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Bariatric Surgery

Laparoscopic sleeve gastrectomy offers a lower risk alternative to the gastric bypass procedure

04/09/2009

Stomach messureSome individuals seeking weight-loss surgery are considered to be high-risk candidates for the more common procedures including laparoscopic gastric bypass (LRYGB) or biliopancreatic diversion/duodenal switch (LBPD/DS). In these cases, a sleeve gastrectomy (SG) can be performed as the first of a two-stage procedure that ultimately includes either the LRYGB or BPD/DS.

SG is a simpler laparoscopic procedure that does not involve rerouting the digestive tract, minimizing tissue trauma and promoting a speedier recovery. During the sleeve gastrectomy, the stomach is completely partitioned using surgical staples and approximately two-thirds of it is removed. Sleeve gastrectomy avoids some of the complications associated with the other major bariatric operations, including intestinal obstruction and anastomotic strictures, and as a purely restrictive procedure, it significantly reduces the risk of malabsorption of nutrients, including proteins, minerals and vitamins.

Advantages of sleeve gastrectomy

Patients typically lose enough weight following SG to significantly reduce their risk profile. If necessary, they can then undergo a more definitive second bariatric procedure. On average, sleeve gastrectomy patients lose 50 to 70 percent of their excess body weight in the first year. This compares favorably with the 30 to 40 percent and 60 to 80 percent excess weight loss rates associated with adjustable gastric banding and gastric bypass operations, respectively. Its effectiveness has been compared to and found to be superior to adjustable gastric banding, without the potential foreign-body and port complications or the need for frequent postoperative adjustments.

Sleeve gastrectomy may also be used as a stand-alone procedure for certain morbidly obese patients who are not candidates for the other bariatric procedures. These include patients with inflammatory bowel disease (IBD) or multiple previous abdominal operations with the resultant formation of excessive intestinal adhesions, or those with certain medical conditions whose treatment requires an intact digestive tract. Sleeve gastrectomy may also be indicated for patients who require weight-loss prior to urgent non-bariatric surgeries, such as those for cancer or orthopedic injury.

Despite its excellent short- and medium-term results and safety profile, sleeve gastrectomy is a relatively new procedure and its long-term outcomes are unknown. As with other bariatric surgeries, durable results will depend upon behavioral and lifestyle changes that support the procedure’s weight-loss objectives.

UCLA bariatric program

The UCLA Laparoscopic and Robotic Bariatric Surgery Program offers a range of surgical treatments for obesity and has been designated a Bariatric Surgery Center of Excellence by the American Society for Metabolic and Bariatric Surgery. The UCLA team lays the foundation for successful postoperative outcomes by providing its patients with a thorough preoperative education, preparation and support program. To ensure positive outcomes, UCLA physicians favor an aggressive postoperative approach to patient care, coordinating this with the patient’s own primary care physician.

Stomach partitioning cuts risk for later intestinal bypass

Laparoscopic sleeve stomach“With sleeve gastrectomy, two-thirds of the stomach is physically removed,” explains Amir Mehran, M.D., director of Bariatric Surgery at UCLA. “As a result of this size restriction, patients lose a lot of weight and are much smaller and healthier.”

Sleeve gastrectomy is often performed as the first part of a two-stage gastric bypass procedure. Sleeve gastrectomy, which does not involve redirection of the small intestine, results in weight loss that make high-risk patients much less risky for the bypass procedure, says Dr. Mehran.

Sleeve gastrectomy also works well as a stand-alone operation in patients who are not candidates for the full bypass procedure, or for those who need to lose weight before another nonbariatric procedure.

Participating Physicians

Amir Mehran, M.D., F.A.C.S.
Assistant Clinical Professor of Surgery
Director of Bariatric Surgery

Erik Dutson, M.D.
Assistant Clinical Professor of Surgery
Director of Minimally Invasive Surgery Fellowship
Co-director, Center for Advanced Surgical
& Interventional Technology (CASIT)

Contact Information

(310) 206-7235 Physician Referral
(310) 825-7163 Bariatric Program
(310) 267-4632 Fax
www.bariatrics.ucla.edu  





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