Laparoscopic Gastric Sleeve Operation - Questions Answered

In response to a recent posting on laparoscopic gastric sleeve operations I did in June 2011 I received several questions.

Pete S. from Columbus, Ohio asked about outcomes and frequency of the gastric sleeve operation nationally.

Pete, I returned from the American Society for Metabolic and Bariatric Surgery in June 2011 and I can tell you that the changes I am seeing in my practice is happening all over the USA and around the world. The frequency of gastric banding has dropped off rapidly and the frequency of the gastric sleeve is increasing rapidly as well. My practice is probably out ahead of the curve somewhat because I have been performing the laparoscopic gastric sleeve longer than many. My first gastric sleeve operation was performed nearly 4 years ago and I have probably performed about 250 of these operations to date.

My practice is now about 50% gastric bypass and 50% gastric sleeve with only one or two gastric bands a month. The gastric sleeve may even be more frequent than the gastric bypass although it may be too early to know for sure. I doubt that this would be the case across the country but the trend is clear.

In regard to outcomes, Across the country there is a range of weight loss from 50% of excess weight lost at 1 year to 80% of excess weight lost at 1 year. As I mentioned in the earlier blog posting I refer to above our average person who has a gastric sleeve loses 78% of their excess weight at 1 year after surgery for those who are at a BMI of 55 or less at the time of surgery. There are several likely reasons for this discrepancy.

1). Technical – Obviously the operation must be performed correctly. The sleeve should be narrow. However, it cannot be so narrow it causes an obstruction along the sleeve. I use a 32 French gastroscope for a sizer and make sure it is not too tight. This allows me to look at the size of the sleeve from the inside of the sleeve before completing the operation to make sure I am happy with the diameter.

One of the most frequent errors that probably contributes to inadequate weight loss is to leave too much room in the top of the stomach called the fundus. When this occurs the fundus is likely to dilate over time making the stomach too large and allowing too much food to be consumed at each meal. This can be corrected but will require an additional operation to remove the excess fundus.

2). Patient must be well prepared – The patient must be ready to make the necessary dietary and behavioral changes to get their best result. This includes being psychologically ready as well. Only participating in a bariatric surgery comprehensive program is likely to do this for most people.

3). Great long term care – It is important to see your bariatric surgeon often after surgery to make sure you are on track. I see my patients at 1, 3, 6 weeks and at 3, 6and 12 months. This allows for mid course corrections if you are not meeting expectations. Ask your surgeon how frequently you will be seen after the operation.

So Pete, hopefully this helps you to understand what is happening on the national scene.