Obesity Surgery Solutions

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Laparoscopic Vertical
Sleeve Gastrectomy

The bariatric procedure commonly referred to as “sleeve gastrectomy” or “vertical sleeve gastrectomy” is an operation that involves subtotal resection of the fundus and body of the stomach to create a long, tubular gastric conduit along the lesser curve.

Real case video of laparoscopic sleeve gastrectomy can be viewed here.

The mechanisms of weight loss and improvement in co-morbidities seen after sleeve gastrectomy might be related to gastric restriction, dimished secretion of the hunger producing hormone "ghrelin", neurohumoral changes related to gastric resection or gastric emptying, or some other unidentified factor or factors.

Recent data include several randomized controlled trials that generally show equivalence or superiority of the laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding with short- and medium-term follow-up periods (5-9 years). In addition to the randomized trials listed, several matched-cohort, prospective, and case-control studies have demonstrate weight loss outcomes, diabetes remission rates, improvements in inflammatory markers and cardiovascular risk, and improvements in a variety of obesity-related co-morbidities after sleeve gastrectomy that are equivalent to or exceed those of Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding.

In average, the surgery takes about 1.0 - 1.5 hours to complete, the average hospital stay is 2 days and most people return to work in about 1-2 weeks following surgery.

Advantages of Laparoscopic Sleeve Gastrectomy

Lower mortality and complication rate of the initial surgery than gastric bypass
Low risk of malabsorption, malnutrition
Provides effective, 50-65% excess weight loss for high risk super-morbidly obese patients
May be converted to gastric bypass or duodenal switch, if indicated
Effectively improves co-morbid conditions such as type 2 diabetes mellitus, hypertension, obstructive sleep apnea
No dumping syndrome

Disadvantages

Irreversible procedure (the resected portion of the stomach is permanently removed)
Potential postoperative complications include staple line leak, bleeding (1-3% in large published series)
Potential long-term complications include gastric dilatation, stricture, heartburn

The above results assume that the patient is compliant with the necessary lifestyle modification requirements following surgery.