Laparoscopic Sleeve Gastrectomy Overview

If you're very overweight, obesity surgery may be a choice for you. Obesity surgery is also called bariatric surgery. Your healthcare provider may advise it if you have a body mass index (BMI) higher than 40 or higher than 35 with certain other obesity-related conditions. These include sleep apnea or diabetes. A BMI higher than 40 typically means that you're about 100 pounds overweight. One of the choices for bariatric surgery is called laparoscopic sleeve gastrectomy (LSG).

The LSG procedure

LSG surgery is a nonreversible procedure done in a hospital under general anesthesia. Your surgeon will make about 5 small cuts in your belly. They will use a thin long scope with a tiny camera at the end to do the surgery. Tools pushed through the incisions will be used to remove about 80% of your stomach. Your surgeon will do the procedure while viewing the images on a TV screen in the operating room.

This surgery takes out the part of your stomach that curves outward. It is called the fundus. After the fundus is taken out, your surgeon will close the rest of your stomach into a tube shape that looks like a banana. Or the sleeve of your shirt. That is why it has been given the name "sleeve gastrectomy." You'll fill up quickly at mealtimes and eat less because you'll have a much smaller stomach.

The fundus secretes a hormone called ghrelin. This hormone may be partly responsible for making you feel hungry. So, removing it may also help you lose weight afterward by decreasing your hunger.

LSG surgery takes about 2 hours. Most people stay in the hospital for about 2 days after surgery.

Reasons to consider LSG surgery

Here are some reasons why LSG may be right for you:

• If you have a BMI of more than 60, LSG may be used as a first surgery to help you lose enough weight. Once that happens, you can safely have a second, more extensive type of weight-loss surgery at a later date. The risks with some forms of bariatric surgery are much higher for people with a BMI of more than 60.

• LSG may be a safer choice for you than other longer and more complicated weight-loss surgeries if you're older or have other risk factors for surgery. These risk factors include heart, lung, or liver problems.

• Your healthcare provider may advise LSG if you have a BMI of about 40 to 50. That's because it's less likely to cause side effects than other forms of weight-loss surgery. Side effects can include stomach ulcers or poor food absorption.

Weight-loss benefits of LSG

In the first 2 years after LSG, most people will lose between 40% and 50% of their body weight. If your BMI before surgery is 60 or more, you may lose about 125 pounds.

Studies also show that if you have obesity-related problems like diabetes, high blood pressure, sleep apnea, or high cholesterol, you have about a 75% chance that these conditions will also improve.

Risks of LSG surgery

Any surgery done under general anesthesia carries some risk for heart and brain damage, but these risks are low. LSG is a shorter procedure than other types of gastric bypass surgery. With LSG surgery you have a 5% to 10% risk for a complication, such as:

• Stomach juices leaking from where the stomach was removed

• Risk of vitamin and iron deficiency

• Higher risk of surgical problems than gastric band surgery

• Risk of hiatal hernia caused by the stomach pushing up against the diaphragm

• Bleeding

• Blood clot that forms in your leg and travels to your lungs and heart

• Narrowing of the inside diameter of the new stomach

• Infection

• Nutrients poorly absorbed

• Bowel blockage

• Poor wound healing

• Heart issues, such as a heart attack

• Lung problems, such as pneumonia

Continue to have careful follow-up with your healthcare provider past the third year after surgery to help protect against gastrointestinal problems and weight regain.

Weight loss after LSG slows down after a few years, and your stomach may stretch and grow. You must make important lifestyle changes that include both better nutrition and regular exercise for any bariatric surgery to succeed. These changes need to be kept for the long term.

Be sure to discuss any type of weight-loss surgery carefully with your healthcare provider. Before surgery you'll need to have a complete physical exam to make sure you are healthy enough to have the procedure. You should also get nutritional and mental health counseling to make sure you're prepared for what to expect after surgery.