| WLS Procedures | Laparoscopic Sleeve Gastrectomy |
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The Sleeve Gastrectomy is a very popular staging operation. It is part of the Biliopancreatic Diversion with Duodenal Switch operation. The Biliopancreatic Diversion with Duodenal Switch is sometimes done in a staged manner by performing the Laparoscopic Sleeve Gastrectomy first, in order to reduce the risk that would be involved with doing the entire Biliopancreatic Diversion with Duodenal Switch Procedure at once. This is employed in situations where the Sleeve Gastrectomy portion of the operation might induce a substantial weight loss over a period of time such that the remainder of the Duodenal Switch Procedure could be performed at a much lower weight, and therefore at much lower risk. The laparoscopic sleeve gastrectomy is a relatively new operation that can be done either as a stand-alone procedure for those who don't have much weight to lose, or as part of a staged operation for high risk patients. The weight loss is projected to be in the range of 45 to 55% of the excess body weight, which is comparable to that of the Laparoscopic Adjustable Gastric Banding Procedures. Preservation of the Pyloric Valve is an important advantage of the sleeve because it preserves the pylorus, the valve that regulates emptying of the stomach, with preservation of several centimeters of the duodenum. This means dumping and marginal ulcers are much less a problem than with the Roux-en-Y Gastric Bypass. The entire procedure is performed laparoscopically. The small stomach pouch is created by using stapling devices. The pouch is created to be small - about 120cc in size. The remaining stomach is removed. The gastrointestinal tract is not altered. The stomach size is simply reduced. The operation restricts food intake very effectively, particularly during the first year, the time of maximum weight loss. Ultimately a sleeve gastrectomy patient will be able to eat about a cup to two of food per meal three times a day, experiencing prolonged satisfaction and fullness from that amount of food while losing weight. Hunger and cravings are controlled, particularly if patient is compliant. This is a profound experience for many, being released from a prison of hunger. The average expected weight loss with the Sleeve Gastrectomy procedure alone in the first year is comparable to that seen with the lap-band - about 45% to 55%. Proceeding with weight loss surgery is a very personal and often difficult decision. Educating yourself about weight loss surgery is a very important first step. Although the information presented here may be very helpful, patients have repeatedly told us that attending the weight loss surgery informational seminar helped the most. For those of you who are not from Kansas, we treat many patients from out-of-state, and from all across the United States. When contacting the office please inform the staff that you are out-of-state and access our out-of-state link for more information on how we can help you with the preparatory process. << Back to Top >> Am I a Sleeve Gastrectomy Candidate? To be a candidate for any type of weight loss surgery, the individual must be morbidly obese. Below are tools you can use to determine if you are morbidly obese and potentially a candidate for the Sleeve Gastrectomy. If you determine you are morbidly obese you are a candidate for the Sleeve Gastrectomy. There are several medically accepted criteria for defining morbid obesity. You are likely morbidly obese if you:
Morbid obesity is usually defined as being 100 pounds over the ideal body weight. A better way of defining morbid obesity is by using the Body Mass Index (BMI). BMI is a calculated number that takes weight and height into consideration. A person weighing 300 pounds that is 5ft tall will have a higher BMI than a person weighing 300 pounds but is 6ft tall. A BMI above 40 indicates that a person is severely obese and therefore a candidate for surgery. Surgery may also be an option for people with a BMI between 35 and 40 who already suffer from cardiopulmonary problems or diabetes. << Back to Top >> How Does the Sleeve Gastrectomy Work? The Sleeve Gastrectomy maintains the principles of restriction. The small pouch restricts food intake and helps maintain satiety. The size of the pouch limits how much food you can eat at any one time. The longer the pouch is full the longer you experience satiety and no hunger. The restriction in food intake is the same as in the duodenal switch or biliopancreatic diversion. It is most effective in the first year or two. Afterwards a decision to proceed with a second operation is made. There is no alteration of the GI tract, the stomach size is simply reduced. Surgery alone will not ensure long-term success. Surgery is a great tool, something to help patients do the work, to reach their health and weight loss goals. The operation will help and to a degree force patients to change their eating habits for life. Please access The Sleeve Gastrectomy Diet Guide to learn more about the nutritional and life style changes. << Back to Top >> The medical and emotional benefits of the Sleeve Gastrectomy procedure begin almost immediately after surgery, and the cosmetic benefits follow their wake. Over time the benefits of Sleeve Gastrectomy surgery may include:
