Laparoscopic Sleeve Gastrectomy with Narration - Dr. Smith

[auburn1159]

This procedure is NOW Covered by BCBS of Alabama (as of June 2011) - so Most INsurances are now gettiing on board with covering this valuable Operation. This procedure is No longer considered Investigational.

[ajtwinpeaks]

doctor, are those big staples won't cause any pain?

[TheFemmgurl]

I watch this vid every now and again to remind myself how small my stomach is. It will b a year soon and this precedure saved my life.

[auburn1159]

Excellent video - and this video and the Dr's excellent website has led me to develop a warm relationship with his associate Dee - who has been more than helpful and timely in sending me materials to allow me to move forward with getting this operation done - hopefully by the end of July. I look forward to meeting Dr Smith very soon - and leaving something behind in his care - 3/4 of my stomach and hopefully he will leave with me a path to adding years and improved lifestyle to my life ...

[katzenartig26]

I had this surgery 8 weeks ago and I found this video really fascinating. The commentary was clear and helpful. Thanks so much for posting this video, it really helps me understand my sleeve better!

[Ganon3force]

Hello, i'm unsure to do this, i'm italian, i can't understand how is possible to not become anorexian after this surgery, if a lose 30 kg in 1 year i'll still losing alost the same after 2 years, so my question is, there's risk to become anorexian after this?

Sorry for bad english.

[rematchsixsix]

My mom is having this done on the 23rd. I'm so worried something will go wrong.

[caceres1975]

Dr Smith... Are insurances covering this procedure??!

[bluecollarboiler]

hey, save that for my dog :-) Seriously, I am looking at bariatric surgery at 6'3" 394, I'm tired of being 2 people.

[drdennissmith]

@KnightMD Well you've proven that you're not really a bariatric surgeon - so many impossible and/or incorrect statements... No one has published 8 articles on SILS Sleeves (and based on "more than 20" cases??). No one I know uses 7 incisions for a RNY. There are not 3 "large volume" retrospective studies, and even if there were, it would be obvious to a real bariatric surgeon that what's needed would be a prospective study for many years. Find someone else to spam!

[drdennissmith]

@KnightMD So all the points I've made are true - even the suture retraction of the liver requires a couple of very small incisions to pass the suture through the abdominal wall I've seen all the videos at all the meetings, and I've still not seen anyone dissect the posterior fundus the way we do (though not reflected in this video, which was recorded > five years ago) Many leaders (Nguyen, etc.) have gone away from calling it "single" incision. So far its not as good an operation.

[drdennissmith]

@KnightMD While it *can* be done through "one" incision, there are still a number of problems with this approach. it's a larger incision = higher risk of infection and hernia. It often has to be done above the belly button because the top of the stomach is too far away. I also haven't yet seen a surgeon adequately dissect the hiatus and the fundus with the "one" incision approach, which actually requires two further small incisions for liver retraction though these aften aren't "counted".

[naira43055]

hello, Dr,Could you please tell me about the staple lin. Isn't it dangerous? What if the staple gets loose and end up in internal organs and cause internal bleeding? Has anything like that ever happened? Sleeve gastrectomy is much better than lap band,but staples worry me too much.

[drdennissmith]

@naira43055 The staple lines can be a problem, but we take many steps to protect them. We use staple line reinforcement nowadays, and then extra clips on top of the staple line, and then glue along the length of the staple line. We also size the staple height to the thickness of the tissue which I think is very important. The staples become overgrown by the stomach tissue and don't migrate - the staple line ends up being one of the strongest parts of the stomach.

[MISSURGERY]

@drdennissmith Great video and explanation of gastric sleeve procedure. Do you offer this procedure through a single incision technique? Thank you.

[zaxterry]

@drdennissmith have you ever had someone die or go into cardiac arrest from this surgery

[caceres1975]

Thanks for your video Dr smith.... I am a Surgeon in Alabama, Do you recommend using a Bougie on the first few cases?? and if so , what size would you use. Again...thanks for your video.  This is a procedure that will substitute the band and maybe the bypass at some point.

[drdennissmith]

@caceres1975 This is actually a pretty old video - I do use a small tube, a 16 Baker tube, for sizing and guidance, and the advantage there is that you can blow up the balloon at its tip and poisiton it in the antrum so you know where it is. I then staple just loosely off the tube, rather than tightly against it. Volume ends up at 60cc. I do a more extensive dissection of the top of the stomach than in this video and always look for hiatal hernias (repair with sutures if necessary).

[TejasRCpilot]

i love to be outdoors and fly my model airplanes every weekend(weather permitting)....how long after surgery till i can get back to my outdoor hobby?

thanks

[drdennissmith]

@TejasRCpilot

It's two weeks of avoiding strenuous activity or lifting over 20# or so. Then you're all clear for anything!

[Linky8101]

awesome. How long did this take? 

[drdennissmith]

@Linky8101

It usually takes about 45 minutes, more or less. We do it a little differently these days, a little smaller tube in the end, but it's basically same idea.

[statelinebristol]

What is the difference between this and a VSG?

[drdennissmith]

@statelinebristol It's the same operation, just by a different name. The "V" in VSG stands for "Vertical". When it first was being done there were several names that were used, including "Lateral" gastrectomy and "Longitudinal" gastrectomy, but "Sleeve Gastrectomy" eventually stuck, and most people don't use the "V" since it's implied. Beware of "VBG", though, which is a completely different (and outdated) operation.

