Obesity is a condition in which sufferers have excessive fat deposits to a point where the person's health is at risk, eventually leading to mortality. Obesity is measured through the Body Mass Index (BMI) with people considered to be overweight at a BMI = 25 and obese at a BMI = 30.1. Long-term studies have shown that conservative medical treatments are ineffective in patients with morbid obesity, with relapse rates of up to 90% irrespective of the choice of conservative treatment. As a result of this, surgical treatments (bariatric surgery) have been increasingly utilised as a means of achieving weight loss in these patients. One of the latest surgical procedures currently being utilised is sleeve gastrectomy (also known as the gastric sleeve procedure or laparoscopic tube gastrectomy).

Laparoscopic sleeve gastrectomy (LSG) involves the surgical removal of the left side of the stomach. The longitudinal stapling results in a stomach which is approximately the size and shape of a banana reducing its capacity. There is no re-routing of intestines or implantation of an artificial device in the abdomen. Weight loss is achieved by the reduction of the stomach size and satiety is induced faster with less food. The removed portion will be sent for histopathology analysis to check that there is no underlying disease process.

When performed laparoscopically, most patients stay in hospital for two nights and are back at work in two weeks. It requires five or six very small incisions. It is in most cases carried out laparoscopically under general anaesthetic. Difficulties with the laparoscopic procedure may necessitate the conversion to an open operation.

The small stomach creates a sense of fullness early so that only a small amount of food can be taken in at any one sitting. Although your stomach will be much smaller, its function remains the same and you will still be able to absorb all the vital nutrients you need without having to take supplements. The removed section of the stomach is actually the portion that "stretches" the most.

Advantages

• Stomach volume is reduced in size, but it functions normally so food can be eaten in only small amounts. The types of foods eaten are not altered
• Minimizes the chance of an ulcer occurring in the stomach
• LSG has only a small risk of bowel blockage or vomiting from a blocked stomach. Much less risk of food intolerance than after a gastric band
• Very effective as a first stage procedure for high BMI patients (BMI >55)

Disadvantages

• IT IS NOT REVERSIBLE. Although the other major surgeries for obesity are difficult to reverse, they are not impossible. Because the stomach is partly removed, it cannot be replaced. This operation is for life
• Because this procedure is fairly new the long-term outcomes are uncertain
• Certainly with all the surgeries that are available for weight loss there is a late regain of a small proportion of the weight lost. The value of this in the case of the LSG is unknown
• As with all the restrictive type of operations, soft foods and fluids that are high in calories are not restricted, and inadequate weight loss may result. Foods such as ice cream, cheeses, dips, soft drinks, chocolate must be taken sparingly
• Because part of the stomach needs to be removed, the stomach that is left must be closed. This is done with a stapling instrument
• Because of this closure there is a risk of holes occurring where it has been stapled
• This is termed a 'leak' and can have a large impact on your recovery

Issues with tube gastrectomy

• Stomach tube may stretch up over time leading to late weight regain. The extent of this is currently unknown
• The amount of weight reduction is in the region of 40-60% of excess wt lost over the first 1-2 years
• It is a good option for people living in remote areas because it is a "set and forget" operation which requires little post op follow up or nutritional supplements
• There is no malabsorption to nutrients

Diet

• Do not drink fluids while eating
• Omit desserts
• Watch beverages rich in calories (carbonated drinks, high-calorie nutritional supplements, milk-shake and high-fat foods).
• Minimal alcohol (contains calories)
• Only eat small quantities
• Eat slowly and chew foods until they are mushy
• Stop eating as soon as you feel full (eat ¼ cup of solid food)
• Portion your total intake of solid foods to up to 3-6 meals a day

We all need liquids to stay hydrated. We suggest you drink water, skim, low fat or soy milk (more than 720 ml per day), low calorie beverages, or tea. BEWARE OF FRUIT JUICE, EVEN FRESHLY SQUEEZED ORANGE JUICE - THEY ARE AN OFTEN FORGOTTEN SOURCE OF CALORIES.

Do not drink anything for 30 minutes before or after each meal. Your stomach is not big enough for both food and liquids!

Slip beverages slowly. Carry a bottle of water at all times.

What happens if I don't follow the diet?

Weight loss surgery is successful 80% of the time. The number one reason it fails (the other 20% of the time) is not following the post-surgery diet. Carbohydrates and fats are your enemy. You must be disciplined and committed to sticking to the programme. That includes changing eating behaviours and exercise habits.

Birth Control and Pregnancy

Many women who undergo weight reduction surgery find that it is easier to become pregnant after they are at a healthy body weight.  It is strongly advised that women of childbearing age use the most effective forms of birth control during the first 16 to 24 months after weight loss surgery. The added demands pregnancy places on your body and the potential for foetal damage make this a most important requirement.