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Winter 2007

Less Invasive Surgery for Morbid Obesity Offered

A relatively new type of surgery has emerged as an attractive option for certain patients who are considered morbidly obese. The sleeve gastrectomy is less invasive than gastric bypass surgery, the current gold standard for weightloss operations, says Amir Mehran, M.D., director of UCLA’s Bariatric Surgery Program.

The minimally invasive procedure partitions a portion of the stomach into a tube with a stapling device and removes the rest. “Whereas the gastric bypass creates a small gastric pouch and re-routes part of the intestine, this is a straight-forward trimming of the stomach to roughly one-third of its previous size,” explains Dr. Mehran.

Although the surgery is too new for long-term outcomes, preliminary evidence suggests that patients are losing 40 to 60 percent of their excess weight in the first one to two years, with a significantly lower risk of complications when compared with the bypass procedure. “It has been called the ‘adjustable band’ that does not need adjusting,” says Dr. Mehran. The smaller stomach size facilitates dieting efforts by producing a sense of fullness after healthier amounts of food consumption, and the weight loss reduces the risk of chronic conditions such as hypertension, diabetes, heart disease, stroke and sleep apnea.

 The best candidates for the gastric sleeve are patients who would be considered high-risk for the bypass procedure, either because of too-high body mass index, multiple previous intra-abdominal surgeries or a history of inflammatory bowel disease. For many of these patients, performing the gastric sleeve first can reduce that risk, enabling the subsequent bypass surgery if necessary, Dr. Mehran explains. It may also be utilized in cases where significant weight loss is required prior to another major operation, such as orthopaedic, spine or cancer operations. Further indications for the sleeve gastrectomy will be reviewed on a case-by-case basis.

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