Laparoscopic Sleeve Gastrectomy

This is a relatively new approach. It is the first component of the duodenal switch operation and involves removing the lateral 2/3rds of the stomach with a stapling device. It can be done laparoscopically ( keyhole surgery) but is not reversible. It basically leaves a stomach tube instead of a stomach sack.

This is the first component of a BPD-DS where the stomach is reduced in size by removing the lateral 2/3rds leaving the stomach in the shape of a tube.

Sometimes it is offered to patients as part of a two stage Bypass operation particularly if they are super obese ( BMI>60) because it allows good weight loss until the patient gets down to a safe weight and the more radical bypass can then be offered laparoscopically when they are at a safer weight.

The residual stomach capacity is about 200mls so a generous entree should be possible.

Issues with Sleeve Gastrectomy

1. Stomach tube may stretch up over time leading to late weight regain. The extent of this is currently unknown
   
   
2. The amount of weight reduction is in the region of 40-60% of excess wt lost over the first 1-2 years
   
   
3. It is a good option for people living in remote areas because it is a "set and forget"
   operation which requires little post op follow up or nutritional supplements
   
   
4. There is no malabsorbtion to nutrients
   
   
5. If weight is regained the second stage of the BPD the intestinal bypass can be added