Laparoscopic Sleeve Gastrectomy

Laparoscopic Sleeve Gastrectomy

In this operation 75-80% of the stomach is removed, and the remaining will be a narrow stomach tube. This is a relatively new operation that has been done since the year 2000 by Dr. Michel Gagner. It was initially done as a first step to a second procedure for the super, super obese patients (BMI > 60 Kg/m2). It proved its efficiency on its own, and since has been established as a solo procedure for the treatment of obesity.

Sleeve Gastrectomy has actually proved better results compared to the Adjustable Gastric Band, as weight loss is better (65-70%), and resolution of Type II Diabetes is also higher in 37-45% but does depend on weight loss.

This procedure does not include any bypass so risk of malabsorption is non-existent. It is a purely restrictive procedure, with no added risk of marginal ulcers or internal hernias as in the gastric bypass.

The main immediate complications are:

  • Leak:  1-2%, minimized by using 40 french bougie (sizer for cutting the stomach) which is done in Jordan Hospital by Dr. Ahmad Bashir. If occurs it requires additional operations for repair, possibly adding a stent from inside versus other drains. If these measures do not control the leak, rarely it has to be converted to gastric bypass.

  • Bleeding: risk is similar to LRYGB.

Other late early complications:

  • Stenosis: narrowing of the stomach tube in 2-3%. It is technically preventable by choosing the proper sizer and with proper technique. If occurs, it can increase the incidence of reflux and late leaks. If short segment, it can respond to dilation through endoscopy, however if long segment it usually requires surgical cutting of the muscle layer only (myotomy) of the stenosis segment, and this usually can be done laparoscopically. 

As for late risks, they are minimal and only Reflux disease carries any significance.

The success rate of this procedure is better than that of the band, and is equal to the gastric bypass, especially in non-sweet eaters.