The gastric sleeve, medically known as a sleeve gastrectomy, is a widely performed bariatric procedure designed to promote significant weight loss. This restrictive operation permanently removes about 80% of the stomach, reducing the amount of food the organ can hold. The remaining portion is reshaped into a narrow, tube-like structure, or “sleeve,” which limits food intake and reduces the production of the hunger hormone ghrelin. The surgery is almost universally performed using a minimally invasive approach, involving several small entry points rather than a single large incision. This technique generally leads to a quicker recovery, less pain, and a lower risk of complications compared to traditional open surgery.
The Standard Laparoscopic Approach
Most gastric sleeve procedures are performed laparoscopically, requiring a specific number of incisions. In this standard minimally invasive technique, surgeons generally create four to six small incisions, or ports, across the abdomen. Each incision is strategically placed to allow the insertion of specialized instruments, typically measuring between 5 and 15 millimeters in length.
One port is dedicated to the laparoscope, a thin tube equipped with a camera and light source that transmits a magnified view of the internal organs to a monitor, guiding the surgeon’s movements. Other ports are used for working instruments, such as graspers, dissectors, and the surgical stapler used to divide and seal the stomach tissue.
The arrangement of these ports allows the surgical team to work simultaneously from different angles, which is critical for maneuvering around the internal anatomy. For instance, one port is often used for liver retraction, holding the liver out of the way to provide clear access to the stomach. Another, slightly larger incision is necessary to safely remove the excised portion of the stomach once stapling is complete. The exact number and placement of these ports can vary based on the patient’s anatomy and the surgeon’s preferred technique, but four to six is the most common practice.
Minimizing Incisions and Scarring
While the standard approach uses multiple small incisions, advancements have introduced variations that reduce the number of entry points and minimize scarring. Single-Incision Laparoscopic Surgery (SILS) is one such technique, where the entire procedure is performed through a single, slightly larger incision, often hidden within the navel. This technique is appealing for aesthetic reasons, as the resulting scar is virtually invisible once fully healed.
The SILS approach requires specialized, flexible instruments manipulated through one entry point, making the surgery technically more demanding. While it offers superior cosmetic results, it is not suitable for all patients; candidates often need a lower body mass index and no history of extensive prior abdominal surgery. In some cases, the surgeon may still need to add one or two tiny auxiliary ports to assist with liver retraction or improve instrument maneuverability, meaning the single-incision concept is sometimes a misnomer.
Robotic-assisted surgery is another modern approach that utilizes the conventional laparoscopic port placement but allows the surgeon to operate with more precision and dexterity. Although it uses a similar number of incisions, the enhanced control offered by the robotic platform can contribute to a highly meticulous procedure. These reduced-port techniques, whether SILS or a reduced four-port laparoscopic method, represent efforts to balance surgical efficacy with the patient’s desire for the least visible scarring.
Incision Care and Healing Timeline
The healing process for gastric sleeve incisions is relatively rapid due to their small size, though careful post-operative care is necessary to prevent complications. On the surface, the small cuts are typically closed with dissolvable sutures, surgical glue, or staples, and the initial skin healing usually occurs within the first one to two weeks. During this time, patients may experience some localized swelling, bruising, and mild discomfort around the sites, which is a normal part of the body’s inflammatory response to surgery.
Patients are generally instructed to keep the incision sites clean and dry, avoiding soaking them in a bath or swimming pool until the surgeon confirms they are sealed. It is crucial to monitor the wounds closely for signs of infection, including increased redness, warmth, persistent pain, or unusual discharge. While the external wounds heal quickly, the internal healing of the staple line on the stomach takes longer, requiring patients to avoid strenuous activities and heavy lifting for approximately four to six weeks.
In the long term, the small laparoscopic incisions fade into thin, linear scars that become significantly less noticeable over several months. Protecting the healing scars from direct sun exposure is recommended, as ultraviolet light can lead to increased pigmentation and make the scars more prominent. Once the skin is fully closed, patients may use scar-reducing products, such as silicone gels, under the guidance of their surgical team to further improve the final cosmetic appearance.