Laparoscopic Banded Sleeve Gastrectomy (LBSG)

General Information

Banded Sleeve Gastrectomy is a surgical procedure that can be performed by miniinvasive (Video)surgery. The procedure reduces the size of the stomach to about 10% of its original volume and results in a limited capacity of food intake. Patients feel full after eating a very small amount of food. The volume of the stomach after LCSG is between 80 and 120 ml. In sleeve gastrectomy, the left side of the stomach is surgically removed by cutting and stapling. This results in a new stomach which is roughly the size and shape of a 20 cm tube. A silastic ring is implanted in upper part of the sleeve. This operation does not involve any “rerouting” or reconnecting of the intestines, it is a simpler operation than the gastric bypass. Also very important is the fact that the operation preserves the pylorus, the muscle that regulates emptying of the stomach. This acts as “natures own functional gastric band” and allows food to remain in the stomach for a while, making the person feel full while the food trickles out. Coupled with the fact that there is no rearrangement of the bowel, it also means dumping and marginal ulcers are not a problem. The normal satiety mechanism is almost always regained by the operation.

Laparoscopic Banded Sleeve Gastrectomy

Laparoscopic Banded Sleeve Gastrectomy – Facts

Duration of surgery

  • between 15 minutes and 1 hour

Anaesthesia

  • general anaesthesia

Hospitalisation

  • 4 - 7 days

Ring function

Adding a silastic band to sleeve gastrectomy might increase the success rate by preventing gastric tube dilatation. A ring diameter of 6.5 cm was chosen on the basis of quality of life and quality of eating studies performed in relation to the size of the ring in banding gastric bypass. However, it must be mentioned that, compared to conventional LSG, additional potential complications may occur using LBSG. These may include silicone band migration, dislocation or infection and dysphagia-related symptoms.

Indications for LBSG

  • BMI over 40 with contraindications for bypass surgery
  • no sweet eaters
  • no binge (volume) eaters
  • no stress eaters
  • accepts follow-up program
  • no heartburn
  • patients in whom there are clear contraindications against gastric bypass or BPD procedure
  • patients in whom it is assumed to be the only operative possibility to introduce surgical obesity treatment
  • patients who need to take medication which depends on exact and reliable intestinal resorption.

Typical LBSG Patient

  • Patient with BMI over 40 with contraindications for bypass surgery
  • no sweet eaters
  • no binge (volume) eaters
  • no stress eaters
  • Patient who accepts follow-up program
  • no heartburn
  • patients in whom there are clear contraindications against gastric bypass or BPD procedure
  • patients in whom it is assumed to be the only operative possibility to introduce surgical obesity treatment
  • patients who need to take medication which depends on exact and reliable intestinal resorption.

Advantages

  • may be used as the first stage of a 2-stage operation. (see below)
  • the operation eliminates the portion of stomach that produces the hormone ghrelin which stimulates hunger
  • low complications rate
  • technically a simpler operation than gastric bypass
  • does not require disconnecting or reconnecting the intestines

Disadvantages

  • Possibility of weight gain after 3 years
  • little is known about possible long-term complications of LSG
  • possible dilatation of stomach pouch after a while, resulting in a secondary operation
  • this procedure involves cutting and stapling of the stomach and therefore leaks and other complications related to stapling may occur
  • Ring-related complications
  • requires more diet discipline than gastric bypass

Operation Time

  • The LBSG procedure takes between 40 minutes to1 hour.

Technical description

Laparoscopic sleeve Gastrectomy reduces the size of the stomach through vertical surgical stapling. At the beginning, the large stomach curve is separated from the omentum majus. Afterwards the gastric tube (32 -34 F) is placed into the stomach. This allows safe and exact formation of the sleeve. The resection is performed using staples (GIA, suturing and cutting machine). The GaBP Ring is placed 60mm below the His angle and closed. The resected part of stomach is removed from the abdominal cavity. The stomach volume after such operation is between 80 and 120 ml.

Hospitalisation Time

  • The procedure requires a 4-to-7-night stay in the hospital after the operation.

After Surgery

After surgery, the patient must follow special diets and vitamin intake to lose weight in a controlled manner.

Lab Tests after LBSG:

  • Morphology1
  • Electrolytes1 in case of vomiting
  • Ferrum1
  • Creatinin in case of vomiting or low drinking rate
  • Haemoglobin A1c1 by DM

1. 1Mo, 3 Mo, 6 Mo, yearly

Supplementation after LBSG:

  • Multivit+minerals
 1 tab. per Day
  • Biotin, Selenium, Vitamin B9 (B11), Zink
 In case of hair problems

 

 

Bariatric Analysis and Reporting Outcome Score – BAROS 

  • Once a year

Standard Medication after Operation

  • PPI 20mg, 0-0-1 (3 Months)

Sport and physical activity

  • Three weeks after operation
  • 3 hours of physical activity per week but under sport medical supervision and medical advice.

Diet after LBSG

see: Diet after a Sleeve Gastrectomy