Laparoscopic sleeve gastrectomy (LSG) is a restrictive bariatric operation. Without bypassing the intestines or causing any gastrointestinal malabsorption, the LSG procedure generates weight loss by removing 85% of the stomach. The stomach is resected vertically and reduced to a narrow tube.
The excellent weight loss success after LSG has been attributed to the removal of the portion of the stomach that is responsible for secreting Ghrelin, a hormone that regulates appetite and hunger. This causes loss or dramatic reduction of appetite.
Sleeve Gastrectomy And Gastric Dilation
Although LSG is quite effective in weight reduction, its success may be limited because of dilation of the gastric tube. This increases the capacity of the stomach and allows more food to be ingested, lessening the restrictive effect.
A Clinical Study
Can Gastric Dilatation Limit the Success of Sleeve Gastrectomy? This is the question Langer and colleagues set to answer by following twenty-three patients who underwent LSG. In this study, LSG resulted in successful weight loss not only in the super-obese but also in the morbidly obese patients with BMI lower than 50kg/m2.
Before the surgery, the patients’ weight ranged from 110-187kg (242-411lb). Eight of the 23 patients were classified as super-obese whereas the rest of them were characterized as just morbidly obese. After 1, 6 12 and 18 months the participants had lost 21%, 46%, 56% and 57% of their excess pre-surgery weight.
When super-obese and morbidly obese patients were compared in terms of the percentage of excess weight they lost, no significant differences where found in the 1 year follow-up.
Conversion of Sleeve Gastrectomy To Gastric Bypass: The Reasons
Re-operation after LSG is a possibility. In this study, two of the 26 patients had to convert their initial LSG surgery to Laparoscopic Roux-en-Y Gastric Bypass (LRYGB). The reasons for the two conversions were:
- Gastro-Esophageal Reflux Disease (GERD). Commonly known as acid reflux, GERD is the condition in which the liquid content in the stomach rushes upwards damaging the lining of the esophagus and causing inflammation. In this study, one patient experienced severe reflux at 15 months postoperatively, after having lost 98% of the pre-surgery excess weight. For this reason, the patient underwent re-operation to LRYGB.
- Weight Regain. In one patient, LSG did not achieve significant weight loss. In fact, one year after the surgery he had lost only 18% of the pre-surgery excess weight. At 2 years postoperatively he had regained all the weight. Therefore, he underwent conversion to LRYGB. Although three other patients experienced partial weight regain 20 months postoperatively, one of them being a female who became pregnant and delivered a baby, not any re-operations were performed.
One year after the LSG 14 of the 26 patients were examined for gastric dilatation. Only one patient presented dilation of the gastric tube and yet she had achieved a loss of 59% of her excess weight at the one year follow-up. At 30 months postoperatively her weight was stable and she was still reporting that she would feel full without having to eat a lot. “This indicates”, Langer points out in his paper, “that gastric dilatation does not necessarily lead to weight regain”
Although two of the 26 patients in this study underwent re-operation of LSG to LRYGB due to acid reflux and inadequate weight loss, and one patient presented gastric dilation, LSG was considered quite effective in weight reduction.