Introduction to Laparoscopic Sleeve Gastrectomy
The Laparoscopic Sleeve Gastrectomy Operation (LSG) is a relatively new weight loss surgery which was originally developed as part of a two-stage operation called a bilio-pancreatic diversion (BPD) or duodenal switch. BPD was devised for super-obese people to provide maximum weight loss. It consisted of doing a Sleeve Gastrectomy first, to achieve some weight loss, to be followed by a second operation where the small intestine was rearranged to cause mal-absorption of nutrients. Unfortunately the BPD carries a high complication rate and commonly resulted in severe vitamin and mineral deficiencies. However, it was noted that a number of patients had better than expected weight loss with just the Sleeve Gastrectomy, and did not require the second procedure. In 1997, a Concensus Conferece was held in New York City where the data was reviewed from multiple centers with experience in Sleeve Gastrectomy. The Bariatric Surgeons present (including Dr. Marvin) agreed that the outcomes supported offering the LSG as a primary operation to treat morbid obesity.
Although, according to the medical literature, the LSG does carry similar early post-operative risk as the Laparoscopic Roux en Y Gastric Bypass (LRYGB), it appears to have very few problems that occur beyond the first week after surgery. It does not have the long-term problems of the LRYGB, i.e., marginal ulcers, small bowel obstruction, or vitamin and mineral deficiencies. Similarly, there is no foreign body which can slip (prolapse) or erode into the stomach as can happen with the Laparoscopic Adjustable Gastric Band Operation (LAGB). Also, the LSG does not require adjustment, like the LAGB, and produces significant weight loss in the first few months.
Current data indicate that the weight loss from the LSG is superior in the first few years, as compared to the LAGB. An adequate comparison between the LSG and the LRYGB has not been done. However, weight loss in our series of patients has been within 10-15% of that noted after the LRYGB. Importantly, the co-morbidities that are associated with morbid obesity – diabetes, high blood pressure, high cholesterol, sleep apnea, etc. - also appear to be cured or improved in similar percentages as those achieved with the LRYGB. Long-term data is not yet available to ensure that results are long-lived. Despite this, we remain cautiously optimistic the LSG will continue to be an excellent choice as a surgical means of curing morbid obesity.