A Safe and Effective Surgical Weight-Loss Procedure for Higher-Risk Patients or those who Want to Minimize the Risk of Weight Loss Surgery | ||||||||
The laparoscopic sleeve Gastrectomy procedure (also called vertical Gastrectomy, Greater Curvature Gastrectomy, Parietal Gastrectomy, Gastric Reduction and even Vertical Gastroplasty) is an emerging procedure that is becoming increasingly popular worldwide. It causes weight loss by restricting the amount of food that can be eaten without any bypass of the intestines or malabsorption. | ||||||||
What is Sleeve Gastrectomy and how does it work? | ||||||||
This procedure generates weight loss solely through gastric restriction (reduced stomach volume). In this procedure, a narrow tube of the stomach, approximately the same diameter as the esophagus and duodenum is fashioned by dividing it vertically. The part of the stomach along the medial (lesser) curvature, which is in continuity with the food pipe (esophagus), is retained as the tube and the part outside the tube, which is the greater curvature of the stomach and the fundus, is removed. | ||||||||
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these patients may not attain a healthy BMI of 30 after gastric bypass. Duodenal Switch is very effective for high BMI patients but unfortunately it may also be quite risky. First stage Laparoscopic Sleeve Gastrectomy emerged as a reasonable solution to this problem. It can be done laparoscopically in patients weighing over 500 pounds. The stomach restriction that occurs allows these patients to lose more than 100 pounds and in many patients more than 200 pounds. This weight loss allows significant improvement in health and effectively "downstages" a patient to a lower risk group. Once the patient’s BMI is lower (35-45) they can return to the operating room for the "second stage" of the procedure, which can either be the Duodenal Switch, Roux en Y gastric bypass or even a Lap Band®. | ||||||||
Soon it was realized that some patients with laparoscopic sleeve gastrectomy not only lose significant weight but also maintain their weight loss for longer than expected and may not opt for a second stage procedure. This gave birth to the idea of Laparoscopic Sleeve Gastrectomy as the sole procedure for weight loss. It had been originally conceived of by Dr. Johnston in England (Magenstrasse and Mill operation). The procedure was slightly modified and the stomach pouch is made smaller than the pouch that Duodenal Switch patients have. It is a significant improvement over prior gastroplasty procedures, which are rarely done due to problems related to the placement of staples, silastic rings and mesh around the stomach pouch. | ||||||||
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When compared to lap Band procedure, Laparoscopic sleeve gastrectomy is a one time procedure and no subsequent adjustments are required. It also avoids the possible complications of a long term foreign body with no possible risks of slippage, erosion, infection etc. The 4 year weight loss results seem to be superior to lap Band. | ||||||||
Laparoscopic Sleeve Gastrectomy in Low BMI patients (BMI 35-45 Kg/M2): | ||||||||
This procedure was started in England as a stand alone weight loss procedure for anyone with a BMI greater than 35 Kg/M2 (Johnston D. Obesity Surg 2003; 13:10-16). It proved to be quite safe and quite effective even at 5 years. 10% of the patients did fail to achieve a BMI below 35 at 5 years and these tended to be the heavier patients, the same ones we would expect to go through a second stage as noted above. Low BMI individuals who should consider this procedure include: | ||||||||
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Laparoscopic sleeve Gastrectomy is very effective as a first stage procedure for high BMI patients (BMI>55 kg/m2). It can be done laparoscopically in patients weighing over 500 pounds. Available results appear promising as a single stage procedure for low BMI patients (BMI 35-45 kg/m2). It is also a very appealing option for people with existing anemia, Crohn's disease and numerous other conditions that make them too high risk for intestinal bypass procedures. | ||||||||
Disadvantages of the Vertical Gastrectomy Weight Loss Surgery: | ||||||||
Laparoscopic sleeve Gastrectomy is a relatively newer procedure being in use as the sole procedure for weight loss only for about 4 years. This is less than lap Band and laparoscopic gastric bypass which have been in use for more than 10 years. This is an active point of discussion for bariatric surgeons. There is a possibility for inadequate weight loss or weight regain in the long term because of the pouch dilatation/enlargement. While this is true for all procedures, it is theoretically more possible with procedures that do not have an intestinal bypass. Since the stomach pouch in sleeve gastrectomy is based on the thick and muscular lesser curvature which is relatively nondistensible, this fear and skepticism may not hold true. Four years follow-up results of laparoscopic sleeve gastrectomy were discussed in the Annual Conference of American Society of Bariatric Surgery in San Diago in July 2007 and the reported weight loss results are equivalent to Laparoscopic Gastric Bypass roux en Y. Higher BMI patients (above 55) will most likely need to have a second stage procedure later to help lose the rest of the weight. Two stages may ultimately be safer and more effective than one operation for these high BMI patients. Soft calories such as ice cream, milk shakes, etc can be absorbed and may slow weight loss while after gastric bypass they will cause dumping and will be avoided due to their unpleasant symptoms. Because the stomach is removed, it is not reversible. It is considered investigational by some surgeons. | ||||||||
Sleeve Gastrectomy: Risks and Complications | ||||||||
As with any surgery, there can be complications. This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur, though significantly less as compared to bypass. The others include: Deep vein thrombophlebitis 0.5%, Non-fatal pulmonary embolus 0.5%, Pneumonia 0.2%, acute respiratory distress syndrome 0.25%, Splenectomy 0.5%, Postoperative bleeding 0.5% and Small bowel obstruction. | ||||||||
Post-Op Dietary Plan for Vertical Gastrectomy Weight-Loss Surgery Patients | ||||||||
As with all surgical weight-loss programs, it is imperative that Sleeve Gastrectomy patients adhere to a strict postoperative diet. Patients must stick to a liquid-based diet for 2 weeks after surgery; 4-6 weeks after the operation, patients graduate to a 600-800 calorie/ day solid diet. Once goal weight is achieved, usually 1-2 years after surgery, most patients can consume about 1000-1200 calories per day. | ||||||||
Long-Term Weight-Loss Results | ||||||||
On average, patients who undergo Vertical Gastrectomy surgery experience a 60-80% loss of excess body weight. Large and rapid weight loss and very few complications make Sleeve Gastrectomy surgery a smart choice for weight-loss in many patients. | ||||||||
The sleeve gastrectomy seems to give the weight loss of the stronger operation (gastric bypass) with the complication profile of the band. Via: www.obesitysurgeries.com |
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Saturday, February 23, 2008
Laparoscopic Sleeve Gastrectomy
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Labels: Obesity Surgeries
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