Laparoscopic Sleeve Gastrectomy
When is this procedure indicated?
It is indicated both in obese patients who, prior to surgery, present symptoms and signs of reflux or Barrett's esophagitis or esophagus, but also in those patients who, from the preoperative evaluation, present a high risk of developing post-sleeve reflux.
How is it performed?
The procedure is conducted by laparoscopic technique through four small accesses. The operator frees the stomach from its main ligaments (gastro-colic ligament, gastro-splenic ligament) using a radiofrequency dissector. A possible jatal hernia is always searched for (and if present, treated in the same operation). A functional 360° anti-reflux plastic is then packed using a small portion of the gastric fundus at the level of the cardia. We then proceed to section the stomach using the latest generation of mechanical suturers, guided by an oro-gastric probe. Finally, the tightness of the gastric suture is verified.
The hospitalization lasts on average 2-3 days. On the first postoperative day, a control X-ray is performed, then the patient begins to take the liquid / semi-liquid diet according to the protocol of re-nourishment, under the guidance of the multidisciplinary team and in particular the dieticians. After discharge, follow-ups are scheduled at 1 month, 3 months, 6 months, 9 months, 12 months. Thereafter, at least one checkup once a year is indicated.
Within the first month the onset of gastric fistula, though rare, is possible. This event, present in less than 1% of cases, can be easily treated in centers with adequate experience.
In a small percentage of cases (4-8%), it is possible to see a weight recovery after years (not complete but partial). In contrast to sleeve gastrectomy, there is no development of gastro-oesophageal reflux. However, all long-term issues are treatable if identified during follow-up.