Being overweight or obese can have serious health implications for the affected person. If you are assessed as morbidly obese you are a candidate for the Sleeve Gastrectomy. The Laparoscopic Sleeve Gastrectomy (LSG) is a popular staging operation to treat obesity. A part of the Biliopancreatic Diversion with Duodenal Switch operation, Laparoscopic Sleeve Gastrectomy is relatively new operation and can be opted as a stand-alone procedure by those who don't have much weight to lose or as a part of a staged treatment by high-risk patients. The Biliopancreatic Diversion is usually done in stages by performing first the Laparoscopic Sleeve Gastrectomy so as to reduce the risk that may be involved in entire Biliopancreatic Diversion, if done at once.

Procedure
Performed entirely laparoscopically the procedure involves five small incisions which takes about an hour. A small pouch about 120cc in size in stomach is made by using stapling devices. The remaining stomach is removed while the gastrointestinal tract is kept unaltered. A “leak test” is done before completing the operation. Thus, the stomach size is dramatically reduced. The Laparoscopic Sleeve Gastrectomy operation requires an overnight stay in the hospital. No drains and nasogastric tubes are required. The patient can return to work and resume strenuous activity in about 2 weeks. For those who have light duty at work, they can possibly get back to work sooner than 2 weeks. But it depends largely on the circumstances of individual patients.

Advantages
Since the stomach reduces to about 150 cc in volume, it results in a restrictive weight loss. The patients feel full and satisfied after a very small amount of food, and therefore, lose weight because they eat less. What's more, they are happy eating less.

A very important fact is that the operation preserves the pylorus, the valve that regulates emptying of the bowels. This valve acts as a "nature's band" and allows food to stay in the stomach for a while, thus making the person feel full while the food trickles out.

The emotional and medical benefits of the procedure begin almost immediately after operation, and the cosmetic benefits follow soon. With Laparoscopic Sleeve Gastrectomy patients can lose around 50% of their excess weight within one and half years half of which is lost in the first 6 months. Over time the benefits of Sleeve Gastrectomy surgery may include significant sustained weight loss, completely normal blood sugar levels within 1 year of surgery, lower or normal blood pressure, lower or normal cholesterol levels, relief from sleep apnea, acid reflux, and urinary stress incontinence and less arthritis pain. Patients also report enhanced mobility and improved mood and self-esteem. Many high-risk conditions, such as heart disease, are arrested or their progression is significantly slowed. Patients also experience improvement in many lung conditions.

Post-Operative Care
LSG is an effective and generally safe operation, however as with all surgeries, it requires postoperative care. Postoperative care for LSG is similar to that after gastric bypass. The day after operation, liquid and soft diet is administered to the patient. Once he/she is able to maintain hydration and pain is managed, the patient is discharged. The mean length of hospitalization is 2-3 days.

For the first six weeks postoperatively, administration of proton pump inhibitors helps reduce gastric acidity and ulceration along the staple line. A high-protein diet and multivitamin supplements are indicated for reducing muscle wasting. Laboratory tests for various parameters are performed at 3, 6 and12 months and yearly thereafter.

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