Gastric Sleeve
Sleeve gastrectomy, also known as gastric sleeve surgery, is the most frequently performed bariatric procedure in the United States. You may be a candidate for this procedure if your body mass index (BMI) is greater than or equal to 40, or between 30 and 40 with other medical problems such as diabetes, sleep apnea, heart disease, and high blood pressure. BMI is the measure of body fat based on your height and weight.
Bariatric surgeries have evolved, with more than half of bariatric surgeries performed in the US now being gastric sleeve procedures. The gastric sleeve procedure is also called vertical sleeve gastrectomy. Metabolic and bariatric surgery encompasses a range of bariatric procedures, including sleeve gastrectomy and gastric bypass, which are utilized to treat obesity and its associated health issues, such as diabetes mellitus and metabolic syndrome. Obese patients who have not succeeded with diet and exercise may be considered eligible for weight loss surgery. These procedures are designed to induce weight loss, help patients lose weight, reduce excess body fat, and achieve a healthier weight. Losing weight through gastric sleeve surgery can help improve obesity-related health problems and support a healthier lifestyle.
Gastric sleeve surgery may be an option for you if you are severely obese and have not been able to shed the excess weight through diet and exercise. The procedure, when combined with lifestyle modifications, can help enhance your overall health and quality of life. Patient education and maintaining a healthy weight through a balanced lifestyle, including a healthy diet and regular exercise, are crucial both before and after surgery. A bariatric surgeon, who specializes in these procedures, will guide you through the process.
Procedure
Gastric sleeve surgery is a type of gastrointestinal surgery that reduces the size of the stomach, resulting in reduced food intake and supporting weight loss. The procedure involves removing a large portion of the stomach, resulting in a smaller stomach that fills up quickly, thereby limiting the amount of food you can eat and the number of calories your body can absorb.
Sleeve gastrectomy is performed within the abdominal cavity using minimally invasive techniques. A laparoscope is a small tube-like instrument fitted with a camera on the end. The camera is connected to a video monitor, which allows the surgeon to perform the surgery by viewing inside your abdomen. This minimally invasive approach is called laparoscopic sleeve gastrectomy. Robotic surgery is another minimally invasive option, offering enhanced precision, while open surgery may be used in some instances where smaller incisions are not feasible.
During the procedure, the stomach is reduced in size. The remaining stomach forms a narrow tube or sleeve, and the staple line is carefully reinforced to prevent complications such as leaks or bleeding.
A key surgical tip is to pay close attention to staple line management throughout the procedure to minimize the risk of postoperative leaks or bleeding.
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Gastric Sleeve FAQs
Regardless of whether you’re paying privately or with insurance, every patient is required to attend an online nutrition and preparation class led by our bariatric coordinator and bariatric nutritionist. The bariatric coordinator had gastric bypass surgery herself, so she’s very familiar with the process, along with the emotions that go along with it. Here, they’ll address all your questions and concerns while providing you with information on pre-operative nutrition, post-operative nutrition, and everything else you need to know about the surgery, including mental preparations. The class will emphasize the importance of following a healthy diet before and after surgery to support weight loss and prevent weight regain. You will also learn about the gradual reintroduction of solid foods after surgery and the importance of monitoring for nutritional deficiencies to ensure long-term health.
At the start of the procedure, you will be given general anesthesia. This will cause you to sleep and allow you to feel no pain throughout the procedure. Your surgeon will create 5 small surgical openings on your abdomen. The laparoscope and small surgical instruments are introduced through these openings into your abdomen. Your surgeon will then vertically divide your stomach and remove a significant portion of it, between 80-90%. The remaining portion of your stomach will be joined together using surgical staples. The final result is a long, tube-like, or banana-shaped stomach.
If a hiatal hernia is present, your surgeon may repair it during the gastric sleeve procedure to reduce the risk of postoperative complications.
The procedure takes about 30-45 minutes to complete. Immediately after, you will be started on a clear liquid diet and will be given medications to help alleviate any pain or discomfort. The initial phase after surgery is characterized by rapid weight loss; therefore, it is essential to follow your surgeon’s recommendations closely to ensure a safe recovery and minimize the risk of complications. Your surgeon will provide you with a special diet plan to help prevent stomach stretching.
Sleeve gastrectomy is performed laparoscopically, avoiding the need for large abdominal incisions. Patients benefit from less pain, shorter hospital stays, and faster recovery.
The surgery reduces the size and volume of your stomach, thereby limiting your food intake and the absorption of calories. As most of the stomach is removed, the procedure also benefits by limiting the amount of hunger-stimulating hormone (ghrelin) produced in your stomach. The surgery results in a stomach that functions normally, which enables you to eat most foods, just in smaller amounts, after your procedure.
The surgery avoids any cutting or changing of your sphincter muscles. Sphincter muscles allow food to enter and exit your stomach. Any injury to the sphincter muscles can cause regurgitation, where acid backs up into the esophagus, leading to heartburn. The pyloric portion of the stomach is left intact, which helps prevent dumping syndrome (rapid gastric emptying, causing cramps, nausea, and diarrhea).
Sleeve gastrectomy is a more straightforward procedure that helps avoid the associated risks of an intestinal bypass. It also avoids the use of foreign materials, unlike a gastric banding procedure.
Most patients, after losing enough weight, experience improvement in their overall health and find it easier to perform their everyday activities.
While sleeve gastrectomy offers many benefits, patients should be aware of potential long-term complications and maintain regular follow-up with their healthcare team to monitor and manage any issues that may arise.
- The gastric sleeve operation may result in stretching of the stomach tube over time, which can lead to late weight regain. The extent of this problem is currently unknown and is also observed in sleeve gastrectomies.
- The procedure is not reversible.
- The amount of weight reduction is typically 50-70% of the excess weight lost over the first 1-2 years.
- There is no malabsorption of nutrients.
- If weight is regained, a second-stage operation known as duodenal switch or Roux-en-Y gastric bypass can be performed. Gastric bypass patients may experience different risks and outcomes, such as higher rates of nutritional deficiencies and complications, compared to those who undergo sleeve gastrectomies.
- Not an option for patients with severe reflux disease.
