Laparoscopic Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy (LSG) is a restrictive procedure to reduce the size of the stomach and thereby limit food intake. During the procedure, approximately 75-85 percent of the stomach is removed, leaving a narrow gastric sleeve or tube that limits the amount of food that can be eaten at one time. After eating a small amount, patients feel full and remain satiated for several hours.

In addition to reducing stomach size, LSG may decrease the amount of “hunger hormone” produced by the stomach and, in turn, cause a decrease in appetite that may also contribute to weight loss. LSG takes about one to two hours to complete, and requires no post-operative drain or nasal tube. Patients are typically able to return to work or resume strenuous activity approximately two weeks after surgery.

LSG is performed using five or six small abdominal incisions to provide access for a video camera and instruments. The stomach is restricted by stapling and divided to reduce its size. Although the volume is significantly reduced, the nerves to the stomach and the outlet valve remain intact. The intestines are not removed or bypassed, and the procedure does not cause decreased absorption of nutrients. Because there is no intestinal bypass, potential complications such as marginal ulcers, vitamin deficiencies, and intestinal obstructions are avoided.

Benefits and Risks of Laparoscopic Sleeve Gastrectomy

Benefits

• Patients may lose 40 to 70 percent of excess body weight in the first year after surgery.
• Laparoscopic technique typically results in small scars, reduced pain, and faster recovery times.
• Obesity-related problems, such as hypertension, diabetes, sleep apnea, and abnormal cholesterol levels, are improved in patients who undergo LSG.
• Patients may return to work and strenuous activities two weeks after surgery.
• Stomach capacity is reduced, but function remains unimpaired so most foods can be eaten.
• Avoiding intestinal bypass virtually eliminates the chances for intestinal obstruction, ulcers, osteoporosis, and protein and vitamin deficiencies.

Risks

• LSG is not reversible since the majority of the stomach is removed.
• Patients with higher BMIs will require a second-stage procedure.
• Like any laparoscopic procedure, LSG carries a small risk of bleeding, infection, or leaks from the staple line. However, these complications occur in less than one percent of cases. The stomach removal technique used in LSG has been performed since the 1980s.
• Overall, the operative risks entailed in LSG are slightly higher than with lap-band surgery, but lower than the risks associated with gastric bypass.