Laparoscopic Single Incision Sleeve Gastrectomy

Body Mass Index (BMI) is a common way to diagnose obesity by comparing body weight to body height. People with BMIs above 30 fall into the obese category, and those with a BMI score of 40 or higher have morbid obesity. A BMI measure within the range of 27.5 to 32.5 presents substantial health dangers when associated with metabolic diseases, particularly in Asian people. 

Obesity often results from a mix of genetics, lifestyle habits, and environmental factors, making it hard to manage with diet and exercise alone. If left untreated, it can lead to long-term disability, reduced life expectancy, and a lower quality of life. When lifestyle changes aren’t enough, medical treatment becomes necessary. In cases of severe obesity, doctors increasingly turn to surgical options to manage the condition and its related health issues.

What is Laparoscopic Single Incision Sleeve Gastrectomy?

Laparoscopic Single Incision Sleeve Gastrectomy (SILS-G) is an advanced bariatric surgery that helps patients lose substantial weight. As the name suggests, this surgical technique uses only one incision point to reduce the stomach size while minimizing surgical scars and reducing postoperative discomfort. Therefore, this surgery is associated with a faster recovery time as compared to traditional multi-port laparoscopic surgery.

During the SILS-G surgery, medical professionals remove a large section of stomach tissue, which amounts to 75-80% of the organ, before creating a tube-like sleeve that remains in the body. You stop feeling full sooner as hunger pangs are reduced after the procedure. If you require obesity treatment with minimal visible scarring and brief hospitalisation, SILS-G surgery is a viable option. The procedure's benefits depend on meticulous patient choices, surgical mastery, and thorough postoperative care.

Benefits of Laparoscopic Single Incision Sleeve Gastrectomy

SILS-G offers several advantages over traditional weight loss methods and even conventional laparoscopic bariatric procedures. These physical and psychological benefits make it a comprehensive approach to long-term weight management.

• Sustained weight loss: You can expect to lose approximately 60-70% of your excess body weight within the first 12 to 18 months post-surgery, provided you follow dietary and activity recommendations. 

• Improvement or remission of comorbidities: Many metabolic conditions, such as diabetes, hypertension, and OSAS, show significant or complete resolution following substantial weight loss.

• Minimally invasive with faster recovery: With only one incision, post-operative pain is reduced, the hospital stay is shorter, and routine activities can be resumed much sooner.

• Reduced hunger and better satiety: The surgery lowers your hunger hormone levels and limits your stomach’s capacity, so you feel full faster and eat less without forced restriction. 

• Improved self-image and psychological well-being: The cosmetic benefit of a single incision and noticeable weight loss contributes to enhanced confidence, social participation, and mental health.

What Health Conditions Require Laparoscopic Single Incision Sleeve Gastrectomy?

• Morbid Obesity with Comorbidities: If your BMI is over 40 or over 35 with serious health issues such as type 2 diabetes, obstructive sleep apnoea, or severe hypertension, SILS-G can be medically recommended to reduce life-threatening risks.

• Uncontrolled Type 2 Diabetes Mellitus: When your diabetes remains uncontrolled despite oral hypoglycemic or insulin therapy and is complicated by obesity, SILS-G can significantly improve glycaemic control and sometimes lead to remission.

• Non-alcoholic fatty Liver Disease (NAFLD) or NASH: In the presence of obesity-related fatty liver changes or non-alcoholic steatohepatitis, reducing visceral fat through surgery can reverse hepatic inflammation and improve liver enzyme profiles.

• Obstructive Sleep Apnoea Syndrome (OSAS): SILS-G helps alleviate the fat deposition around your neck and upper airway that contributes to nocturnal breathing interruptions, leading to better sleep quality and cardiovascular health.

• Polycystic Ovarian Syndrome (PCOS): For women with PCOS and obesity, surgical weight loss enhances hormonal balance, improves ovulatory function, and may restore fertility, especially when medications have failed.

• Degenerative Joint Disease/Osteoarthritis: If you have obesity-related joint degeneration, especially in weight-bearing joints like knees or hips, reducing excess body weight through surgery helps relieve chronic pain and delays the need for joint replacement.

• Cardiometabolic Syndrome: In cases where obesity coexists with hypertension, dyslipidaemia, and insulin resistance, surgical weight loss can help re-establish metabolic equilibrium, reducing long-term cardiovascular risk.

