Laparoscopic Sleeve Gastrectomy

sleev-gas

The following is general information about the sleeve gastrectomy but it does not and cannot take the place of detailed discussion with your surgeon. This information is not intended and must not be taken as personal medical advice.

Sleeve gastrectomy is now the commonest operation performed for obesity in Australia. Basically it is a reduction in the volume of the stomach which induces satiety (hunger satisfaction) with greatly reduced food volume. At LapSurgery we have been performing this procedure since 2006.

What Can a Sleeve Gastrectomy do for Me?

Sustained weight loss after sleeve gastrectomy can transform your life.

  • Energy levels may improve.
  • Problems with joint pain and mobility may be improved.
  • Resolution or improvement of current medical problems
  • Decreased risk of diseases such as diabetes, heart attack, stroke and cancers

What is a Sleeve Gastrectomy?

The normal stomach (which is NOT enlarged in obese patients) holds about 1.5 litres of food. We reduce the size of the stomach by resecting the “bulgy” bit of the stomach – see the diagram. The resected part of the stomach is removed completely. The remaining “sleeve” of stomach holds only about 150 mls, thus the stomach capacity is reduced by 90%.

How Does it Work?

The effect of the sleeve gastrectomy is that you can eat a very small meal, feel full and satisfied and the hunger you would currently feel after eating such a small meal does not occur.

What Are the Risks?

All surgery involves some risk. Risks can be broken down into two groups, those related to surgery in general and those specific to the operation being performed. Risks of surgery in general include risks of anaesthetics, infections inside the abdomen and in the wound, lung problems, blood clots in the leg or lungs and, very rarely, death. If you have other health problems such as heart or lung problems, diabetes, smoking the general risks of surgery are increased.

When assessing the risks of surgery you must also consider and balance the risks of NOT having the surgery and remaining significantly overweight

These will be discussed in detail with you prior to the operation by your surgeon. Possible complications include but are not limited to:

Complications Specific to the Sleeve Gastrectomy

Leakage – A Serious Complication

When we remove the stomach we use a stapling device to seal the stomach. A triple row of titanium staples seals the cut edges of the stomach. This produces a very secure closure of the cut edges of the stomach. However, right at the top edge of the stomach there can be a failure of the staples to seal fully. If this happens there will be a leakage of stomach contents into the abdominal cavity which can give rise to peritonitis. This usually only occurs in the first 2 weeks after the operation and occurs in about 1% of patients. If you have had previous stomach surgery such as a gastric band the leak rate is significantly higher and must be discussed thoroughly with your surgeon.

This is a very serious complication and could keep you in hospital for several weeks. Further operation may be required which may not be laparoscopic (keyhole) surgery.

The leak will eventually seal by itself or by other treatments and once this occurs the operation will work just as well as if the complication had not occurred.

Narrowing (Stenosis) of the Sleeve.

On rare occasions part of the sleeve will narrow and you may be unable to swallow foods properly. This is easily fixed in most cases by a simple gastroscopy and opening up the narrowed area with an inflatable balloon. In very rare cases it may not be possible to cure the problem and conversion to a gastric bypass may be necessary.

Dilatation (Stretching) of the Sleeve

This is uncommon and mostly seen at the upper end of the sleeve. Our preferred option in this situation is to convert to a gastric bypass.

Gastric Reflux (Heartburn)

Most patients will have some reflux in the first few months after a sleeve gastrectomy which may be controlled with acid lowering medications. A very small group of patients may experience very severe reflux not controlled by medication. In this instance conversion to a gastric bypass may be necessary.

Long Term Weight Gain

Unfortunately a small number of patients will either not lose the expected amount of weight or will at a later date put some of the weight back on. We have a comprehensive multi-disciplinary service that can help you get back on track.

Vitamin deficiency

Following weight loss surgery each patient has the potential of vitamin deficiency and LapSurgery Australia strongly recommends to all patients that they have a regular daily multivitamin in order to reduce the risks of other medical conditions such as osteoporosis, thiamine deficiency along and other vitamin and mineral deficiencies. More information is given to patients at the time of consultation with our dietitian.

Risks Common to All Types of Surgery

The following are the commonest of the complications but please note that this is not a comprehensive list of possible complications but does cover most events.

The Risk of the Anaesthetic.
Anaesthetic risks are extremely low because when you come to your operation any conditions which might increase your anaesthetic risk such as high blood pressure, diabetes or sleep apnoea will have been brought under control. All of our anaesthetists are experienced with dealing with the specific problems of patients with excess weight and have full access to all of the tests and information gathered during your preoperative assessment.



Bleeding.
Although uncommon, bleeding can occur during an otherwise routine operation and could require blood transfusion and possibly abandoning the laparoscopic (keyhole) approach for a major incision in the abdomen. Occasionally, after a routine operation, bleeding can commence some hours after an operation and require a return to the operating theatre.

