Question 3. Who Do We Offer Laparoscopic Sleeve Gastrectomy?

This procedure is primarily used as part of a staged approach to surgical weight loss. Patients who have a very high body mass index (BMI>50) or who are at risk for undergoing anesthesia or a longer procedure due to heart or lung problems may benefit from this staged approach.

Sometimes the decision to proceed with a two-stage approach is made before surgery due to these known risk factors. In other patients, the decision to perform sleeve gastrectomy (instead of gastric bypass) is made during the operation. Reasons for making this decision intraoperatively include an excessively large liver or extensive scar tissue that would make the gastric bypass procedure too long or unsafe. 

In patients who undergo LSG as a first stage procedure, the second stage (duodenal switch) is performed 12 to 18 months later after significant weight loss has occurred and the risk of anesthesia is much lower (and the liver has decreased in size). Though this approach involves two procedures, we believe it is safe and effective for selected patients.  Laparoscopic Sleeve Gastrectomy can also be used as a primary procedure when the BMI is between 40 and 50.

There is relatively little data regarding the use of LSG as a stand-alone procedure in patients with lower BMI’s (between 30 and 40) and it should be considered an investigational procedure in this patient group. We are offering this procedure to diabetic patients with a BMI between 30 and 40.