Laparoscopic Sleeve Gastrectomy

What is Laparoscopic Sleeve Gastrectomy?

Laparoscopic Sleeve Gastrectomy is a minimally invasive weight loss surgery that involves changing the stomach’s structure. During the surgery, bariatric surgeons remove about 70–80% of stomach tissue to create a sleeve-shaped structure, which results in substantially reduced stomach capacity. These changes restrict your food intake and influence key hormonal responses, such as ghrelin, which regulates hunger, insulin, and blood sugar levels, reducing food cravings and improving metabolic control. 

Laparoscopic techniques allow surgeons to operate using high-definition camera technology while making small incisions bilaterally to manipulate the stomach through specialised instruments. The surgical procedure maintains normal intestinal function by refraining from bypassing or repositioning operations on the intestines. It results in minimal body trauma, permitting patients to recover faster, reducing infection risks, and hospital stays.

Benefits of Laparoscopic Sleeve Gastrectomy

Laparoscopic Sleeve Gastrectomy is a life-altering intervention that addresses not just your weight but also the physiological imbalances that accompany obesity. The benefits extend beyond the visible.

• Sustainable Weight Loss: If you adhere to dietary and exercise guidelines, you can expect to lose up to 60–70% of your excess weight within the first 12–18 months.

• Resolution of Comorbidities: Many conditions, such as type 2 diabetes, hypertension, GERD, and sleep apnea, show marked improvement or complete resolution after surgery.

• Improved Metabolic Health: Hormonal and metabolic improvements improve glycemic control, lipid profiles, and insulin sensitivity.

• Better Quality of Life: The surgery restores mobility, increases energy levels, and helps you engage in social, professional, and personal activities with renewed confidence.

• Preserved Nutrient Absorption: Unlike bypass surgeries, this procedure does not significantly alter nutrient absorption, reducing the risk of long-term deficiencies.

• Lower Surgical Risk: The minimally invasive nature of the surgery reduces wound complications, blood loss, and recovery time.

What Health Conditions Require Laparoscopic Sleeve Gastrectomy?

Morbid Obesity (BMI ≥ 40 kg/m²): When your BMI reaches 40 or above, you are at high risk for multiple life-threatening conditions. In such cases, sleeve gastrectomy offers a long-term, evidence-based method to achieve sustainable weight loss and improve survival.

Obesity with Comorbidities (BMI ≥ 35 kg/m²): If you suffer from obesity-related conditions such as type 2 diabetes, hypertension, obstructive sleep apnea, or osteoarthritis, and your BMI is 35 or more, sleeve gastrectomy can significantly improve your overall health and reduce your dependency on long-term medications.

Uncontrolled Type 2 Diabetes: In cases where diabetes remains uncontrolled despite lifestyle and pharmacological interventions, sleeve gastrectomy enhances insulin sensitivity and glycemic control, often reducing or eliminating the need for insulin therapy.

Non-Alcoholic Fatty Liver Disease (NAFLD): If you are diagnosed with NAFLD or non-alcoholic steatohepatitis (NASH), weight loss induced by this surgery can help prevent the progression to liver fibrosis and cirrhosis by improving liver enzymes and reducing fat accumulation.

Polycystic Ovary Syndrome (PCOS) with Obesity: In women with PCOS, obesity often exacerbates menstrual irregularities, infertility, and insulin resistance. Laparoscopic Sleeve Gastrectomy can restore hormonal balance, improve ovulatory function, and enhance fertility outcomes.

Obesity-Induced Mobility Restrictions: If your weight severely limits your ability to move, exercise, or perform daily activities, this surgery helps restore functional independence and enhances physical capability, improving your quality of life.

Indications for Laparoscopic Sleeve Gastrectomy

Laparoscopic Sleeve Gastrectomy is not a cosmetic procedure. It is a medically indicated surgery for those whose health and longevity are threatened by excess weight. You may be a suitable candidate if conservative weight loss strategies have failed despite your best efforts. This surgery is indicated when obesity is refractory to non-surgical methods and you are committed to a long-term lifestyle transformation.

• BMI ≥ 40 kg/m² Without Comorbidities: You qualify for this procedure if your BMI is 40 or higher, even without additional health problems, due to the high risk of future complications.

