Laparoscopic Sleeve Gastrectomy

A newer, reliable alternative to the LAGB, that is easier to live with than the gastric bypass

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.
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