Obesity Surgery

Description:

This rising restrictive procedure (<10 years) is based on reducing the size of the stomach, by removing 80-90% of the gastric volume, without any interference with the continuity of the digestive tube. This technique is also called “Calibrated Vertical Gastrectomy” and will give a “banana” shape to the stomach after stapling and removing the fundus of the stomach. Calibration is done over an orogastric tube that is introduced from the mouth into the stomach by the anesthesiologist before performing the stapling.
By removing this reservoir part of the stomach, that has the ability to distend, a feeling of an early satiety is obtained. Another important key to success of this intervention is its hormonal component. The removed gastric part is responsible for the secretion of an important hunger stimulating hormone (Grehlin) which explains the decreased appetite even after small meals. The operative time varies between 45 minutes and 1 hour.

Advantages/Disadvantages

The advantages of Sleeve Gastrectomy are:

• Simple, relatively safe procedure
• No interruption of the continuity of the digestive tube
• No anastomosis
• No foreign body
• Short operative time
• No dumpimg syndrome
• Short recovery period
• Few side effects
• Effective first stage procedure for high BMI patients
• Wide range of tolerated food

The disadvantages of Sleeve Gastrectomy are:

• Strict dietary compliance is required
• Not reversible
• Bleeding (staple line, spleen, liver)
• Gastric leak, fistula or abscess formation
• Gastro-esophageal reflux
• May require a second stage surgery in case of insufficient weight loss

Results

This intervention will achieve 70-100% EWL (Excess Weight Loss) during the first two years and 60-70% EWL in the 5th year on follow-up. The mortality rate of this procedure is very low: 0.05-0.7%.

The morbidity is also quite low with limited early postoperative complications. It is technically easy, safe and as effective as gastric bypass.
The redo surgery can be a re-sleeve gastrectomy or a plication over the sleeved stomach, a mini gastric bypass, a Roux-en-Y gastric bypass or even more complex surgery such as biliopancreatic diversion and duodenal switch (as a 2nd stage procedure)

Complications

Most patients will not have postoperative complications after Sleeve Gastrectomy, however it can occur. Early complications will depend on the patient’s health status.
These potential risks are not more dramatic than those of any open or laparoscopic procedure (such as appendectomy, hernia repair or gallbladder removal).

One should always keep in mind that the potential risks of obesity surgery are outweighed by its benefits. Thus all kind of possible complication are evoked and explained thoroughly prior to the procedure.

Specific complications for adjustable gastric band are:

• Deep venous thrombosis (clots of blood in the leg veins) and pulmonary emboli.
• Damage or bleeding from adjacent organ (liver, spleen, aorta, pancreas…) (1%)
• Gastric or esophageal leak (2-7%)
• Trocar site incisional hernia (2%)
• Stenosis
• Gastro-esophageal reflux disease (10%)
• Long term weight regain is possible
• Other general complications (allergy to medication, heart problems, problems from anesthesia, organ failure that may rarely lead to death (0.05-0.4%)

Our experience

We have successfully completed more than 506 Sleeve Gastrectomies since 2004. Considered as the pioneers of Laparoscopic Sleeve Gastrectomy in Lebanon, we are performing this procedure almost daily in our institution. The mid-term results are excellent with important excess weight loss in almost all of our series as published in IFSO 2011 (Hamburg), IFSO 2012 (Barcelona) and IFSO 2013 (Istanbul). “What makes our experience and success grow is your trust in us”.