LAPAROSCOPIC SLEEVE GASTRECTOMY

What is laparoscopic sleeve gastrectomy?

                Sleeve gastrectomy 

Laparoscopic sleeve gastrectomy is rapidly becoming most commonly performed procedure, first performed in 1988 as first stage of duodenal switch after this procedure the patient was seen to loose weight rapid / sustained  weight loss observed. 

Bariatric surgery is the most common performed gastrointestinal surgery in the USA.Obesity is the most second living cause of the preventable death. 

Laparoscopic  Gastric Sleeve is a minimally invasive surgery  or Vertical sleeve gastrectomy is the most popular weight loss surgery. It is done by removing a large portion of your stomach about 70-80% portion of stomach. The stomach you are left with is narrow and long, shaped like a banana. 

Main cause of sleeve gastrectomy is morbid obesity. Laparoscopic sleeve gastrectomy is a safe procedure and durable bariatric procedure that can be done in a minimally invasive manner. 

The stomach makes a hormone called ghrelin, which your brain receives and signals appetite to increase. With so much of the stomach cut out, ghrelin levels drop, so you experience less hunger and craving. So it works through both reduced capacity and reduced hunger.

Advantage of laparoscopic sleeve gastrectomy :

1. Bariatric surgery causes long-term remission of difficult-to-control type 2 diabetes.

2. Weight loss surgery decreases the risk of heart diseases and control your blood pressure.

3. Obese people feel depressed due to poor body image but after the surgery they feel more happy about their body image and feel very confidence for everything.

4. Due to excessive weight, it puts a lots off stress on the bone due to which obese people have pain in their joints, but after surgery their will be no joint pain.

5. It's get difficult for obese women to conceive or get pregnancy,  but baraitric surgery improve the fertility which will help in pregnancy.

6. Sleeve gastrectomy surgery decreases the risk of metabolic syndrome, pregnancy complications, gallbladder disease and high blood pressure, diabetes, joints pain or more.

Pre-operative instruction for the patient: 

If patient taking blood thinners like aspirin, plavix, coudamin discuss with surgeon whether patient should continue or stop medication before surgery. 

If patient smoke its stop before the surgery because its increasing the risk of complications. 

Don't eat or drink anything after midnight or night before come to the hospital. 

Leaves valuable or costly items and accessories at home but come with medical insurance card and identity card

Pre surgery patient get epidural pain catheter for helping to reduce pain after the surgery. 

Pre surgery catheterization done for the drainage of urine, if its necessary according to surgery. 

Before the surgery, patient undergo imaging procedure, such as computed tomography (CT) & an assessment of cardiovascular fitness patient also meet with an anestheologists prior to the procedure and also dietician comes to patient to explain about the diet.The preoperative blood and urine test also done. 

Procedure of laparoscopic sleeve gastrectomy :

Laparoscopic sleeve gastrectomy done under the full general anesthesia with  endotracheal tube intubation.General anesthesia for pain relief during surgery and comfort to patient.patient asleep during whole surgery. 

Fentanyl citrate and muscle relaxtant given to the patient and Endotracheal intubation will given and hypnotic agent like propofol given. 

Than anesthesist continue watching monitor and watch vital signs including pulse, spo2(saturation ), E.C.G,  body temperature and blood until the  patient  will not shifted from operation theatre to general ward.

In procedure of sleeve gastrectomy giving small 2mm incision above the illiac umblical fossa and veris needle introduce the umbilical then the irrigation or sunction test and hanging drop test after then insufflation start here with co2 gas insufflation flow should be 1 litre per minute and we have kept it pressure 18 in the case after 1 litre of flow we have to increase the flow rate 3 litre per minutes approximately 4.5 litre gas was to introduce it. 

after that above in the midline insert optical trocar that is supra umbilical 10mm and another one is left hypochondrium that is for the right hand instrument working port midclavicular line and this port for the ligasure or hormonic probe in the right hand.

Another one is in right hypochondrium and that is the left instruments for holding and lifting of stomach with the grassper and 1.5mm trocar is introduced in epigastric region for liver retraction (nathanson retractor) another left anterior axillary line approximately 7.5cm lateral and below the second port that is for the assistance to lift the omentum  then surgeon tackle with short gastric and in this case surgeon use nathanson retractor,  so one 1.5mm  epigastric nathanson liver retractor will goes percutaneously but trocar has to make a space for that then introduce the nathanson retractor than surgeon diagnose the abdominal cavity then start cutting short gastric with ligasure or hormonic probe the cartilage introduce for the gastrectomy buji insert by the anesthesist for the judgement of stomach and traction at the time of the stapling and every stapling check the movement of buji done by anesthesist.  

5 to 6 cartilage are used in this procedure after the remove the stomach from the side of 12mm port and done leak test by mythelene blue through the ryles tube and place the drain inside for the drainage. 

Precautions after Bariatric Surgery:

1. Don't take anti-inflammatory drugs.

2. Vitamin and mineral supplements will be a lifelong requirement.

3. Women should avoid getting pregnant for 2 yrs after pregnancy because your ability to take the normal quantities of a balanced diet and rapid

4. Weight loss will impact your nutritional status of your body for that reason patient should take continue multivitamin supplement. 

5. Follow a diet from registered dietician  which will be low in calories, fats and sweets.

6. Eat your food slowly and chew small bites throughly.

7. Avoid bread, raw vegetables, meat etc. that are not easily chewed and digest.

8. Avoid eating a large amount in one time. And eat a small amount in every 2 hrs.

9. Try to exercise for 30 -45 minutes daily.

10. Stay engaged with activities and group of people who will remind you about your weight loss goals and will encourage you for a healthy lifestyle.

Side Effects of Bariatric Surgery:

Bariatric Surgery doesn’t have any serious side effects, some common side effects include constipation, infection etc.

Bariatric post operative diet:

Aftet the surgery first one to four weeks liquids and very soft food ( soup / yogurt,  juices, skim milk etc )

After four to six weeks slightly thicker diet gradually switch to solid food. 

Long term bariatric diet 

Patient can eat most food except thick breads and thick meats must eat proper chewing and eat slowly. Comfortably eat a small selected  solid meal.

After four to six weeks solid food following some rules eat three times small meal a day, eat slowly and chew properly. Stop eating when  feel full. Don't drink while eating  avoid fibrous food. Drink enough fluids during day exercise 30 minutes a day

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