Before I start and to clear any confusion, I must answer an important question: are there other names for Laparoscopic sleeve gastrectomy?
Yes! Laparoscopic sleeve gastrectomy is also called sleeve gastrectomy, gastric sleeve, vertical sleeve gastrectomy, VSG, LSG and simply sleeve!
Let me go back to the first question.
Why is sleeve gastrectomy currently the most popular bariatric operation in the world?
There are several reasons:
- Sleeve gastrectomy is a highly effective weight loss and metabolic procedure. The average weight loss after the procedure is around 30%. This compares favourably with other weight loss procedures.
- It has a low risk of complications.
- It is easy to understand how this procedure is done and how it works compared to other bariatric operations.
- Obesity is a chronic relapsing disease (meaning that it might not resolve forever with one-off treatment). A proportion of patients who have bariatric surgery will require further dietary, psychological, medical, or surgical treatment. Sleeve gastrectomy is very versatile, and it fits well with the chronicity of obesity. It is possible to modify this procedure, revise it and convert it to another bariatric operation after it is done. This possibility is not available for some other weight loss procedures.
- It is possible to perform sleeve gastrectomy in patients with all degrees of obesity including people who are affected by very severe obesity and whose weight is extremely high. Some other bariatric procedures are impossible to do or have significantly higher risks if they are done in people affected by very severe obesity.
- People who do not have much weight to lose might consider a gastric sleeve too due to its effectiveness and low risk of complications.
- In the long term, the worst problem that can happen after sleeve gastrectomy are weight regain and reflux (heartburn)while other bariatric operations might result in more severe complications in the long term.
What is laparoscopic sleeve gastrectomy then?
Laparoscopic sleeve gastrectomy is an operation that is done under general anaesthetic (the patient is fully asleep) and uses keyhole surgery techniques (laparoscopic surgery). When doing this procedure, I remove about three-fourths of the stomach. The volume of the stomach after sleeve gastrectomy is reduced to about one hundred millilitres.
How does sleeve gastrectomy work?
Sleeve gastrectomy is frequently misunderstood. People think that the operation works by reducing the size of the stomach. However, that is incorrect! The Gastric sleeve works mainly through its hormonal effect on the hunger feeling. We normally feel hungry because there is a hunger hormone called ghrelin that circulates in our blood. This hunger hormone is produced by the part of the stomach that we remove during the procedure. After the procedure, the level of this hunger hormone is significantly reduced. Patients tell me, after the surgery, that they don’t eat because they don’t feel hungry rather than they don’t eat because if they ate any more, they would be sick. In addition to the effect on the hunger hormone, obviously, the volume of the stomach is reduced and subsequently if they eat more than the new volume of their stomach, they are going to be sick. There are other hormonal effects of sleeve gastrectomy but the effect on the hunger hormone is possibly the most important.
What to expect after sleeve gastrectomy?
The operation takes 45 minutes to two hours to perform. After surgery, you will go to the recovery room and then to the ward. You will stay in the hospital one night and you are highly likely to be discharged home the day after your surgery.
On the day of surgery, I will allow you to drink clear fluids (water/flavoured water, peppermint tea). On the morning after the surgery, I will allow you to drink any type of fluid that you would like (we advise avoiding sugary drinks after the surgery). Surgeons differ in the timing of the introduction of food to their patients after the surgery. However, I allow my patients to have a pureed diet 24 hours after having a sleeve gastrectomy. People get confused about what pureed diet is. My definition of pureed food is any food that has a consistency that is like the consistency of yoghurt. I ask my patients to stay on a pureed diet for four weeks after the surgery. After four weeks they can move to a soft diet. A soft diet has a consistency like the consistency of mashed potato. They cannot eat solid food for six weeks after the surgery.
After the operation, I encourage people to start physical activity very quickly! On the day of surgery, the nursing team ask patients to walk around the room and go to the toilet on their own if that is possible. I encourage my patients to walk and increase their physical activity very quickly after surgery if they adhere to the following three restrictions. They should not lift up heavy objects (anything heavier than 10 pounds) for six weeks after the operation. They should not swim or have a bath for two weeks. They should not drive until they are able to do an emergency stop without pain (this normally takes about 10 days to two weeks). If a patient wishes to go for a run the day after discharge, and they feel up to it, I might not have objections!
What should the patient consider?
- There are other bariatric procedures that have different profiles of effectiveness and risks. It makes sense to consider all options before pursuing sleeve gastrectomy.
- If you have specific medical conditions like reflux disease (usually manifests itself with heartburn) and diabetes, you should discuss with your surgeon whether sleeve gastrectomy is the best option for you.
- Laparoscopic sleeve gastrectomy is a relatively new operation. We know more about the long-term effects (>15 years) of other bariatric operations compared to this procedure.
What should you do if you are interested in sleeve gastrectomy or another bariatric procedure and wish to take it further?
It is simple, book a consultation with me today!
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