Indications for Laparoscopic Single Incision Sleeve Gastrectomy

Laparoscopic Single Incision Sleeve Gastrectomy is indicated in a specific subset of candidates where weight loss is necessary for survival and non-surgical measures have failed. This procedure might be recommended if you have tried multiple diets, exercise, and pharmacotherapy plans without meaningful or lasting weight loss. Your eligibility also depends on whether obesity complicates other medical conditions and whether you are physically fit to undergo surgery. Below are the most common indications: 

• Severe or morbid obesity unresponsive to medical therapy: SILS-G is considered when conservative approaches such as diet, exercise, and medication have been unsuccessful in reducing your BMI below a critical threshold.

• Presence of obesity-related comorbid conditions: Conditions such as type 2 diabetes, hypertension, OSAS, or cardiovascular disease that are worsened by obesity make you a strong candidate for surgical intervention.

• BMI criteria with ethnic consideration: If you are of South Asian descent, a BMI over 32.5 with comorbidities or 37.5 without comorbidities is sufficient to consider bariatric surgery based on regional guidelines.

• Psychological readiness and informed consent: You must be mentally prepared to commit to lifelong dietary and lifestyle changes. A psychiatric evaluation is often required to confirm your suitability.

Key Aspects of the Surgical Procedure

Laparoscopic Single-Incision Sleeve Gastrectomy is a technically sophisticated surgery that involves precise anatomical and functional alterations. Understanding the procedural nuances, even in simplified terms, is essential for being mentally prepared and confident about the outcome.

• Single-incision laparoscopic entry: A small incision is made near your umbilicus (belly button) to insert a specialised laparoscopic port. Surgical instruments and a camera are introduced through this to perform the procedure internally.

• Creation of the gastric sleeve: The surgeon carefully removes 75-80% of the stomach along the greater curvature using surgical staplers, leaving a banana-shaped sleeve with much less food.

• Preservation of the pylorus and intestinal anatomy: Your stomach’s pyloric valve is preserved to regulate food emptying, and no part of the intestine is bypassed, minimising nutritional malabsorption.

• Reduction of hunger hormone secretion: The part of the stomach removed contains cells responsible for producing ghrelin. Its elimination results in a natural decrease in your appetite.

• Minimal scarring and cosmetic advantage: As only one incision is made, you benefit from a nearly scarless abdomen post-surgery, which is particularly important for body image and self-confidence.

Will I Need Any Pre-Procedure Investigations?

Yes, pre-procedure investigations are crucial to ensure your safety and readiness for Laparoscopic Single Incision Sleeve Gastrectomy. These tests help rule out conditions affecting surgical risk and post-operative recovery. Based on your medical history, the following assessments will typically be recommended:

• Complete blood count and metabolic panel: This helps assess anaemia, electrolyte imbalances, kidney function, and nutritional status to prepare your body for surgery.

• Liver function tests and abdominal ultrasound: These detect fatty liver changes, hepatomegaly, or gallstones, which may alter your surgical plan or require simultaneous procedures.

• Upper gastrointestinal endoscopy: Performed to examine your stomach lining and rule out ulcers, gastritis, or hiatal hernias that could complicate the procedure.

• Hormonal and endocrinological profile: Includes tests for thyroid function, cortisol, and insulin levels to identify any underlying metabolic disorders that must be optimised pre-operatively.

• Cardiac and pulmonary evaluation: This includes an ECG, echocardiogram, and chest X-ray to ensure your heart and lungs can handle the anaesthesia and the physiological stress of surgery.

• Nutritional and psychological assessment: A registered dietician will review your eating habits and deficiencies, while a psychologist evaluates your mental readiness and ability to follow lifestyle changes.

What Happens During the Procedure?

Laparoscopic Single Incision Sleeve Gastrectomy is a precision-driven, minimally invasive surgery. It is performed through a single, small incision—usually at the navel—to reduce surgical trauma and enhance cosmetic outcomes. The procedure aims to remove a significant portion of your stomach, which restricts food intake and induces hormonal changes that help regulate hunger.

• Anaesthesia Administration: You will be placed under general anaesthesia to ensure you remain unconscious and pain-free throughout the surgery.

• Single Incision Entry: A small incision is made near your belly button. Specialised laparoscopic instruments and a camera are inserted through this access point.

• Stomach Resection: Nearly 75-80% of your stomach is removed along its greater curvature. The remaining stomach takes the shape of a slender sleeve.