• BMI ≥ 35 kg/m² With One or More Comorbidities: If your BMI is above 35 and you have associated conditions like diabetes, hypertension, or sleep apnea, this surgery offers therapeutic benefits.

• Failure of Lifestyle and Medical Management: If you’ve tried structured weight-loss programs and pharmacotherapy without success for at least six months, sleeve gastrectomy becomes a viable next step.

• Age Between 18 and 65 Years: Most candidates fall within this age bracket, though highly motivated candidates may be selected after a comprehensive evaluation.

• Psychological Readiness and Compliance: You must be mentally prepared and willing to comply with long-term dietary, behavioural, and medical guidelines post-surgery.

Key Aspects of the Surgical Procedure

Laparoscopic Sleeve Gastrectomy involves precise surgical planning and execution. You must understand what the surgery entails, both anatomically and functionally.

• Minimally Invasive Approach: The procedure is performed laparoscopically through 4–5 small incisions, ensuring less pain, quicker recovery, and reduced postoperative complications.

• Stomach Resection: Nearly 75% of your stomach is removed along the greater curvature, leaving behind a banana-shaped sleeve that holds 100–150 mL of food.

• Preservation of Digestive Continuity: Unlike gastric bypass, the intestines are left untouched, preserving natural food passage and nutrient absorption.

• Hormonal Modulation: The surgery reduces the production of ghrelin, the hunger hormone, which helps suppress appetite and control blood sugar.

• Duration and Anaesthesia: The procedure takes about 60–90 minutes and is performed under general anaesthesia. You’ll remain under close monitoring throughout.

• Hospital Stay: If you are stable and meet post-op recovery benchmarks, you may be discharged within 2–3 days after surgery.

Will I Need Any Pre-Procedure Investigations?

A thorough preoperative evaluation is essential to determine your readiness for surgery, assess risk factors, and plan individualised care. Each test aims to optimise your safety and surgical outcome.

• Nutritional and Psychological Evaluation: You’ll undergo assessments to confirm your understanding of the surgery, readiness for lifestyle changes, and ability to comply with post-op instructions.

• Complete Blood Work: CBC, liver function tests, kidney profile, and thyroid tests help evaluate organ function and rule out underlying conditions.

• Glycaemic Status: HbA1c and fasting glucose levels are checked to determine diabetes control and adjust perioperative management accordingly.

• Imaging Studies: Chest X-ray and abdominal ultrasound are used to detect fatty liver, gallstones, or structural abnormalities in your digestive system.

• Endoscopy: A preoperative upper GI endoscopy helps detect any gastritis, ulcers, or H. pylori infection that must be treated before surgery.

• Cardiac and Pulmonary Clearance: ECG, echocardiogram, and pulmonary function tests ensure your heart and lungs are fit for anaesthesia and surgery.

• Nutrient Level Assessment: Baseline vitamin B12, iron, calcium, and vitamin D levels are evaluated to identify and address any deficiencies in advance.

What Happens During the Procedure?

• Anaesthesia and Incision: You will first receive general anaesthesia to ensure a pain-free experience. The surgeon then makes 4–5 small incisions on your abdomen to insert the laparoscopic instruments.

• Stomach Reshaping: Using a laparoscope and stapling device, the surgeon removes approximately 75–80% of your stomach, leaving behind a narrow, tube-like sleeve. This significantly reduces your stomach’s capacity and impacts hunger hormones like ghrelin.

• Staple Line Inspection: The newly created sleeve is tested for leaks and bleeding using high-pressure dye tests. Any issues are addressed immediately before closure.

• Closure and Recovery Initiation: Instruments are withdrawn, and the incisions are closed with sutures or surgical glue. You are then moved to recovery, where vital signs are monitored closely.

The procedure typically lasts 60–90 minutes, depending on your anatomy and associated conditions.

How Long Does Recovery Take from Laparoscopic Sleeve Gastrectomy? 

Recovery after Laparoscopic Sleeve Gastrectomy involves both short-term hospital care and long-term lifestyle modifications. Your healing journey is gradual, and each phase requires close monitoring and adherence to medical guidance.

