Surgery

Laparoscopic Sleeve Gastrectomy & Gastric Bypass

Why It’s Done (Indications)

Indicated for severe obesity (typically BMI > 35-40) or obesity-related medical conditions such as type 2 diabetes, high blood pressure, and sleep apnea, when diet and lifestyle changes haven't achieved lasting weight loss.

How to Prepare (Preparations)

• A 2-week pre-operative liver-shrinking low-calorie diet.
• Comprehensive evaluation by a multidisciplinary team (dietitian, psychologist, cardiologist).
• Fasting (no food or drink) for 6 hours before surgery.
• Pause blood-thinning medications as instructed by your doctor.

What Happens (Procedural Details)

Laparoscopic Sleeve Gastrectomy:

1. Setup & Access: Under general anaesthesia, 4 to 5 small keyhole incisions are made in the upper abdomen to introduce the camera and instruments into an inflated abdominal cavity.
2. Dividing Attachments: The outer curved edge of the stomach is freed from its blood supply and fatty tissue attachments.
3. Stapling the Sleeve: A soft calibration tube (bougie) is inserted through the mouth into the stomach to act as a size guide. Using a laparoscopic stapling device, the surgeon cuts vertically down the length of the stomach, removing about 80% of its volume.
4. Inspection: The remaining stomach is now a narrow, tubular "sleeve" roughly the size of a banana. The staple line is tested for leaks using dye or air pressure before removing the excised stomach portion.
    

Laparoscopic Gastric Bypass (Roux-en-Y):

1. Pouch Creation: After creating keyhole access, the surgeon uses surgical staplers to divide the upper part of the stomach, creating a tiny pouch (about the size of an egg) at the top, completely separated from the rest of the stomach.
2. Bypassing the Intestine: The small intestine is cut a short distance down. The lower end is brought up and stapled directly to the newly created small stomach pouch.
3. Reconnecting the Intestines: The upper section of the small intestine (draining digestive juices from the bypassed main stomach) is re-attached further down the small intestine in a "Y" configuration.
4. Testing: All staple lines are checked for leaks, tools are removed, and keyholes are closed.
    

Recovery (Postoperative Care)

• Hospital stay of 1 to 3 days.
• Strict dietary progression: liquids for 2 weeks, pureed food for 2 weeks, then soft solid foods.
• Lifelong daily multivitamin, iron, and calcium supplementation is essential.
   

Risks (Potential Complications)

• Staple line leak or bleeding.
• Nutritional deficiencies or gallstone formation due to rapid weight loss.
• Acid reflux or internal hernias (more common with bypass).