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.

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, in coordination with lifestyle modifications, can help improve your overall health and quality of life.

Procedure

Gastric sleeve surgery works by changing the structure of your stomach and reducing the size by about two-thirds. The result is a smaller stomach that fills up quickly, thereby limiting the quantity of food you can eat and the number of calories absorbed by your body.

Sleeve gastrectomy is performed laparoscopically. 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 seeing inside of your abdomen.

How Is Gastric Sleeve Surgery Performed?

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 divide your stomach in a vertical manner and remove a major 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.

How Long Does Gastric Sleeve Surgery Take?

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. Your surgeon will provide you with a special diet plan to avoid stretching of the stomach.

What Are The Benefits?

  • 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 calorie absorption. 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 that 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, acid backing up into the esophagus, and heartburn. The pyloric portion of the stomach is left intact and helps avoid dumping syndrome (rapid gastric emptying causing cramps, nausea, and diarrhea).
  • Sleeve gastrectomy is a simpler procedure and helps avoid the associated risks of an intestinal bypass. It also avoids the use of foreign materials such as with a gastric banding procedure.
  • Most of the patients, after losing enough weight, are able to experience improvement in their overall health and find it easier to perform their everyday activities.

What Are The Disadvantages?

  • The stomach tube may stretch over time leading to late weight regain. The extent of this problem is currently unknown.
  • The procedure is not reversible.
  • The amount of weight reduction is typically 50-70% of 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.
  • Not an option for patients with severe reflux disease.