Sleeve gastrectomy, sometimes called vertical sleeve gastrectomy or sleeve bariatric surgery is a type of restrictive weight loss surgery which means weight loss is achieved by restricting the amount of food consumed before feeling full. It is considered as one of the newer types of bariatric surgery although some physicians have tried using the procedure before.
Sleeve Gastrectomy Bariatric Surgery
Current literature for sleeve bariatric surgery notes that indications for the surgery are the same as other bariatric procedures such as gastric bypass or gastric banding. The National Institutes of Health (NIH) requires a body mass index (BMI) greater than 40, suggesting the equivalent of being about 100 pounds overweight for men and 80 pounds overweight for women. Other patients with BMIs between 35 and 39 may also be candidates for weight loss surgery if obesity-related illnesses such as diabetes, high blood pressure or high cholesterol are present.
Sleeve bariatric surgery may also be considered as a starting point or the first part of a 2-staged operation. Having the procedure as a starting point is usually recommended for those who are very obese having BMI of greater than 60 or those who carry their weight in the belly area.
In the staged approach, a multi-step operation like the gastric bypass or the duodenal switch is broken down into 2 simpler and safer operations. The initial weight loss given by the first part of the staged procedure makes it safer to proceed to the next step. Patients are expected to lose 30 to 50% or 80 to 100 pounds or more resulting from the first part. The timing of the second procedure will depend on the rate of weight loss following the gastric sleeve surgery. Approximately around 8 to 12 months after the first, the second procedure is done.
Risks of Sleeve Gastrectomy Bariatric Surgery
The surgery involves risks such as infections, pneumonia or bleeding post procedure. Other after surgery complication unique to the sleeve bariatric surgery is leaking of the sleeve. The operation requires stapling inside the stomach, and there is always a chance that the staples wonâ€™t hold, resulting in a leak which may in turn result to infection of surrounding tissues.
Unlike gastric bypass or duodenal switch, there is no bypass of the small intestines with the gastric sleeve, so all nutrients are absorbed and very little chance exists of absorption issues.The risk of postoperative complications average out between 3-5%. Severely overweight patients run a higher risk of incurring operative complications. The risk of mortality is, according to literature, below 0.3%.
To decrease the occurrence of post surgery complications, patients who smoke are advised to quit smoking at least one month before and after the procedure. A special diet is also prescribed to patients weeks prior to the surgery.
The surgery is performed in a hospital or surgery center under general anesthesia. Usually, physicians do the procedure laparoscopically to minimize complications and hasten recovery. The surgery begins with multiple half-inch long incisions in the stomach, which serves as opening for the instruments to enter. Then the surgeon removes about three-quarters or approximately 60 to 80% of the stomach along the greater curvature. The cutaway part is removed and not left in place as with gastric bypass surgery thus the stomach reduction and gastric sleeve procedure is permanent and irreversible. The resulting new stomach sealed thru staples is now a thin tube or roughly the size and shape of a banana, which spans the original distance from the esophagus to the small intestine.
The pyloric valve and other sphincter muscles remain intact and continue to function normally after the surgery. Once the surgeon determines that the staples are holding the stomach closed and no areas are leaking, the instruments are withdrawn and the incisions are closed, typically absorbable sutures and sterile tape.
Following surgery, patients will need to follow a liquid diet for about two weeks while the body heals. The diet will slowly progress from soft to solid foods. At about 4 to 6 weeks after surgery, most patients will usually be able to eat a regular solid diet. Food must then be chewed properly, eating should be done slowly and only small quantities of food must be consumed. Eating and drinking at the same time must also be avoided.
Aside from restricting the amount of food taken before feeling full, the fundus, the area that secretes ghrelin that makes people hungry, is also removed. Therefore weight loss is also achieved through the use of hormonal mechanism. The surgery is considered safer compared to other weight loss procedure since it does not involve any rerouting.
It is the safest option for people with complex medical issues as well. However, unlike other weight loss surgery, the expected weight loss of gastric sleeve surgery is not quite extensive and since the stomach tube may stretch over time weight may be regained. As with all surgical weight loss programs, weight loss ultimately depends on adopting a new lifestyle, healthy diet, and regular exercise.