Laparoscopic Sleeve Gastrectomy Overview
If you are severely overweight, obesity surgery may be an option for you. Obesity surgery is also called bariatric surgery. Your doctor may recommend it if you have a body mass index (BMI) higher than 40. A BMI of greater than 40 typically means that you are about 100 pounds overweight. One of the newer options for bariatric surgery is called laparoscopic sleeve gastrectomy (LSG).
The LSG procedure
LSG surgery is done in a hospital under general anesthesia. Your surgeon will make about five small cuts in your belly. He or she will do the surgery using a thin, long, flexible telescope with a tiny camera at the end. Instruments pushed through the incisions will be used to remove about 80% of your stomach. Your surgeon will do the procedure using images on a TV screen in the operating room.
This surgery takes out the part of your stomach that curves outward, 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, hence the name "sleeve gastrectomy." Because you will have a much smaller stomach, you will fill up quickly at mealtimes and eat less.
The fundus contains most of the area of your stomach that secretes a hormone called ghrelin. Because ghrelin may be partly responsible for making you feel hungry, taking out this part of your stomach 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 so you can then safely have a more extensive type of weight-loss surgery such as a gastric bypass or duodenal switch with biliopancreatic diversion. The risks with some forms of bariatric surgery are much higher for people with a BMI over 60.
If you are older or have other risk factors for surgery like heart, lung, or liver problems, LSG may be a safer option for you than other longer and more complicated weight-loss surgeries.
If you have a BMI of about 40 to 50, your doctor may recommend LSG as the primary weight-loss surgery. That's because it's less likely to cause side effects, such as stomach ulcers or poor food absorption than other forms of weight-loss surgery.
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, 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 quite 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:
Leaking of stomach juices from where the stomach has been removed
Blood clot that forms in your leg and travels to your lung
Narrowing of the inside diameter of the new stomach
To help protect against GI problems and weight regain, you should continue to have careful follow-up past the third year after surgery.
Weight loss after LSG slows down after a few years, and your stomach may stretch and grow. For any bariatric surgery to succeed, you must make important lifestyle changes that include both better nutrition and regular exercise.
Be sure to discuss any type of weight-loss surgery carefully with your doctor. Before surgery you will need to have a complete physical exam to make sure you are healthy enough to have the procedure. You should also receive nutritional and mental health counseling to make sure you are prepared for what to expect after surgery.
- Foster, Sara, RN, MPH
- MMI board-certified, academically affiliated clinician