Guy Slater - Laparoscopic Sleeve Gastrectomy

LSG: Who is it for?

The laparoscopic sleeve gastrectomy is suitable, for most patients

With low to moderately high BMIs; BMI 35 to 50 kg/m²
From young to middle-aged
With metabolic illness, such as diabetes, high blood pressue, sleep apnoea
Who are men: Men do well with LSG
Who are able to control their sweet tooth
Who want to continue to enjoy a normal social life, including alcohol and smoking.

LSG: The procedure and recovery

Laparoscopic (Keyhole) surgery: 4 or 6 small incisions
General Anaesthetic
Two night hospital stay
Two week recovery time
70% of the stomach is removed, using special titanium staples
The stomach is converted into a narrow tube, just over 1cm in diameter
The capacity of the stomach is drastically reduced

LSG: Mechanism of Action

Reduced Appetite

A hunger hormone called gherilin is produced by cells in the upper stomach
Sleeve gastrectomy removes this part of the stomach
Reduced gherilin levels and reduced hunger

Reduced portion size

Patients feel full sooner, due to the reduced stomach capacity
In the short term patients eat a few mouthfuls of food
In the longer-term, patients will eat a child-sized portion

LSG: Weight loss & Impact on Metabolic Illness

LSG is just behind the gastric bypass in terms of reliability of weight loss and impact on metabolic illness. There is a risk of weight regain, two to three years post surgery, if patients do not adhere to the recommended diet.

A person who is ten stone over their ideal weight, can expect to lose 6 to 7 stone and sometimes more. The weight loss will result in:

Remission or much better control of type 2 diabetes mellitus
Improved blood pressure control
Remission of obstructive sleep apnoea
Improved mobility and a better quality of life

LSG: Diet & Lifestyle

LSG is the most sociable operation, with least restriction on lifestyle

More textured foods, such as red meat maybe difficult to eat
Foods that swell, such as pasta and rice, may be difficult to eat
Eating out, can sometimes be challenging, if the menu is restrictive
Sugar containing foods, will not cause dumping, but can contribute to weight regain
Alcohol can be drunk, but should be drunk sensibly
Although not recommended, patients can smoke with LSG, unlike the LRYGB

LSG: Aftercare & Maintenance

Two years aftercare is essential

For support, with the recommended diet, moving from pureed to solid foods
To learn how to eat with the sleeve, to ensure the best long-term outcome
To reduce the risk of weight regain, due to poor compliance with diet
To learn how to prioritise protein, to ensure the only weight lost, is fat

Severe vitamin and mineral deficiencies are rare with the sleeve

Mulit-vitamins and minerals should still be taken daily, as recommended
Additional iron maybe needed. Vitamin B₁₂ injections or a spray maybe needed
Annual blood tests are recommended, but are not as vital, as they are for the bypass

LSG: Risks and Complications

The risks of LSG are low, if an experienced surgeon performs the surgery.

Death

Is a risk with any major operation, but with Sleeve gastrectomy, overall is below 1:1000

Peritonitis (severe intra-abdominal infection) can occur if the staple line leaks

This is uncommon, risk below 1:100
Will usually occur in the first 48 hours after surgery, while in hospital
Sometimes a staple line leak, will present later as an intra-abdominal abscess
A staple line leak, is the most concerning complication, that can occur after WLS
A leak may need further operations, a prolonged hospital stay and a longer time off work

Bleeding can occur

1 in 100 patients bleed after the surgery
Mostly this is minor bleeding and may not need further intervention
It might be necessary to re-operate to control any bleeding
Very occasionally a blood transfusion, will be needed.