Laparoscopic Conventional Sleeve Gastrectomy (LCSG)

Indications for LCSG

• BMI mostly over 50
• BMI 35- 50 with contraindications for bypass surgery or band implantation
• Well-motivated (accepts nutritionist and psychological criteria)
• no sweet eaters
• no binge (volume) eaters
• no stress eaters accepts follow-up program
• no heartburn

Advantages

few complications does not require disconnecting or reconnecting the intestines technically a simpler operation than gastric bypass 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

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 involves cutting and stapling of the stomach and therefore leaks and other complications related to stapling may occur requires more dietary discipline than gastric bypass

Operation Time

• The LCSG procedure takes between 40 minutes and one hour.

What is a 2-Stage Operation?

Certain patients may have a body shape that makes their surgery more technically difficult. For example, patients with a BMI over 60 — particularly those who carry their weight in their belly area — may be at increased risk for bariatric surgery. If you fall into this category, you may benefit from 2-stage bariatric surgery. In the staged approach, a multi-step operation like the gastric bypass or the duodenal switch is broken down into 2 simpler and safer operations. In the first stage, a sleeve gastrectomy is performed. This allows you to lose 80 to 100 pounds (ca. 40-50 kilos/ca. 6.5-8 stones) or more, which will make the second part of the operation substantially safer. The second stage operation is usually performed 8 to 12 months after the first. The “sleeve” stomach is converted into a formal gastric bypass. This will permit additional weight loss. Both stages of the surgery can be performed as key hole surgery, with the advantages of shorter recovery, shorter incisions, fewer incision-related problems and less pain.

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 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 LCSG:

• 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 LCSG:

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 LCSG