The gastric sleeve procedure is definitively laparoscopic, as the vast majority of these surgeries are performed using a minimally invasive approach. Formally known as Laparoscopic Sleeve Gastrectomy (LSG), this technique has become the standard of care for surgical weight loss. The laparoscopic method uses smaller incisions and causes less disruption to the body compared to traditional open surgery. This approach is widely adopted due to its numerous advantages, establishing it as the preferred route for the most frequently performed weight loss operation globally.
Anatomy and Goal of the Gastric Sleeve
The goal of a gastric sleeve procedure is to permanently reduce the size of the stomach, restricting food intake and producing significant hormonal changes. The surgeon transforms the stomach from its natural pouch-like shape into a narrow, vertical tube, resembling a sleeve. This is achieved by surgically removing approximately 75% to 80% of the stomach, specifically the large, curved section known as the greater curvature.
This anatomical restriction immediately limits the volume of food a person can consume, reducing the stomach’s capacity from up to 1,500 milliliters to a small reservoir of about 60 to 150 milliliters. Beyond physical restriction, the procedure works through a powerful hormonal mechanism. The portion of the stomach removed, particularly the fundus, is the primary site for the production of the hormone ghrelin.
Ghrelin is often referred to as the “hunger hormone” because it signals the brain to stimulate appetite. Removing the tissue responsible for most ghrelin production causes a substantial drop in the hormone’s circulating levels. This hormonal shift results in a decrease in hunger and an increased feeling of satiety, making adherence to smaller portion sizes easier for the patient. The dual effect of physical restriction and hormonal appetite suppression is the foundation of the gastric sleeve’s effectiveness.
The Laparoscopic Technique
The laparoscopic approach, frequently called “keyhole surgery,” is a minimally invasive technique providing the surgeon access to the abdominal cavity without a large incision. The procedure typically begins with the creation of four to six small incisions, measuring 5 to 12 millimeters in length, across the abdomen. Specialized hollow tubes called trocars are inserted through these openings, acting as working ports for the instruments.
The abdomen is then inflated with carbon dioxide gas (insufflation), which creates a working space by lifting the abdominal wall away from the internal organs. A laparoscope, a thin tube equipped with a high-definition camera and a light source, is passed through one of the trocars. This camera transmits a magnified image of the surgical field onto video monitors in the operating room.
The surgeon performs the operation by manipulating long, thin instruments through the remaining trocar ports. Key steps involve dissecting the stomach away from the surrounding tissue and blood vessels along the greater curvature. A calibrated sizing device, known as a bougie, is temporarily placed inside the stomach to guide the stapling process and ensure the remaining sleeve is narrow.
Specialized surgical staplers simultaneously cut and seal the stomach tissue. They are fired sequentially along the bougie from the antrum, about 5 centimeters from the pylorus, all the way up to the Angle of His near the esophagus. The resected portion of the stomach (the large outer curve) is then carefully removed from the abdomen through one of the existing small port sites. The final step involves inspecting and testing the new staple line for integrity before the instruments and trocars are removed and the incisions are closed.
Why Minimally Invasive is Preferred
The preference for the laparoscopic method stems from its ability to achieve the surgical result with significantly less physical trauma compared to traditional open surgery, which requires a single, long incision. The smaller incisions dramatically reduce muscle and tissue damage, which is the primary source of postoperative discomfort. Patients experience less post-operative pain and require lower doses of pain medication.
The reduced risk of complications related to the wound site is a major advantage. Laparoscopic incisions lead to less blood loss and carry a lower risk of developing wound infections or hernias compared to the large abdominal opening required for an open procedure. Furthermore, the cosmetic outcome is significantly better, as the small incisions fade into faint scars. This less-invasive technique has made the operation safer, particularly for patients with risk factors like heart or lung issues.
Short-Term Recovery and Hospital Stay
The minimally invasive nature of the laparoscopic technique directly contributes to a rapid initial recovery timeline. Patients are encouraged to begin light movement, such as walking, within hours of the procedure to prevent complications like blood clots. This early mobilization is a hallmark of the laparoscopic recovery process.
The typical hospital stay following a laparoscopic sleeve gastrectomy ranges from one to three days. Medical staff monitor the patient closely for immediate complications and ensure pain is managed effectively during this time. Patients are usually able to return to light daily activities, such as office work or household tasks, within one week of discharge. The rapid initial recovery allows for a quicker return to normal life compared to the extended recovery period necessitated by a large open incision.