[rubinstarfrench]

My wife had this surgery done in June, 2008, and the 80% of her stomach removed. Up to now, may 2010, she has lost 140 pounds and feels great with herself. Mi esposa se hizo esta operación en junio de 2008 y se le sacó el 80% de su estómago. Hasta hoy, mayo 2010, ha perdido 140 libras y se siente excelente consigo misma.

Greetings from / Saludos desde: Guayaquil, Ecuador, Sudamérica.

[mcataa]

my mom had this surgery and she lost 40 kilograms in 1 year !

[Maschinepistol]

Hey what's that white stuff that's flying around?

[chrmar02]

i have my surgery in 5 days !!!!..cant wait

[oOosnapitsmeli]

I had this procedure done on March 8, 2007. I have lost a total of 140 lbs. I went from a size 24 to a size 6! At this time it has been 3 years and I am still a size 6. I enjoy all types of foods and I drnk socially wine, and cocktails. I am sorry I did not do this sooner.

[vapetlover]

My Dr. does not do this procedure. I plan to have the lap band and should have a sugery date as soon as insurance has responded favorably (4-5 weeks). My daughter in law is an emergency room physician; she and my son had the roux-n-y a couple of years ago and are doing just great, however, she stated if she were to do it again, she would get the sleeve procedure. Can you explain why this might be a better choice?

[crazyamielou]

was sleeved 3 1/2 months ago and have lost 25kg (ish).... feeling fantastic.... 10kg (ish) to go!!! YAH ME!!!

[fergodayol]

Few coments: how do you meassure how wide is your sleeve, we use a 46 fr buie at my practice, in stomachs with much fat around them is very difficult to just do it by feeling, and I´ll think you are leaving too wide sleeves in those cases, but your results will say. Going with the stapler to the spleen leaves a very wide opening in the stomach, we usually point the stapler to the Hiss angle. Running sutures is very easy to do and will get more hemosthasis than clips.

[soldner234]

Are there studies showing this?

[samanem]

A lot of it is opinion and the experiences of many surgeons expressed at meetings, but there was a study several years ago by Shikora, et al. It may have been published in a journal, may have been presented at a meeting.

There are always differences of opinion, and as with all operations, there is more than *one* way to do it. As long as it's not recognized as a way *not* to do it! :-)

[soldner234]

Using clips seems a less secure way of achieving hemostasis at the staple line .  Suture throws would be better.

[samanem]

Oversewing a staple line can actually make the leak rate higher, since it can jeopardize the blood supply to the staple line. In more than ten years of doing these staple lines laparoscopically I've not ever had a staple line break down and start leaking, so I'm not eager to change what I'm doing. There are many other surgeons using clips as well.

[Mekaniac]

oh wow...

[AWvids]

how the fuck is this a waste of time? It's educational, and good to watch if you have had the surgery or just want to know more!! if you don't like it, don't watch it!!!!!

[vishalprasad93]

I did this surgery 1 year ago and have lost 30kg plus It has changed my life

[lemaro1977]

I´m not doctor, but it´s very interesting!

[frecklesz14]

i got the sleeve,and to tell you the truth i had no idea it was done dat way.... the doctors recorded the procedure but it looks nothing like this lol.... this video is less complicated =]

[kerry3219]

Hello,kerry horner here.I am traveling to India to get this operation done.I was just wanting to know,how much weight have you lost? Also is it easy to keep it off as i am also considering the gastric bypass.I'll look forward to hearing from you.Kerry.

[renegadeskinninja]

0_0

o my god

[medicalbroadcast]

I would agree with aiannelli1 that the fundus was not completely mobilized near the esophagus. I also believe that the resulted tube is too wide. There must be very good tension around the 30 Fr bougie during stapling if we want to have a nice narrow tube giving good weight loss.

[drdennissmith]

I recently completed an exhaustive review of the LSG literature in preparing for helping teach a course at Ethicon. Bougies used by most lately are sizes 32-40. Weight loss correllates poorly with bougie size as long as its in this range. Narrower tubes and loss of antrum increase nausea and reflux symptoms. Stapling tightly on a bougie is considered to increase the leak rate. As long as the tubular structure is preserved, going right up to the esophagus probably only increases the leak rate.

[aiannelli1]

I would like to see the postoperative swallow X rays. The gastric fundus was not fully mobilized as the left pillar was not dissected. I would have cut the adhesions with the upper pole of the spleen in order to resect the whole fundus. Otherwise a nice procedure.

[samanem]

I appreciate your comments. The goal is a narrow stomach tube. I preserve a few attachments at the top of the stomach, varying from case to case depending on the anatomy, in order to rpeserve some blood supply here, as many feel poor blood supply contributes to leaks in this area. I've done hundreds of these as standalones and as part of the Lap DS, and I've not had a leak up here. Swallow studies indeed show a narrow stomach at the top. I vary my approach here due to varying anatomy.

[MCRapcio]

kurwa... zaraz puszcze pawia

[xxSickwithpainxx]

lol

[albo75]

Myself receive that operation 6 months ago, at the day I´m doing fine, lost about 70 pounds.

If someone decides to do this type of surgery, I will recommended because this is gonna change your whole life....

Greetings from Ecuador