Treatment for Morbid Obesity: Laparoscopic Sleeve Gastrectomy

What is Laparoscopic Sleeve Gastrectomy?

Laparoscopic sleeve gastrectomy is a minimally invasive surgery to treat morbid obesity and diabetes. It is a surgical procedure that removes around 70-80% of the stomach and shape it into a tube- like structure of around 150ml.

It works by greatly reducing the size of the stomach, thus reducing the amount of food eaten. At the same time, the fundus of the stomach is also removed during the surgery. The fundus secretes a hormone called grehlin, which is responsible for hunger sensation. After the fundus is being removed during laparoscopic sleeve gastrectomy, the hunger signal is being suppressed and this also contributes to the significant amount of weight loss.

Is Laparoscopic Sleeve Gastrectomy safe?

No surgical procedure is free of risks. The overall risks of laparoscopic sleeve gastrectomy is less than 1%, comparable to many other general surgical procedures that are commonly performed. The following is a list of the possible complications:

• Bleeding
• Infection
• Leakage from the staple line
• Acid reflux- Around 30% of patients who receive laparoscopic sleeve gastrectomy will experience acid reflux and some patient who already have reflux symptoms may get worse. However, most of these situations can be treated with medications.
• Gallstones- Loosing weight quickly after surgery may cause more fat to be processed through the liver and lead to cholesterol stones forming in the gallbladder
• Nutritional deficiencies- It is often very difficult to make sure and control the amount of nutrients taken after surgery since the amount of food eating will be significantly reduced. Therefore, regular follow-up with your surgeon and dietitian, in addition to taking long- term nutritional supplements will help to reduce the risk.

The advantages of Laparoscopic Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy is a surgical treatment for morbid obesity and many other obesity related conditions, especially diabetes. It is mainly offered to patients with morbid obesity i.e. BMI >35 or BMI >30 with one more more obesity related conditions. After the operation, patients are expected to loose 60-70% of their excess weight within 2 years. The following are a number of diseases which laparoscopic sleeve gastrectomy may potentially improve or even cure:

• Diabetes
• Hypertension
• Hyperlipidemia (high cholesterol)
• Fatty liver
• Obstructive sleep apnea
• Osteoarthritis

Procedure guide of Laparoscopic Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy is a minimally- invasive surgical procedure that is done inside the hospital under general anesthesia. The following is an overall rundown of the surgery:

1. You might be asked to be admitted to the hospital one night before the surgery for some basic investigations before the surgery.
2. You will be asked to stop eating and drinking about 6-8 hours before the surgery.
3. You will receive general anesthesia by a qualified anesthesiologist.
4. Your surgeon will make 3-4 small cuts on your abdomen where specialized instruments will be inserted into your abdomen to perform the surgery.
5. About 70-80% of the stomach will be removed and the remaining shaped into a tube- like structure of about 150ml.
6. The surgery usually takes about 90 minutes to complete.

Instructions after Laparoscopic Sleeve Gastrectomy

Soon after the surgery, you will be woken up and escorted to the recovery room. Once your surgeon and nurses are satisfied that you are stable after the surgery, you will be taken back to the ward. The following is a list of what may happen after the surgery:

1. You will likely be allowed to drink small amounts of water soon after the surgery.
2. A mixture of oral and intravenous analgesics will be given to relieve the pain from the surgery.
3. You will be encouraged to get out of bed and mobilize the next day and will be allowed to drink fluids.
4. Most patient will stay in the hospital for 2 more days after the surgery
5. During the first few weeks after the operation, you will have to follow strict dietary instructions from a qualified dietitian in order to allow the stomach to heal well and ensure that you intake an adequate amount of nutrition. 
6. During the first 10 days after the operation, you will be advised not to shower or get your wounds wet. This is mainly to help avoid wound infection.
7. After the surgery, it usually takes around 3-4 weeks before you can return to work as it takes time for the body to adapt to a new eating habit and to get use to dietary instructions from the dietitian.