Gastrectomy
Laparoscopic Sleeve Gastrectomy has emerged out as an effective method to lose weight. Depending upon your pre-operative weight, patients can lose upto 40-70% of their weight in the first year of the surgery*. As a result, patients can expect improvement in the obesity related co-morbidities such as diabetes, hypertension, abnormal cholesterol levels, strokes, etc.
Who are Right Candidates for Laparoscopic Sleeve Gastrectomy?
All those patients who have a Body Mass Index greater than 35 and are suspected with medical problems like diabetes, high blood pressure etc are a right candidate for the surgery. If you have a BMI greater than 40, still you make a good choice for the surgery. Before you opt for such a surgery, it is important for you to statistically know all the details as you have only 2% chance of losing your weight*. The idea of the surgery is to reduce the size of the stomach to the size of a banana to restrict your food intake so that you can lose weight quickly.
If you have tried non-surgical programs, but have not seen long term success, then this is the right treatment for you. But it takes great courage to prepare yourself and your body to adopt a new lifestyle post this surgery. Even before you make up your mind, do discuss your long term expectations and health condition with your surgeon, so that he can plan out the best treatment for you.