With the Sleeve Gastrectomy, patients lose around 50% of their excess weight within one and a half years. Half of that weight is lost in the first 6 months. Weight regain is more common with purely restrictive operations. Research is in progress determining the efficacy of the Sleeve Gastrectomy as a stand-alone weight loss procedure vs. as a staging operation. The co-morbidities of clinically severe obesity begin to resolve before complete weight loss occurs. These include better control or cure of diabetes; lowered or normalized blood pressure and cholesterol; relief from sleep apnea, severe acid reflux, and urinary stress incontinence; eased lower back, knee and hip pain. Patients also report enhanced mobility. Many conditions, such as evolving heart disease, have been arrested or its progression significantly slowed. << Back to Top >> As with all surgery, there are risks. Patients considering surgery must weigh the risks and benefits of surgery against the severity of their obesity. The decision to proceed is based on the premise that the treatment should be less harmful than the disease being treated. Complications can occur as with any type of surgery; please review Risks and Benefits of Surgery for a more detailed list. Below is a list of some specific complications that are unique to the Sleeve Gastrectomy procedure:
<< Back to Top >> Deciding on the Sleeve Gastrectomy The decision about which operation is best for you is a complicated one. Although the information presented here may be helpful, you will be able to learn substantially more about the benefits and risks of the Sleeve Gastrectomy operation during your consultation with the bariatric surgeon or at our free weight loss surgery informational seminars. To arrange an appointment call (913) 322-7401. << Back to Top >> Post-operative support can greatly help patients improve upon their weight loss success. Our weight loss surgery program has a comprehensive post-operative support program. We encourage patients to take advantage of the informational seminars, nutritional classes, behavior modification classes, and social support groups offered. There is a lot of information we have introduced to you and want you to understand. The support programs are designed to motivate you, as well as continue your education in the area of nutrition, behavior modification, and your weight loss operation. Patients who have weight loss surgery must have lifelong medical follow-up. Our surgeons want to meet with you on a regular basis particularly during the first and second year when rapid weight loss occurs. Your primary care doctor is also a very important extension of your post-operative care. As you start losing weight your medical problems will start improving and you may not require the same dose of your medications. Together we monitor and adjust your need for medication. The long term side effects of weight loss surgery can be subtle, and can appear months to years after the surgery. As mentioned above, nutritional and vitamin deficiencies are possible, but are successfully managed with supplements. Protein malnutrition is potentially a major problem, but it is rare with proper follow-up. << Back to Top >> Proceeding with weight loss surgery is a very personal and often difficult decision. Educating yourself about weight loss surgery informational seminars is a very important first step. Although the information presented here may be very helpful, patients have repeatedly told us, that attending the weight loss surgery helped them the most. At the seminar, you will be able to separate fact from fiction, meet the surgeons, ask questions, and hear testimonials from patients who have already undergone weight loss surgery. The patient testimonials are often the highlight of the seminar. Individuals considering weight loss surgery enjoy talking to patients and getting first hand accounts of how the operations have worked for them and how it has changed their lives. The next step is to meet in consultation with the surgeon. The visit has multiple purposes: determine your health and operative risk, discuss which operation may be best for you, answer your specific questions and concerns, and start the preparatory process toward getting insurance pre-approval and scheduling your surgery. You can save about 45 minutes of your time at the doctor’s office by filling out the New Patient Forms prior to coming for your doctor consultation. While waiting for your insurance approval or obtaining your medical work-up, start reading the Preparatory Guide and the Sleeve Gastrectomy Diet Guide. These will prepare you for your surgery as well as what to expect after your operation. For further questions do not hesitate to contact the office at (913) 322-7401. << Back to Top >> About Medical Insurance Coverage To determine if your insurance policy covers obesity (or "weight loss") surgery, please refer to the policy information that all insured people receive after they have paid their first premium, or if they have chosen a plan offered by their employer. Some policies will automatically exclude bariatric surgery. Others may have certain criteria about which bariatric procedures they cover, and how much of the costs they cover. At the time of the seminar our office staff is present and can help you read and interpret your policy information if you have it with you. After your consultation with the surgeon our office obtains pre-authorization for you from your insurance company. For more information about insurance coverage for obesity surgery, please access About Medical Insurance Coverage. << Back to Top >> |
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