The Gastric Sleeve, formally known as a Sleeve Gastrectomy, is a popular weight-loss procedure that fundamentally changes the stomach’s structure. During the surgery, a large portion of the stomach is permanently removed, leaving behind a narrow, tube-like section, or “sleeve,” which significantly restricts food intake. This procedure is typically performed using minimally invasive laparoscopic surgery, which avoids a single, large abdominal incision. Instead, surgeons use a series of smaller entry points to access the abdominal cavity and perform the stomach reduction. This standard technique results in reduced trauma to the abdominal wall and faster recovery.
The Standard Laparoscopic Approach
The most common technique for a sleeve gastrectomy involves creating a set of small punctures in the abdomen for specialized tools. The standard laparoscopic approach requires the surgeon to make between five and six distinct incisions, strategically placed across the midsection. These small openings, known as port sites, are generally sized between 5 millimeters and 15 millimeters (about a quarter to a half-inch).
Each incision serves a specific function during the procedure. One port is reserved for the laparoscope, a slender instrument fitted with a camera and light source that transmits a magnified view to a monitor. The remaining ports are working ports, facilitating the insertion of long, thin surgical instruments like graspers, dissectors, and the surgical stapler. One port is often used to retract the liver, providing a clear view of the stomach.
Minimally Invasive Variations
While the five-to-six port method remains the standard, variations have been developed to reduce the number of visible scars. One notable technique is Single Incision Laparoscopic Surgery (SILS), which performs the entire procedure through a single entry point. In SILS, all necessary instruments and the camera are channeled through a specialized port usually placed within the natural folds of the navel.
This method typically results in only one incision (1.5 to 2 centimeters long), offering a significant cosmetic benefit as the scar is concealed within the belly button. Another evolution is the reduced-port approach, an intermediate step between SILS and the standard method. Surgeons using this technique may utilize only three or four incisions, often by combining the function of two instruments into a single port. These advanced techniques require a high level of surgical skill and are often reserved for patients who meet specific anatomical criteria.
Scarring and Post-Operative Incision Care
The small incisions made during a laparoscopic gastric sleeve heal quickly and result in minimal scarring compared to traditional open surgery. Surgeons close these small wounds using a variety of methods, including dissolvable sutures placed beneath the skin, surgical staples, or medical adhesive (surgical glue). The initial healing phase for the skin incisions typically takes about two to four weeks, during which the small lines begin to flatten and fade.
Immediate post-operative care focuses on keeping the incision sites clean and dry to prevent infection. Patients are instructed to gently wash the area with mild soap and water, avoiding scrubbing, and to watch for warning signs like increased redness, warmth, swelling, or unusual discharge. Once the incisions are fully closed and healed (usually after the first month), patients may begin applying over-the-counter treatments like silicone gel or sheets to diminish the long-term visibility of the scars.