Laparoscopic Sleeve Gastrectomy Surgery
(click here to see the vertical
sleeve gastrectomy in pictures!)
Gastrectomy is a combination of two Latin words: gastro,
meaning “stomach,” and -ectomia, which means “to cut out.”
Sleeve gastrectomy is a restrictive surgery that permanently reduces
the size of the stomach by removing and discarding 90-95 percent of your
stomach! This procedure looks attractive to people who wish to lose
weight but do not want to deal with the risks of bypass surgery.
The EARLY weight loss observed is not as fast as with the gastric bypass
but faster than with the lap band. However, remember that the LONG TERM
weight loss with ALL procedures is the same (according to the Swedish
Obesity study) and that if you lose more than 2 lbs a week, that isn't
bodyfat but muscle and bone because the body can only process 2 lbs of
fat a week (that's 7000 calories of bodyfat).
If
your stomach holds 40 oz now, after a sleeve gastrectomy, it will only
hold 1-2 oz.
Advantages
- By avoiding the intestinal bypass done with the RNY, the chance of
intestinal obstruction (blockage), anemia, osteoporosis, protein
deficiency and vitamin deficiency are lessened.
- Though the stomach is very small, the openings are left intact, so
you may not get stuff stuck in the stoma (manmade openings like in the
gastric bypass)
- The EARLY weight loss is not as good as the gastric bypass but with
less
malabsorption of vitamins. (Remember studies have suggested the
long term weight loss to be the same with ALL procedures even the much
safer lap band)
Risks
- Although thought to be safer than gastric bypass, truth be known,
the safety of this procedure has NOT YET been established because it
is very new. Of concern is the amount of stomach removed.
Most surgeons are now removing and throwing out, 90-95 percent of the
stomach and since the stomach is a critical digestive organ, this
might cause some vitamin deficiencies as well as protein deficiencies.
- The vertical sleeve gastrectomy is NOT reversible at all.
- Vertical sleeve gastrectomy patients are told they have "fully
functional stomachs" but since the stomach is now only 1-2 oz, this is
highly UNLIKELY. In truth, all that is left from their stomach
is 1-2 oz pouch which is the same size as a gastric bypass patient
except the gastric bypass patient can have their stomach reconnected
if there are problems.
- A percentage of patients get severe reflux... not only of acid but
of bile as well.
- Anytime you have anesthesia or surgery, there is a risk of blood
clots, other complications or death. The risk of death with the
gastric sleeve is likely considerably less than the bypass but
higher than with the adjustable lap band.
- In the long term, you may be in higher risk for a herniated
stomach or distention of the esophagus. Some patients have
complained that the tiny part of the stomach left can "twist"
- Because of most of the stomach being cut away, the digestion of
protein and vitamin B12 may be compromised. This is due to less
stomach acid and also possibly a lower amount of "intrinsic factor"
being produced. You may have to take vitamin B12 shots. - should
check levels often.
- As in all WLS procedure, smoking puts you at higher risks for
infection etc
- Complications can occur with the stapling, such as leaks or
bleeding.
- What's left of your stomach may stretch in time.
- Many foods that you eat now may cause discomfort, nausea or vomiting
after your surgery.
- Any WLS puts you at higher than normal risk of developing
gallstones and gallbladder disease.
- Unlike the lap band, the amount of restriction is not adjustable.
If you need a revision, it's another risky surgery.
- With any weight loss surgery, you may not maintain your weight
loss unless you eat a healthy diet and exercise regularly. That's why
long term follow up is important.
NOTE: Since this is a reasonably new procedure, many insurance
companies may not cover this surgery. Also, there is a lack of
published evidence for sustained weight loss beyond 3 years however even
with WLS surgeries on which studies exist, the evidence suggests that
most patients do NOT retain much weight off. The Swedish Obesity
study reported at the 10 year point after gastric bypass and VBG, the
average retained weight loss was 16 percent of the original weight and
that only 35 percent of those with diabetes were still "disease free"
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