Laparoscopic Sleeve Gastrectomy

What is a laparoscopic sleeve gastrectomy?
It is an operation to convert the stomach into a long thin tube. This is done by stapling it along its length and then removing the excess. It is performed for helping very overweight patients achieve substantial weight loss because it restricts the amount that someone can eat.
It may be used as a stand-alone operation or the first part of a two stage operation for very large patients. The second stage is carried out a number of months later when the patient has lost a significant amount of weight. This means that the risks of needing further surgical procedures are much less.
What does laparoscopic mean?
The operation is carried out laparoscopically, which is also known as keyhole surgery. This means that the surgeon makes five small incisions (cuts) in the abdomen (belly) to get to the stomach. The surgeon may decide to convert to an open procedure (the traditional way of carrying out this operation through a longer incision) if they think it would be safer.
What does the operation involve?
The operation takes up to two hours. For some patients, the surgery can be technically difficult depending on body-build or previous surgery. In these circumstances the operation can take longer.
Before the operation
You will come into hospital on the day of surgery.
You will wear anti-embolism socks (like very tight stockings) to prevent blood clots forming in your legs.
The anaesthetist will see you before or on the morning of surgery.
After the operation
You will probably have:
1. Oxygen in your nose
2. A drip in your arm
3. A morphine machine to control your pain
4. A wound drain to remove excess blood and fluid (during the first night)
5. A catheter to drain your bladder (for one day).
you will be allowed to sip water and as soon as your intestines are working, you will be able to start increasing your fluid intake and then start a liquid diet.
You may need laxatives to help you regularly open your bowels.
The physiotherapist will help you to exercise and to get out of bed.
You will probably be ready to go home two days after the operation.
You may have dissolvable stitches (that disappear naturally after a while).
We will arrange regular appointments for follow up.
We will give you a leaflet about eating and drinking after your sleeve gastrectomy operation.
At home
You may feel tired for about a month but can generally go back to work after two weeks
Take gentle exercise.
No heavy lifting, such as children, luggage. You will need to arrange some assistance if lifting is part of your everyday life.
Do not drive till you can depress the brake pedal hard enough to perform an emergency stop.
Keep the wound clean by taking a shower rather than a bath.
Watch for signs of wound infection such as:
1. pain
2. redness
3. swelling
4. discharge (oozing)
Are there any risks from the surgery itself?
This is a common and safe procedure, but every procedure has some risks associated with it. These are related to the anaesthetic and the surgery itself:
Bleeding may occur during the operation. If this happens, you might need a blood transfusion which will be done at the same time as the operation.
Damage to internal organs: this can happen as a result of placing instruments in the abdomen. This is rare (1 in 1000) but higher in patients who have previously had surgery to the abdomen. If an injury does happen, open surgery may be needed which involves a much bigger cut
Leaks from staple line: This may require fasting (not eating or drinking), antibiotics and intravenous fluids in order for the perforation to heal. In some cases you may require additional surgery.
A blood clot may occur in the legs or in the lungs which means you will require medication to keep your blood thin for several weeks or months.
Hernia can occur as a result of the incisions into the abdomen but it is less likely with laparoscopic surgery as the incisions are quite small
Infection: can occur in the wounds, lungs and urine, in fact anywhere because of the nature of the surgery and the tubes into and out of your body post-operatively.
Heart Attack: This can be as a result of the physical stress of surgery or pre-existing heart problems
Overall the figure published in medical journals for all these risks together ranges from 5% to 20%. Therefore we believe 15% is a reasonable figure to have in mind. In most patients these complications will be mild, but in a small proportion may lead to an emergency re-operation, a period in intensive care and / or extended hospital stay.
Death: the risk of death at the time of operation is very small but the complications just described, result in a measurable risk of death and the figure published in medical journals are about 0.5%
Long Term Consequences of Gastric Banding
The operation results in severe restriction of your capacity to eat solid food. This is the main way it works.
It may also help reduce appetite.
People are concerned about symptoms of acid reflux afterwards, but there is no evidence this occurs more than it does in anyone else who is overweight.
The operation may be enough to provide the weight control you are looking for, permanently on its own. However, it is sometimes the weight loss can plateau before personal targets have been reached.
In this case the operation can be follow by a “Stage 2” at the new, lighter weight you have reached. The risk of this part is correspondingly reduced. Stage 2 could consist either of
1. an operation that works by further restricting intake and that affects appetite (Gastric Bypass) or
2. an operation that greatly reduces the absorption of the food you are able to eat after the Sleeve Gastrectomy.
3. There are advantages and disadvantages to both, which are best considered at the time.
For your safety you must remain under medical follow-up for the rest of your life, with several visits in the first year and at least an annual visit thereafter.
We view this as a partnership between you and us. It is very important that you understand you will be taking the major share of the responsibility, by coming to the appointments that we send you.
Are there any benefits from the surgery?
This surgery is a proven method of weight loss.
When combined with a supervised diet, increased activity and behaviour modification, it can lead to long-term weight loss and the associated health benefits.
Weight loss is more than with non-surgical programmes Average excess weight loss is 60 to 70% (for example, if a patient is 10 stone over weight then we would expect him/her to lose on average 6 to 7 stone).
It keeps the pyloric valve intact (a stomach muscle) which avoids some of the complications of other types of bypass surgery such as:
1. 'dumping' (when sweet foods cause you to sweat and feel faint)
2. strictures (a restriction or tightening)
3. blockages
Are there any alternatives?
We believe the advantages of laparoscopic sleeve gastrectomy surgery outweigh its disadvantages. This view is shared by many surgical teams in the UK, Europe and America
Balancing Risks
We feel it is important for patients to have a clear view of the commitments and risks attaching to this surgery. However, these have to be balanced against the longer term risks of remaining severely overweight.
We advise that you discuss these issues carefully with appropriate family members or friends.
Because the two sets of risks occur on a different timescale, it may be difficult to weigh one against the other.
Therefore please ask whatever questions you wish.
Any questions?
If you have any questions or worries, please contact the Obesity Service for advise on 020 7 1008083
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