Laparoscopic Sleeve Gastrectomy
The Laparoscopic Sleeve Gastrectomy (LSG), sometimes called the vertical sleeve gastrectomy (VSG), is an operation in which the left side of the stomach (greater curvature) is surgically removed. This is a restrictive bariatric surgery.
The surgeon creates a small, sleeve-shaped stomach that is roughly the size of a banana. It is generally done laparoscopically. It is larger than the stomach pouch created during Roux-en-Y (RNY) bypass. The Sleeve Gastrectomy does not involve any "rerouting" or reconnecting of the intestines. It is often simpler than the RNY gastric bypass. It does not require implantation of a device such as the adjustable gastric band.
Patients who have severe acid reflux or acid-related changes in their esophagus are not candidates for a sleeve gastrectomy. It is important to remember that this operation is not reversible because the stomach is removed.
Specific Risks of Laparoscopic Sleeve Gastrectomy
- Leak — The laparoscopic sleeve gastrectomy operation involves the division of the stomach. The sutured or stapled connection is referred to as a staple line. The staple line can leak, spilling intestinal contents into the abdominal cavity. This may result in pain, fever, peritonitis (inflammation in the abdominal cavity), sepsis or death. A recognized leak may require no treatment, antibiotic treatment, drainage or reoperation for correction.
Reoperation may be laparoscopic or through a traditional open incision. A staple line leak may result in a prolonged hospital stay, intensive care unit stay, mechanical ventilation (breathing machine), nutrition through intestinal tubes or intravenous lines and possibly death.
- Chronic Nausea and Vomiting — Nausea and vomiting is reported in a small percentage of gastric sleeve patients. Treatment may include medications, diet modification or possible reoperation.
- Stomach Obstruction — Stomach obstruction can result from the narrowing or twisting of the stomach sleeve. This may lead to persistent nausea and vomiting. A stomach obstruction may require reoperation. Narrowing of the stomach may require stretching or reoperation. Stomach obstruction occurs in less than 2 percent of patients.
- Gallstones — Rapid weight loss can cause gallstones and inflammation of the gall bladder. This may require removal of the gall bladder. The gall bladder may be removed at the time of gastric bypass surgery if gallstones are present. Additional risks of gall bladder surgery include, but are not limited to, bile leak, injury to the bile ducts, inflammation of the pancreas, retained stones in the bile ducts, and persistent pains similar to gall bladder symptoms. The high risk of gallstones can be reduced by taking a medication called Actigall twice daily for six months after gastric bypass surgery.
- Bleeding — Bleeding may occur from the stomach staple line. This may result in blood transfusions or reoperation.
- Acid Reflux — Acid reflux may occur in a small percentage of patients requiring diet modification, medications or reoperation.
- Conversion to an Open Procedure —There is always the possibility that a laparoscopic or minimally-invasive procedure such as Laparoscopic Sleeve Gastrectomy will be converted to an open procedure. This involves removal of laparoscopes and creation of a traditional long incision. This may be necessary because of bleeding, difficult anatomy, injury to other organs, scarring for previous surgery or failure of the technology required for laparoscopy. Conversion to an open procedure may result in a longer hospital stay, increased postoperative pain and more scarring. This occurs in approximately 5 percent of laparoscopic cases.
- Inadequate Weight Loss — There is no expressed or implied guarantee that a specific amount of weight loss or a specific rate of weight loss will result from this procedure. Weight loss may not be permanent. Failure may result from not following the recommended postoperative diet, exercise and follow-up exams. Inadequate weight loss may require additional surgeries to revise the bypass. Exercise is necessary to achieve maximum weight loss results.
- Reoperation — Any of the complications listed above and others not listed may result in a need for further surgeries. Reoperation may be necessary to confirm that a complication has or has not occurred. Plastic surgery procedures may be desired at a later date to remove excess skin and tissue resulting from weight loss. You will need to consult with your insurance carrier to determine if subsequent procedure costs will be covered.
- All Other Risks — It is not possible to list all potential risks and complications of any surgery. Results from this and any surgical procedure can vary from patient to patient.
- Death — Unexpected complications of anesthesia or surgery can result in death. Death occurs in less than 1 percent of gastric sleeve patients, some patient populations have higher risks. Some studies have reported up to 5 percent death risk.
Follow Up After Sleeve Gastrectomy Surgery
This is where the work begins. We will assess how we can best help you after your surgery. This is a life-changing operation, so don't be surprised if you encounter some challenges after surgery.
Routine follow-up appointments are scheduled at the following intervals (or more often depending on your particular situation):
- Sleeve Gastrectomy — Two weeks, three months, six months and one year.
There are specific laboratory tests that need to be done after your surgery. Tests are scheduled at the following intervals:
- Sleeve Gastrectomy — Three months, six months, one year and as needed. We will advise you on what labs are needed when we see you at your follow-up appointments.
Virginia Mason offers bariatric surgery services at two convenient locations in Seattle and Federal Way. You can reach the bariatric surgery team by calling (206) 341-1997 or toll-free at (800) 354-9527, ext. 11997.