Sleeve Gastrectomy Procedure
The vertical sleeve gastrectomy is preformed under a general anesthetic almost always using laparoscopic technique. The abdomen is inflated with carbon dioxide gas. A laparoscope is introduced into the abdomen, and an examination is made of the abdominal organs. The blood vessels are disconnected from the stomach along the outer or left side of the stomach (greater curvature) starting about 5 cm. from the pylorus working upward. Any adhesions (scar tissues) are taken down from the back of the stomach. A sizer, called a bougie, is inserted into the stomach through the patients mouth by the anesthesiologist. The bougie is between 13-15 mm in diameter depending on surgeon preference. The sizer helps assure that the sleeve is not too wide and not too narrow. A surgical stapler is then used to divide the stomach. The stapler simultaneously places six parallel rows of staples, and cuts down the middle between them. The cut (transection) is started 5 cm. from the pylorus. The transection is carried upward by a series of firings of the stapler to the top of the stomach near the esophagus.
Most surgeons reinforce the staple line to decrease the risks of bleeding and of staple line breakdown and leakage. Many surgeons oversew or dunk the staple line, while others use specialized materials applied to the stapler to buttress the staple line.
Once the transection is completed, the portion of the stomach that has been excised is removed from the abdomen. The surgeon then checks the staple lines to make sure that there isn’t any bleeding. The gas is removed from the abdomen, and the small skin incisions are closed with stitches under the skin. The skin edges are then glued together.
Most patients stay in the hospital for one or two nights after surgery. The length of stay depends on many factors: the general health of the patient, recovery from anesthetic drugs, evidence of that there is no bleeding, ability to take liquids, general sense of well being, and the patient’s home situation and support.
The speed of recovery depends to a large part on the patient’s general condition before surgery. Most patients can return to work one to three weeks after surgery. It is always better to overestimate time off work than to try to get back to work too soon.