Infections.
Again these are uncommon with laparoscopic surgery, but occasionally one of the small keyhole wounds can become infected and require antibiotics or drainage. Uncommonly, an infection inside the abdominal cavity or the chest can occur.

Damage to Other Organs.
Although uncommon, during laparoscopic surgery it is possible to inadvertently damage another organ such as the spleen or the bowel. Normally this can be diagnosed and repaired during the operation but very rarely this damage may not be obvious until some hours or even days after the procedure and will then require appropriate management.

Conversion to Open Operation.
Rarely, it is not possible to complete an operation with keyhole surgery and a full abdominal incision may be necessary. This is more likely to be the case if you have had previous surgery on your stomach such as a gastric band or stomach stapling.

Blood Clots to the Legs or Lung (Pulmonary Embolus)
Blood clots to the legs or the lungs are a very serious complication. At LapSurgery we use the maximum protection against this occurring. Shortly before the operation you will be given a blood thinning injection and have stockings placed on your legs. A further device will also be placed on your legs which keeps pumping blood through your legs whilst you’re asleep to minimise the chance of a clot forming whilst you are on the operating table.

Using these precautions and the early mobilisation after the surgery that is possible with the keyhole operation, these complications have been uncommon in our patients.

Reducing the Risks of Surgery

At LapSurgery, long before your operation takes place, you will undergo a comprehensive assessment of your health so that we can identify any risks and minimise these.

If, after your initial visit to the surgeon, you decide to go ahead with surgery we will arrange a comprehensive set of blood tests and an appointment with a specialist physician experienced in preparing patients for surgery and minimising any risks. Patients with significant weight problems will often have other conditions related to their weight (comorbidities) which, in many cases, can increase the risks of surgery. Poorly treated high blood pressure, poorly controlled diabetes, untreated sleep apnoea, vitamin deficiencies, urine infections and cardiac problems are often present and these MUST be treated properly before surgery. Sometimes this will involve other tests such as sleep tests, blood pressure monitoring and heart tests before we can go ahead with the surgery. The very high safety levels with which we perform this sort of surgery are very dependent on this initial thorough investigation and optimisation of treatment of comorbidities BEFORE surgery takes place.

One of the risks of this sort of surgery, often not listed in the usual complications, is the lack of education and understanding of both the preoperative preparation and the post-operative management of your lifestyle and dietary habits. We have a dietitian at LapSurgery to educate and supervise your weight loss journey. We are also very aware that years of frustration with your weight problems and some of the prejudice you will have faced about your weight can have an effect on your mental well-being and so all patients are seen initially by our psychologist as part of the assessment. Follow up counselling is available should you wish.

Conclusion

What you have read above is a summary of the operation of sleeve gastrectomy. This is not sufficient information in itself and every aspect of the sleeve, the preparation for surgery and the possible complications are always specific to an individual and must be discussed at length with your surgeon.

Good results are only achieved when you, the patient, are well informed and educated about the procedure and the operation is done by a dedicated, experienced multidisciplinary service such as we provide at LapSurgery.

We look forward to helping you.

When comparing costs, please be aware that our costs include all of the following:

  • Initial consultation with Surgeon
  • Pre-operative assessment with Specialist Physician
  • Clinical Psychologist consultation
  • Dietitian consultations inclusive of 1 x pre-operative, 3 x post-operative appointments
  • Surgeon, Assistant Surgeon and Anaesthetist
  • Access to on-call Surgeon at all times
  • Comprehensive after care at Medicare rebate (unless Medicare ruling changes)

Our operations are performed only in Private Hospitals. These costs can vary according to your particular private health cover. The out of pocket cost will range between $5000 and $7000 depending on the operation performed and Medicare and Private Health cover rebates. It may be possible to fund this out of pocket cost from your Superannuation, call us to enquire. Please telephone (03) 9760 2777, email: info@lapsurg.net.au or contact us here.

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The team at LAPSurgery Australia are recognised for their exceptional and major contribution to the Government sponsored Bariatric Safety Registry (BSR). The BSR tracks surgical complications and provides an unbiased safety record for weight loss surgery.

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FAQ

  • Mulgrave Private Hospital - Mulgrave
  • Knox Private Hospital - Wantirna
  • Peninsula Private Hospital – Frankston
  • St John of God Berwick Hospital - Berwick
  • Initial consult with Surgeon
  • Pre-operative assessment by Specialist Physician
  • (2) weeks prior you will have a consultation with the dietitian
  • (2) weeks prior you will have a consultation with our counsellor
  • (1) week prior a consultation with the pre-admission nurse of the hospital.
  • (1) week prior a final consultation with your surgeon
  • Post-operative appointment with LapSurgery Australia's Nurse (7-10 days post op)
  • Dietitian (1-2 weeks post op)
  • Surgeon and Nurse review (5-6 weeks post op)
  • Dietitian (3 months post op)
  • Surgeon and Nurse review (4-5 months post op)
  • Dietitian (6 months post op)
  • Specialist Physician review with comprehensive blood test (12 months post op)
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