Sleeve

Sleeve

Sleeve Gastrectomy (Laparoscopic Sleeve Gastrectomy, LSG)

???? Definition

Sleeve gastrectomy is a bariatric (weight-loss) surgery in which about 70–80% of the stomach (mainly the greater curvature and fundus) is removed.The remaining stomach is shaped into a narrow tube or “sleeve.”

It works by both restricting food intake and reducing ghrelin (the hunger hormone).

???? Mechanism of Action

1. Reduced gastric capacity → patients can only eat small portions.
2. Reduced ghrelin secretion → less hunger and better appetite control.
3. Metabolic changes → improved insulin sensitivity, better control of type 2 diabetes.

???? Indications

BMI ≥ 40 (morbid obesity).

BMI ≥ 35 with comorbidities (e.g., type 2 diabetes, hypertension, obstructive sleep apnea, fatty liver disease).

Failed conservative management (diet, exercise, medications).

Usually for patients between 18–65 years (with exceptions)

???? Advantages

Significant and rapid weight loss (50–70% excess weight loss within 1–2 years).

Improvement or remission of comorbidities (diabetes, hypertension, obstructive sleep apnea, non-alcoholic fattyliver disease).

No intestinal bypass, so normal nutrient absorption is mostly preserved.

Technically simpler than gastric bypass.

???? Disadvantages / Risks

Irreversible (part of the stomach is permanently removed).

Risk of staple-line leak (major complication).

Possible stricture formation.

GERD (de novo or worsened).

Bleeding, infection, nutritional deficiencies.

Long-term weight loss may be slightly less than gastric bypass.

???? Postoperative Care

Hospital stay: usually 2–3 days.

Diet progression:

1. Clear liquids (2 weeks)
2. Pureed / soft diet (2–4 weeks)
3. Gradual return to solid, healthy foods.

Supplementation: multivitamins, vitamin B12, iron, calcium, vitamin D.

Lifelong follow-up and lifestyle modification (diet + exercise).

???? Outcomes

On average, 50–60% of excess body weight loss is maintained at 5 years.

High rates of remission or improvement in metabolic comorbidities.

Substantial improvement in quality of life and physical activity.