Laparoscopic Sleeve Gastrectomy
What is Gastric Sleeve Surgery?
Bariatric surgery (surgery for obesity) includes several different types of operations. Laparoscopic sleeve gastrectomy or gastric sleeve is a relatively new weight loss procedure that reduces the size of the stomach from a sac to a narrow tube. Weight is lost because of early satiety (the feeling of fullness after eating), largely due to the smaller size of the stomach. Also, some appetite stimulating hormones normally produced by the stomach are reduced by the procedure. Apart from this, the stomach digests calories and nutrients in an almost normal way.
After surgery, patients start on liquids before moving to a pureed diet while the stomach heals. Several weeks after gastric sleeve surgery patients progress to eating three small meals a day of normal consistency food. Entree sized meals are enough to produce a sensation of fullness, making it easier for patients to limit the amount they eat.
Why would I need this procedure?
Bariatric surgery reduces the risk of death from obesity. Many obesity-related conditions, such as type II diabetes, obstructive sleep apnoea, joint pain from arthritis, high cholesterol and high blood pressure, are either completely resolved or substantially improved.
Most patients achieve good to excellent weight loss results following gastric sleeve surgery; typically this is 60 to 70 per cent of excess weight. Patients lose most of their excess weight in the first year and can lose more weight over the next six to 12 months. Weight will usually stabilise after this. There can be some weight regain, but this is usually minor. There is no amount of weight loss that is guaranteed.
How do I prepare for this surgery?
Please contact your specialist at least five days before the test if you are:
- Taking blood thinners/anticoagulants i.e. Warfarin, Clopidogrel (Plavix), Dabigatran (Pradaxa), Enoxaparin (Clexane), Ticagrelor (Brilinta)
- Taking Lithium medication
- Suffering with a heart, lung or bleeding condition including having a pacemaker, heart valve disease or replacement
- Suffering with kidney disease
2-3 weeks before surgery you commence the OPTIFAST diet, a very low-calorie diet (VLCD) that is <800kcal per day that completely replaces your meals/ diet (Nutritionally complete).
If you smoke, you should attempt to restrict this for at least two weeks prior to surgery.
Try to increase your physical exercise for at least 2 weeks before surgery as well to help you be in the best condition for your procedure.
Hospital staff will contact you and obtain your personal health history and may call you to clarify any information.
You will also be contacted by the customer service team to give you fasting instructions, time of arrival and to finalise payment arrangements.
What happens during surgery?
The sleeve gastrectomy is done by laparoscopic surgery, which involves several very small incisions, rather than open surgery, which uses one large incision. Harmless CO2 gas is introduced into the abdomen, inflating it, and creating a space for the surgeon to work. The surgeon introduces a long narrow camera and surgical instruments, and uses these to perform the procedure.
Laparoscopic procedures have the advantages of less pain, a shorter hospital stay, and a quicker recovery, as well as a significantly reduced risk of wound infection or wound hernias. If, for some reason, your surgeon cannot complete the procedure laparoscopically, he can switch safely to the open procedure. The chance of this happening is low and would only be done in your best interests.
How long will I need to stay at the hospital?
Usually patients recover after a two night stay and are ready to go home. After surgery, patients start on liquids before moving to a pureed diet while the stomach heals.
Healthy lifestyle changes, with improved diet and regular exercise, lead to a better outcome after the surgery. The laparoscopic gastric sleeve procedure is best seen as a tool that makes these lifestyle changes achievable for most patients.
For more information on what to expect before and after your procedure, please click on the links below:
Why would I need a gastroscopy?
Your specialist may recommend this test if you have symptoms such as:
An endoscopy can be used to see if you have:
Having a Gastroscopy?The journey explained, from consultation to follow up in
a short video below.
What happens during a gastroscopy?
You can stay in your own clothing and your nurse will take you to the room where you will have the gastroscopy. To help you relax and be as comfortable as possible, the back of your throat will be sprayed with a local anaesthetic. You may be given a sedative as an injection through a vein in your hand. The medicine may make you feel sleepy and afterwards you might not remember having the test.
You will be asked to lie on your side and put a plastic mouth guard between your teeth. This protects your teeth and stops you biting the endoscope. Your specialist will ask you to swallow the first part of the endoscope. Your specialist will pass the endoscope gently down your food pipe, into your stomach and the first part of the intestine. Your specialist watches the video screen for anything unusual. Gas is passed down a channel in the endoscope into the stomach to make the stomach lining easier to see. This may make you feel full and want to belch.
Your specialist may pass an instrument through the endoscope and take a very small piece of the gut lining (biopsy). This should not be painful. The biopsy can be looked at under a microscope to identify many conditions and your specialist may take a biopsy even if cancer is not thought to be the problem. The endoscope is then gently pulled out.
A gastroscopy takes about 10 minutes. (It can be uncomfortable but it is not usually painful).
After having the procedure
If you have had sedation you must be taken home by a responsible friend or family member and be cared for that day and night, or have someone on hand in case of any problems.
For at least 12 hours after sedation you must not:
- Drive a car or motorcycle (this is against the law)
- Operate machinery
- Make any important decisions or sign any legal contracts (the medicine used may temporarily reduce your understanding/impair judgment)
- Drink any alcohol or take sleeping tablets.
Will I need to stay overnight at the hospital?
A gastroscopy is a day-stay procedure, which means you can go home after the test. You must be taken home by a responsible friend or family member and be cared for that day and night, or have someone on hand in case of problems.
For more information on what to expect before and after your gastroscopy, please click on the links below to download our information pamphlets.