The sleeve gastrectomy is the most popular weight loss procedure in Australia, according to the Bariatric Surgery Register. This is based on its consistent, acceptable results and excellent safety.
In our view, it is the best primary bariatric procedure for most obese patients.
What is the procedure?
Laparoscopic (keyhole) surgery is used to remove most of the stomach, leaving a narrow tube with a capacity of 125ml but no obstruction to the passage of food other than the normal muscles.
Once a general anaesthetic has been administered, five keyhole ports are inserted into the patient’s abdomen. The operation begins by separating the stomach from the greater omentum (a fatty apron that hangs off the stomach and lays over our intestines). The diaphragm is then inspected for any signs of a hiatus hernia, and if present, a repair will be performed with the sleeve resection. A calibration tube or sizing tube is then inserted down the patient’s oesophagus and into the lower stomach to ensure the correct amount of the stomach is removed.
A stapling and cutting device is used to divide the stomach until it is completely separated from the portion of stomach that will remain. The remaining stomach is approximately 1/2 cup or 125ml in volume, which for most people, equates to a removal of between 70 and 80 percent.
The sleeved stomach is removed via the keyhole an for further examination at a pathology laboratory.
For many surgeons this completes the procedure. However, at Circle of Care, we perform additional laparoscopic stitching in order to try to prevent all known major complications of sleeve resection:
- We ‘imbricate’ or bury the top portion of the staple line (where leaks commonly occur) - a technique that has seen a zero percent leakage rate in over 2,163 operations.
- We then take the omentum and stitch on a fat patch over the buried staple line for further reinforcement.
- We insert a ‘cardiopexy’ stitch to prevent the new sleeve from migrating up into the chest, which would cause severe reflux, before placing final stitches to prevent twisting of the sleeve, which can cause intermittent obstruction.
All wounds are then closed with buried dissolvable sutures and local anaesthetic is injected to numb the port sites. Photo documentation is taken throughout the procedure in order to show our patients step-by-step how their procedure progressed.
How does it work?
With a patient’s stomach now much smaller, their appetite is significantly reduced. In fact, many patients report never feeling hungry and maintaining regular meal times as a discipline rather than being driven by a craving.
Additionally, only a small portion of food is required to achieve the feeling of satisfaction; this then leads to substantial weight loss over a 12-month period. About 70 to 80 percent of excess weight is lost over this timeframe, with some patients able to achieve 100 percent excess weight loss.
During this time, our allied health program will advise how to adapt your eating technique to get the most out of your sleeve and to support you in achieving long-term lifestyle change.