OBESITY – LAP SLEEVE GASTRECTOMY
LAPAROSCOPIC SLEEVE GASTRECTOMY:
In Indian scenario with difficult long term follow up, regular additional nutrition, mineral, vitamin supplementation, Laparoscopic Sleeve Gastrectomy is effective weight reduction surgery for obese. There won’t be any major anatomical, functional alteration of digestive tract & with almost nil post operative morbidity & mortality. Studies also suggested that weight reduction following sleeve gastrectomy is as equal as of with gastric bypass.
-Under General anesthesia, patient will be positioned in low lithotomy or over bean bag for easy position mobilization and accessibility.
-Pneumo peritoneum is created with Hasson’s or visi port technique
-Abdomen visualized & access operability.
-On regular basis we preferred to use Nathenson’s self-retaining liver retractor & 3 working ports
-Short gastric vessels are ligated along the greater curvature of stomach till fundus of stomach
-Stomach mobilized above till OG junction
-Using 32 / 34 French bougie as guide, vertical sleeve gastrectomy done with Ultra GI Endo stappplers.
-75% of the stomach was removed (Restrictive bariatric)
-Hemostasis achieved & abdomen closed in layers after taking specimen out through umbilical port.
Sleeve gastrectomy is a restrictive procedure. It greatly reduces the size of the stomach and limits the amount of food that can be eaten at one time. It does not cause decreased absorption of nutrients or bypass the intestines. After this surgery, patients feel full after eating very small amounts of food. Sleeve gastrectomy may also cause a decrease in appetite. In addition to reducing the size of the stomach, the procedure reduces the amount of the “hunger hormone,” ghrelin, produced by the stomach. The duration of this effect is not clear yet, but most patients have significantly decreased hunger after the operation.
Postoperatively patients monitored as like any other laparoscopic surgery. 2nd post operative day contrast scan can be performed to see any contrast leak followed by patients will be started liquid diet as tolerated and can be discharged on the same day. Further follow up will be after a week and diet will be gradually increased from clear liquid to full liquids and to soft diet as tolerated under guidance of experienced dietician
-No major morbidity & almost nil mortality
-Very short hospital stay, early return to activity
-Restrictive bariatric surgery with effective weight loss by limiting intake & decreasing hunger
-No functional, major anatomical disturbance
-It does not involve any digestive anastomosis, no mesenteric defects are created eliminating the risk of internal hernia
- It is not associated with Dumping syndrome, the risk of peptic ulcer is low and the absorption of nutrients, vitamins, minerals and drugs is not altered
At APOLLO, we perform Laparoscopic sleeve gastrectomy as a multidisciplinary team with well trained and qualified laparoscopic and bariatric surgeons, high end anaesthesiologists, well trained ot staff including nurses and technicians and good quality equipment, ICU set up as back up if necessary, dieticians, psychologists and behavioural therapists and fitness experts on a regular basis and achieving effective & satisfactory results. Our patients usually discharge on 2nd post operative day with liquid diet. And patients are back to work in less than a week. We have seen effective weight loss of around 60% percentile in 6 months without major nutritional disturbances. However, bariatric surgery is not a resort in cases of childhood obesity because the child needs to attain his full growth potential until the age of 18 and so as to not interfere with normal growth physiology
1. How long does the surgery take?
A. A gastric sleeve surgery takes anywhere between 1.5 to 3 hours.
2. How long will I have to stay in the hospital?
A. 3-5 days.
3. When can I go back to work?
A. One should be able to work and resume all normal activities in 2 weeks, and full recovery can be expected in 30 days.
4. How much of my stomach will be removed?
5. How much and how fast a weight loss can I expect?
A. Maximum weight loss is seen in the first 10 months and one can expect to lose upto 21% weight by the third year.
Gastric sleeve over gastric banding: Gastric sleeve requires no readjustments and therefore no reoperations. Also, the fullness produced is more satisfying than the feeling of obstruction caused by banding.
Over gastric bypass surgery: A gastric sleeve does not involve any rerouting and is hence faster, easier and safer. Also, there are no vitamin and mineral deficiencies.
Dr RAJNESH C REDDY
MBBS; MS,FICS Bariatric surgeon Fellow In Laparoscopic surgeon
Senior consultant Laparoscopic & Bariatric surgeon
Apollo Health City, Hyderabad