What is a Laparoscopic Sleeve Gastrectomy?
 

The laparoscopic sleeve gastrectomy (LSG) originated as the restrictive part of the duodenal switch operation. In the last several years, though, it has been used by some surgeons as a staging procedure prior to a gastric bypass or duodenal switch in very high risk patients. It has also been used as a primary, stand-alone procedure by some surgeons.

How is the Sleeve Gastrectomy Performed?
The majority of sleeve gastrectomies performed today are completed laparoscopically. During the sleeve gastrectomy, about 75 percent of the stomach is removed leaving a narrow gastric tube or “sleeve.” No intestines are removed or bypassed during the sleeve gastrectomy. This procedure takes one to two hours to complete. This short operative time is an important advantage for patients with severe heart or lung disease.

Weight-Loss
LSG is a restrictive procedure. It greatly reduces the size of the stomach and limits the amount of food that can be eaten at one time. It does not cause decreased absorption of nutrients or bypass the intestines. After this surgery, patients feel full after eating very small amounts of food. LSG may also cause a decrease in appetite.
In addition to reducing the size of the stomach, the procedure reduces the amount of the “hunger hormone,” ghrelin, produced by the stomach. The duration of this effect is not clear yet, but most patients have significantly decreased hunger after the operation.

Complications
LSG has been used successfully for many different types of bariatric patients. Since it is a relatively new procedure, there is no data regarding weight-loss, complications or weight regain beyond three years. The risk of major post-operative complications after LSG is 5-10 percent, which is less than the risk associated with gastric bypass or malabsorptive procedures such as duodenal switch.

This is primarily because the small intestine is not divided and reconnected during LSG as compared to the bypass procedures. This lower risk and shorter operative time is the main reason we use it as a staging procedure for high-risk patients.

Complications that can occur after LSG include: a leak from the sleeve which results in an infection or abscess, deep venous thrombosis or pulmonary embolism, narrowing of the sleeve (stricture) requiring endoscopic dilation and bleeding. Major complications requiring re-operation are uncommon after sleeve gastrectomy and occur in less than 5 percent of patients.

Conclusion
Several studies have documented excellent weight-loss up to three years after LSG. In higher BMI patients who undergo LSG as a first stage procedure, the average patient will lose 40 – 50 percent of their excess weight in the first two years after the procedure. This typically equates to about 125 pounds of weight-loss for patients with a BMI greater than 60.

Patients with lower BMIs who undergo LSG will lose a larger proportion of their excess weight (60 – 80 percent) within three years of the surgery. More than 75 percent of patients will have significant improvement or resolution of major obesity-related co-morbidities such as diabetes, hypertension, sleep apnea and hyperlipidemia following sleeve gastrectomy.

Note: Individuals affected by morbid obesity rely on their insurance provider to assist them in the process of seeking access to safe and effective medical treatment. Many times they experience difficulty when working with their insurance providers, such as repeated denials of claims. In addition, the process often times seems complicated, and physically and emotionally draining. For more information on working with your insurance provider, please visit the OAC Web site and view the OAC’s Insurance Guide, titled Working with Your Insurance Provider: A Guide to Seeking Weight-loss Surgery.
Source: ObesityAction.org, September 15, 2009