• Staple Line Integrity: Before completion, the staple line is tested for leakage using a dye test or air insufflation to ensure safety.

• Incision Closure: The instruments are withdrawn, and the incision is sutured carefully for optimal healing and minimal scarring.

How Long Does Recovery Take from Laparoscopic Single Incision Sleeve Gastrectomy?

Due to its minimally invasive nature, recovery from this surgery is faster than that from traditional bariatric procedures. However, the duration and nature of recovery depend on your general health and adherence to post-operative guidelines.
Immediate Postoperative Period

You may stay in the hospital for 2-3 days. Your vitals, fluid balance, and mobility are closely monitored. Pain is typically manageable with prescribed medication.

First Two Weeks

You will begin with a clear liquid diet and gradually move to pureed foods. You should avoid strenuous activities, but are encouraged to walk to prevent blood clots.

3 to 6 Weeks

You can resume work if it does not involve heavy lifting. A soft diet continues, and energy levels begin improving. Your care team will review your nutritional intake and hydration regularly.

Beyond 6 Weeks

Solid foods are gradually introduced. Weight loss becomes evident, and long-term diet planning begins. Regular follow-ups assess progress, address concerns, and reinforce lifestyle changes needed for sustainable results.

How to Know if You Are Eligible for Laparoscopic Single Incision Sleeve Gastrectomy? 

Eligibility for this procedure is based on specific clinical parameters and your readiness to commit to long-term lifestyle changes. A detailed evaluation helps determine if this surgical route is appropriate for your condition.

• Body Mass Index (BMI): You may be eligible if your BMI is ≥40 or ≥35 and you have associated health risks like type 2 diabetes, hypertension, or sleep apnea.

• Previous Weight Loss Attempts: Before considering surgery, you should have attempted medically supervised weight loss programs without sustainable success.

• Obesity-Related Comorbidities: The Presence of severe health conditions such as fatty liver disease, polycystic ovarian syndrome, or joint disorders may justify surgical intervention.

• Psychological Readiness: A psychological evaluation ensures you have realistic expectations and emotional preparedness for significant lifestyle changes post-surgery.

• Age and Overall Health: The most suitable candidates are between 18 and 65. Your cardiopulmonary fitness and absence of contraindicating illnesses will be assessed.

Risks or Side Effects of Laparoscopic Single Incision Sleeve Gastrectomy

Though minimally invasive, this surgery carries significant risks (mostly seen in 0.5-1% of the cases) you should understand before proceeding. These are rare but can occur and require prompt medical attention if they do.

• Staple Line Leak: Leakage from the gastric sleeve can cause infection or abscess formation. It requires urgent diagnosis and possibly re-operation or drainage.

• Nutrient Deficiencies: Reduced stomach capacity can limit absorption of vital nutrients like iron, vitamin B12, and calcium, necessitating long-term supplementation.

• Stricture or Narrowing: The new stomach sleeve can sometimes narrow over time, leading to difficulty swallowing or food intolerance, which might need endoscopic dilation.

• Gastroesophageal Reflux Disease (GERD): Some individuals may experience or develop acid reflux symptoms post-surgery, requiring dietary changes or long-term medication.

Each risk is carefully monitored with pre- and post-operative planning to minimise complications and ensure safe recovery.

Why Choose Manipal Hospitals for Laparoscopic Single Incision Sleeve Gastrectomy? 

Your choice of hospital significantly impacts the safety and outcomes of bariatric surgery. Manipal Hospitals offers an ideal blend of surgical expertise, personalised care, and state-of-the-art technology.

• Expert Bariatric Surgeons: You are treated by highly trained specialists with advanced skills in laparoscopic and single-incision bariatric procedures, ensuring surgical precision.

• Multidisciplinary Care Team: Your care extends beyond the operating room. Dietitians, psychologists, physiotherapists, and endocrinologists collaborate for holistic support throughout your weight loss journey.

• Minimally Invasive Infrastructure: Advanced laparoscopic suites enable minimal scarring, reduced postoperative pain, and faster recovery, tailored to your comfort and safety.

• Comprehensive Pre-Op Evaluation: Your eligibility and risks are thoroughly assessed with detailed investigations, counselling, and risk stratification.

• Continuity of Care: From nutritional guidance to follow-ups and long-term monitoring, you receive structured support designed to help you maintain your health outcomes.

At Manipal Hospitals, you receive more than surgery—you receive long-term support for a healthier life.