The Laparoscopic Sleeve Gastrectomy is a relatively new operation that can be done either as a standalone procedure for those who don't have much weight to lose, for those who are older or higher risk, or as
part of a staged operation.
The weight loss with the Sleeve Gastrectomy has been running in the range of 55% to 75% of the excess body weight, depending on your circumstances. It has been shown to have better weight loss than the Lap Banding procedures.
If you are relatively young and otherwise healthy, able to exercise and are very good about following the program, you can many times exceed these averages, getting almost up to the kind of weight loss we would see with the RNY or the Dudoenal Switch.
Dr. Smith has been one of the leaders in laparoscopic techniques of performing the Sleeve Gastrectomy, having done them laparoscopically as part of the Duodenal Switch operation since 1999, and continues to be involved with teaching the technique to other bariatric surgeons.
This operation is the only bariatric procedure that has no malabsorption (as the RNY and DS do) and no foreign body issues (as the Lap-Band® does). There is a very low risk at the time of surgery, relative to the RNY and the DS, and an extremely low risk of needing another operation in the future, especially compared to Laparoscopic Gastric Banding procedures.
Weight Loss Mechanism
The reduction of the size of the stomach, to about 60 cc in volume results in a powerful restrictive weight loss. As a result, patients feel full after a very small amount of food, and therefore lose weight because they eat less, and they are happy eating less. There are also significant effects on the hunger mechanisms that make the weight loss seen with the Sleeve Gastectomy even better than would be seen just with a small stomach pouch. Hunger is favorably affected because there is a reduced capacity to produce Ghrelin, a substance that plays a role in how you feel and relieve hunger.
Preservation of Pyloric Valve
Also very important is the fact that it preserves the pylorus, the valve that regulates emptying of the stomach. This acts as "natures band" and allows food to hold up in the stomach for a while, making the person feel full while the food trickles out. Coupled with the fact that there is no rearrangement of the bowel, it also means dumping and marginal ulcers are not a problem. The normal satiety mechanism is enhanced by this mechanism.
The Sleeve Gastrectomy operation is done with 5 small incisions, and takes 45 minutes to an hour to do. Dr. Smith uses a small tube to size the Sleeve so that the diameter of the resulting stomach pouch is not too small or too large. He does a "leak test" in the operating room before he completes the operation. Having the Laparoscopic Sleeve Gastrectomy usually involves just an overnight stay in the hospital.
There is no drain or nasogastric tube. You are able to return to work, resume heavy lifting and strenuous activity, in most cases, in about two weeks from the time of surgery. If you are able to do light duty at work,
there is the possibility of going back to work sooner than two weeks.