Laparoscopic Sleeve Gastrectomy
Laparoscopic Sleeve Gastrectomy is a popular restrictive bariatric operation. It is reported that patients lose between 60-70% of their excess weight. The operation is done under general anaesthesia and is performed laparoscopically through four or five small incisions. Around 80% of the patient’s left portion of the stomach is being removed. What is left is a ‘banana’ shaped stomach.
The nerve supply to the stomach is preserved so the food arrival into the duodenum (first part of the small bowel) will beslow (although faster than before the operation) and gradually leading to prolonged satiety, early fullness. Dumping syndrome is a rare side effect after a sleeve gastrectomy (a common side effect after a gastric bypass).Another mechanism of weight loss results from changes in a gut hormone called ‘Ghrelin’ which is secreted in the fundus of the stomach which has now been removed. The reduction in this hormone causes a reduction in appetite so the patient feels less hungry.With these two mechanisms working together most patients successfully lose up to 70% of their excess weight.
Laparoscopic Sleeve Gastrectomy is not indicated for patients with reflux disease, large hiatal hernias and sweet eaters. Acid reflux is a common side effect after the sleeve gastrectomy as up to 20% of patients will develop new heartburn. Rarely a sleeve needs to be converted to a Roux Y gastric by-pass because of reflux symptoms.
Like all weight loss surgery procedures, the Sleeve Gastrectomy is a tool. Used correctly and following the advice given by Dr Papoulas and his team, you can expect to achieve a weight loss of between 60-70% of your excess body weight. You will need to make lifestyle changes to work with the procedure. The more you are willing to change, the better the results you can expect.
Image 1. Laparoscopic Sleeve Gastrectomy
Laparoscopic Mini Gastric Bypass
Laparoscopic Mini Gastric Bypass uses a combination of malabsorption andrestriction to achieve the result of weight reduction.Because a mini gastric bypass closes off a large part of the stomach and delays food from entering, it is able to limit the volume of food that the stomach can hold and decrease food intake.It also bypasses around 2 meters of small bowel hence the malabsorption effect.
The mini gastric bypass creates a long stomach pouch (15cm approximately), which is divided from the rest of the stomach. No food can then enter the rest of the stomach which is below the staple line. The stomach does continue to produce the enzymes and gastric juices which are important for digestion, as well as the absorption of nutrients.
The pouch in the mini gastric bypass is longer than in the Roux en Y gastric bypass to avoid reflux of bile in the oesophagus. The mini gastric bypass is performed with key holes surgery, usually 4 small incisions, and takes around 90 minutes to be completed. The average hospital stay is 2 days. Patients are routinely followed up by the surgeon and the dietitian in close intervals.
The downside of the mini gastric bypass compared to Roux-en-Y Bypass is reflux of bile. Patients with bile reflux symptoms may need the mini gastric bypass converted to a Roux en Y gastric by pass.
Like all weight loss surgery procedures, the Mini Gastric Bypass is a tool. Used correctly and following the advice given by Dr Papoulas and his team, you can expect to achieve weight loss of between 70-75% of your excess body weight over 2 years.You will need to make lifestyle changes to work with the procedure. The more you are willing to change, the better the results you can expect.
Image 2: Laparoscopic Mini Gastric Bypass creating a long gastric pouch and performing a single gastrointestinal anastomosis bypassing around 200cm of small bowel.
Laparoscopic Roux-en-Y Gastric Bypass
Laparoscopic Roux-en-Y Gastric Bypass (RYGB) combines malabsorption andrestriction to achieve the result of weight reduction.
There are two stages to this operation. In the first part, the stomach is divided into two parts using a surgical stapler.The smaller part of the stomach is then joined (anastomosis) to the second part of the small bowel (jejunum).During the second part of the operation a new joint (anastomosis) is made between the jejunum and the jejunum to allow food to reach the remaining part of the small bowel and avoid reflux of acid and bile into the oesophagus.
Food no longer passes through the entire length of the intestines but instead leaves the small pouch and enters the second part of the jejunum bypassing the most of the stomach and the first part of the small bowel (duodenum and part of the jejunum).A Gastric Bypass produces excellent weight loss (approximately 70% of the excess body weight)and in different ways which are not completely understood.The hormone Ghrelin is secreted in a different way and so the patient will no longer feel hunger in the first few months after having the operation.The gut hormones will be secreted as they used to before the excess weight was put on so often Type 2 diabetes goes into remission.
RYGB is performed via 5 tiny incisions and takes around 2.5-3 hours. The average length of stay is 2-3 days. Patients will be followed closely thereafter by the bariatric team including regular appointments with Dr Papoulas and the clinical dietitian.
Some of the vitamins and electrolytes (calcium, zinc and others) will need to be supplemented for life as they are usually absorbed in the part of the stomach and small bowel by-passed.Like all weight loss surgery procedures, the Gastric Bypass is a tool. Used correctly and following the advice given by Dr Papoulas and his team, you can expect to achieve weight loss of between 70-75% of your excess body weight over 2 years.You will need to make lifestyle changes to work with the procedure. The more you are willing to change, the better the results you can expect.
Image 3: Laparoscopic Roux-en-Y Gastric Bypass creating a small gastric pouch, an alimentary limb (green arrows) around 150cm long, a biliopancreatic limp (red arrows) around 50cm long and a common channel where the food (green arrows) is mixed with the digestive juices (red arrows).