• Immediate Recovery (First 2–3 Days): You will stay in the hospital for 1–2 nights. During this time, you will receive IV fluids, pain control, and support with ambulation. Liquids will be introduced gradually under supervision.

• Short-Term Recovery (First 2 Weeks): Once discharged, follow a liquid diet as your stomach heals. You may resume light activities within a week, but must avoid lifting heavy objects or strenuous tasks.

• Mid-Term Recovery (2–6 Weeks): Your diet progresses to pureed and soft foods. Energy levels improve, and you may return to work if it doesn’t involve physical exertion. Your surgeon will assess healing during follow-up visits.

• Long-Term Recovery (6 Weeks and Beyond): Solid foods are reintroduced in phases. You’ll work closely with a dietitian and bariatric team to adapt to new eating habits and prevent nutritional deficiencies.

Full recovery takes 6–8 weeks with structured support and regular follow-ups.

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

Eligibility for Laparoscopic Sleeve Gastrectomy is determined after a comprehensive assessment of your physical health, obesity-related complications, and past attempts at weight management. This decision is clinical and tailored.

• Body Mass Index (BMI) Criteria: You may be eligible if your BMI is ≥40 or ≥35 and you have one or more obesity-related complications, such as type 2 diabetes, obstructive sleep apnea, or hypertension.

• Ineffective Conservative Management: If supervised diet, exercise, and medical therapy have not led to sustained weight loss, surgical intervention may be appropriate for you.

• Absence of Contraindications: You must not have any significant psychiatric illnesses, substance abuse, or medical conditions that contraindicate surgery or anaesthesia.

• Psychological Readiness: A mental health evaluation helps confirm your emotional preparedness and realistic expectations. You must commit to lifestyle changes post-surgery.

• Age Considerations: Candidates between 18 and 65 are generally considered. A special evaluation is needed if you fall outside this age range.

A multi-disciplinary team will guide you through this eligibility process to ensure safety and long-term success.

Risks or Side Effects of Laparoscopic Sleeve Gastrectomy

While Laparoscopic Sleeve Gastrectomy is considered safe, like all surgeries, it carries potential risks and side effects (which is rarely seen in 0.5-1% of the cases). Understanding them helps you prepare and manage outcomes effectively.

• Staple Line Leak: A rare but serious complication, a staple line leak may cause infection or abscess. Surgeons test the integrity of the staple line during the procedure and monitor it closely post-surgery.

• Nutritional Deficiencies: Because your food intake reduces significantly, you may develop deficiencies in iron, B12, calcium, or vitamin D. Regular supplementation and follow-ups are mandatory.s

• Gastrointestinal Symptoms: You may experience nausea, vomiting, acid reflux, or constipation, particularly during the early postoperative phase. These typically resolve with diet adjustment and medical support.

• Stricture or Narrowing: The sleeve may become too tight or scarred, making swallowing difficult. This may require endoscopic dilation.

Continuous follow-up and patient education are essential for the early identification and management of these issues.

Why Choose Manipal Hospitals for Laparoscopic Sleeve Gastrectomy? 

Choosing the right medical centre is vital for safe outcomes in bariatric surgery. Manipal Hospitals offers a comprehensive, evidence-based approach tailored to your unique metabolic profile and weight-loss goals.

• Experienced Bariatric Surgeons: You are treated by surgeons with advanced training in laparoscopic and metabolic surgeries, ensuring precision and safety at every step.

• Advanced Surgical Infrastructure: Our operating rooms have state-of-the-art laparoscopic and robotic technologies that enable minimally invasive surgery and faster recovery.

• Multidisciplinary Evaluation: To ensure holistic care, you undergo a thorough assessment by a bariatric team that includes endocrinologists, dietitians, psychologists, and anesthesiologists.

• Structured Follow-Up Care: Postoperative support includes nutritional counselling, behavioural therapy, and regular monitoring, critical for long-term weight management and health improvement.

• Infection-Controlled Facilities: Manipal Hospitals adheres to stringent infection control protocols, enhancing your safety and comfort during your hospital stay and recovery.

Your surgical journey at Manipal Hospitals is guided by medical excellence, compassionate care, and a commitment to improving the quality of life through personalised treatment.