Laparoscopic sleeve gastrectomy (LSG)

This operation has some resemblance to the old – fashioned so – called ‘stomach stapling’ procedures of the 1980s and 1990s (the vertical banded gastroplasty) and has probably replaced them worldwide. It involves removing the outer part of the stomach, thus significantly reducing the capacity to store food and generate hunger signals. People who undergo this operation lose hunger quickly during a meal and find it hard to overeat. Their stomach is turned into a narrow tube with a volume at least 75 per cent smaller than before. Their maximum meal size is reduced to less than one cup of food, but the restriction in volume of food that can be eaten usually occurs without significant restriction of the types of food that can be eaten. Vomiting is less common than with the band, but reflux is more common. Although the side effects of this gastroplasty a re far less than ‘stomach stapling’, the procedure is permanent, so any side effects might also be permanent.

Figure. Laparoscopic gastric plication. The greater curve (GC) of the stomach is folded inwards several times to create a small gastric tube similar to a sleeve gastrectomy. A band can also be placed at the top of the plicated (narrow) stomach.

The weight loss is quite rapid initially but weight regain occurs if patients do not change their eating habits. The sleeve gastrectomy can be us ed along the path towards a gastric bypass (see below) for patients wanting to consider some of the benefits of the bypass (ease of weight loss, minimal vomiting), without the negatives (potential calcium, iron and vitamin B12 deficiency problems, and the small risk of blockages of the small bowel). If long – term weight loss is not sufficient, the sleeve can be converted laparoscopically to a bypass without undue difficulty. If someone has a permanent side effect from a sleeve gastrectomy, they may require a gastric bypass to address it.

This operation may be ideal for:

  • People wishing to avoid the risk of device failure or vomiting with a gastric band
  • People who do not wish to have the vitamin supplements needed with a gastric bypass
  • People who may initially be too unwell to tolerate a bypass but probably require it due to significant weight and metabolic problems (as stage one of two – stage surgery)

Because part of the stomach is removed it is therefore permanent . Any unwanted side effects would also be perm anent unless treated.

Figure. Sleeve gastrectomy. A narrow stomach tube is created and the outer part of the stomach discarded. This can be done as a stand – alone operation , or it can be made stronger with more weight loss by changing it to a bypass months or years later.

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