The procedure is also called laparoscopic sleeve gastrectomy (LSG) or vertical sleeve gastrectomy (VSG).This weight loss procedure involves the reduction in the size of the stomach by about 25%. A portion along the greater curvature (left side) is removed in this procedure. Finally, a sleeve shaped structure is obtained and hence the name. The shape is analogous to that of a banana. The procedure is commonly done laparoscopically.
Sleeve gastrectomy evolved from duodenal switch, which was the bariatric procedure used in early days. The procedure then began to be incorporated in a 2 step gastric bypass procedure. The large success obtained in this operation made this an individual surgical procedure.
Presently, sleeve gastrectomy is one among the most sought out weight loss option.
In this procedure, the surgeon makes a couple of incisions in the abdomen. The laparoscope and the instruments used for surgery passed through these cuts. A camera connected to the laparoscope enables the surgeon to clearly see the inner side of the stomach. Through this procedure, almost 80% of the belly portion is removed. The left-over portions are stitched together. The sphincter muscles are left untouched since these are important in the injection & ejection of food to/from the stomach. The fundus present in the stomach is however removed. This is an essential part for the secretion of ghrelin, the substance that creates the sensation of hunger. The entire surgical procedure takes about 1.5 hours to complete.
The effect of such a surgery can be pronounced during eating. The stomach becomes empty after consuming little quantity of food. This is due to the small size of the stomach.
There are many advantages for this procedure, among which some are mentioned below:
More some individuals, this procedure can result in extensive weight loss. The extent of such a loss is such that this seriously interferes with the normal metabolism. This results in the person being tired and pale.
Sleeve gastrectomy is often recommended for those persons who have a body mass index of 40 or more. It is to be made clear that just this procedure alone does not suffice in treating obesity. Suitable lifestyle changes are also very necessary.
The most common form of gastric banding is the laparoscopic adjustable gastric banding (LAGB). This is primarily because of the fact that it involves only minimal incision.
This method proves to be advantageous for treating conditions that are very much related to obesity like hypertension, type 2 diabetes, arthritis, sleep apnea etc. After having this surgery, the body weight falls considerably. This fall in weight loss can result in fall in the risk to other problems relating to body weight. For those who have a very high body mass index, this procedure can be recommended.
Procedure: For numbing the pain & to make the process comfortable, general anesthesia is given. A tiny camera is placed in the stomach and the surgery is performed by looking the images captured by this camera. This apparatus is known as a laparoscope. About 1-5 incisions are made in the abdomen to insert the laparoscope and the surgical micro-instruments. A band is placed the upper portion of the stomach to bifurcate from the lower part. This band is made of rubber like material and is tightened so that a small pouch is formed in the upper part. A port of small size is left under the stomach skin. This can help in further increase or decrease in pouch size. Through this port, the surgeon can either inflate or deflate the band, which is analogous to that of a balloon. It takes 60-90minutes for the procedure to complete. Complications for this procedure are rare. If present, they shall include band slippage, food obstruction through the band, gastric perforation etc. During the initial days after surgery, only light and cooked food needs to be taken. Gradually, more complex food can be taken in.
Certain changes in the lifestyle need to be practiced. The food has to be chewed slowly and thoroughly before swallowing in. The food should not be dry and needs to have more water content. A balanced diet containing the right amount of proteins, vitamins and minerals is always advisable. A loss of weight equaling 25% of the total weight can be achieved on a long term basis. Care should be taken to maintain appropriate nutrition because it is very easy for a person to have nutritional issues.
Bariatric surgery is the answer for reducing weight and maintaining weight loss in long term. It is advised in morbid obesity where BMI is >35 with other medical problems like high blood pressure, diabetes, heart disease or in any person with BMI>40. BMI charts are available to calculate , from one’s body weight in kilograms & height in meters or ask your family doctor .
Morbid obesity does not appear to be a simple lack of self control by the patient, & hence morbid obesity is now considered a disease by the doctors.
The operation is done using laparoscopic technique (key hole surgery) with 5-6, small,
5-12 mm incisions in the abdominal skin. Hence after surgery, pain is minimal , one can move in bed soon after surgery, can walk and visit the toilet the next day. Patient goes home in 3-4 days and is allowed normal activity & can return to work in 2weeks.
The operation can be a Restrictive surgery or one producing Malabsorption. In most patients a restrictive procedure suffices. The most commonly done restrictive procedure is by cutting out a major part of stomach so that only a stomach tube is left behind & rest of the stomach is removed. The patient can consume only limited quantity of food thus leading to inevitable weight loss.
The onus lies with the patient as to how suitable he/she is to be taken up for surgery. One month before surgery , patient will be put on a special low calorie high protein diet. If this diet is followed faithfully person will start loosing weight & thus significant weight loss will occur before surgery itself. A patient who faithfully follows the special diet only will be taken up for surgery. The body fat reserves are thus depleted before surgery itself. Upto 1-2 years after surgery the patient will keep on loosing weight reaching normal or near normal BMI . Beyond that time life style changes which have been acquired by the patient, will continue to ensure fitness.
Patients who have other associated medical conditions also show marked improvement. Immediately after operation, improvement in diabetes is seen. Even before any weight loss in the patient, the medicines required for control of diabetes are reduced or stopped. This improved status of diabetes is progressive. As weight loss starts the blood pressure also comes under control requiring smaller doses of medicine and can get completely cured. Breathing problems, sleeping problems, heart problems, heart burn, high cholesterol, joint pains, depression & Gynaecological problems of menstrual irregularities & infertility undergo marked improvement & continue to improve as weight is lost. Some of these problems are completely cured and may not require any further medicines.
|Obesity increases your chance to develop one of these diseases--
Benefits of Weight loss Surgery :
Why would anyone have surgery to lose weight?
Prevention of debilitating diseases such as arthritis, diabetes, and sleep apnea
Guidelines for Surgery
American Diabetes Association (ADA) Guidelines 2016