What is Sleeve Gastrectomy?
Sleeve gastrectomy, or vertical sleeve gastrectomy, is one of the relatively newer types of weight loss surgery. However, it has been performed for several years. This surgery can also be referred to medically as gastric sleeve resection, gastric sleeve surgery, tube gastrectomy or laparoscopic sleeve gastrectomy.
It was originally used as a “first-stage” procedure in patients with a very high BMI and/or with serious co-morbidities. The sleeve gastrectomy would be performed on the patient with the expectation that a second procedure (either the Roux en Y gastric bypass or the duodenal switch) would be performed after the patient has lost enough weight so that the second procedure could safely be performed. It was discovered that many patients did well with the sleeve gastrectomy alone and did not need the second procedure.
It is performed laparoscopically, meaning that the surgeon makes small incisions as opposed to one large incision. The advantages of this surgery are that there is less malabsorption of minerals and vitamins than the gastric bypass.
How does sleeve Gastrectomy work?
It is not only restrictive type of weight loss surgery but also it removes the hunger promoting hormone (ghrelin) which is removed with excised stomach, thus decreasing appetite. During this procedure a weight loss surgeon removes about 85 % of the stomach so that it takes the shape of a tube or sleeve. The tube-shaped stomach that is left is sealed closed with staples. So many people called it the “New Stapling Operation”. The volume of this long narrow vertical pouch (the tube) is about 75-125 ml compared to the original size of the stomach which is about 2000 ml. So it can significantly restrict the volume of food that can be eaten. There are no changes of the intestines, and no new connections need to be made thus the sleeeve gastrectomy produces any malabsorption of nutrients. This make it safer, easier, and faster to perform.
Who is a good candidate for Sleeve Gastrectomy?
The indications for this surgery are those aged 18-65 years old (with some exceptions) with body mass index greater than 40. In addition people with body mass index greater than 35 may also be candidates for this surgery if they have obesity-related illnesses such as diabetes, high blood pressure or high cholesterol. It can be done as a single stage procedure or as a two stages procedure for super obese patients followed by gastric bypass after losing some weight.
Sleeve Gastrectomy Surgery risks and complications?
It is important for you to understand that the risks of surgery are low and that the majority of patients have no complications. However, as with any surgery, there may be immediate and long-term complications and risks. These risks are greater for individuals who suffer from obesity. Your weight, age and medical history play a significant role in determining your specific risks.
Possible general risks can include:
- Complications due to anesthesia and medications
- Deep vein thrombosis
- Pulmonary embolism
- Heart attack
Risks and disadvantages of sleeve gastrectomy include:
- Leaking of the staple lines as there is always a chance that the staples won’t hold, resulting in a leak. The leaking stomach acids frequently lead to infection of surrounding tissues and other serious problems that may require another operation or a drainage tube.
- Weight may be regained over time, because the stomach can stretch.
- People do sometimes get gastro-esophageal reflux disease (GERD), when stomach contents rise up into the esophagus for some periods.
Advantages Of Sleeve Gastrectomy?
Compared with other types of weight loss surgery:
- No need for adjustment.
- No foreign bodies are left in the body during the procedure. With gastric banding, the band may slip, erode or become infected.
- Less invasive
- Less operating time
- Less operative and short-term mortality than gastric bypass.
- Low risk of nutritional deficiencies associated with gastric bypass as it does not interfere with absorption, so vitamin deficiencies are less likely to occur.
- The feeling of fullness that you get from the sleeve gastrectomy is much more satisfying than the feeling of obstruction or discomfort that you get with the adjustable gastric band.
- Few patients vomit after the sleeve gastrectomy, while many patients continue to have vomiting episodes long after they have their Lap BAND placed.
What to expect after Sleeve Gastrectomy?
The operation is quite safe and just an overnight hospital stay. Most people can return to normal activities in 1 to 2 weeks. The expected weight loss from this surgery is on average 60-70% of excess weight. This procedure requires less effort than adjustable gastric banding to be successful. In addition, vomiting is less than with adjustable gastric banding. Patient must be committed to good eating habits and exercise.