Sleeve Gastrectomy

Sleeve Gastrectomy – Introduction

sleeve gastrectomyVertical sleeve gastrectomy is a type of bariatric surgery that removes a large portion of the stomach and it is a restrictive procedure. The new smaller stomach is reduced and shaped the size of a banana. Gastric sleeve surgery limits the amount of food which can be eaten by making the patient feel full after eating small amounts of food.

Sleeve Gastrectomy Procedure

Sleeve gastrectomy surgery is performed under general anesthesia. Those interested in gastric sleeve may also want to find out more about gastric plication, a type of laparoscopic bariatric surgery. Five or six small incisions are made in the abdomen and the procedure is performed using a video camera (laparoscope) and long instruments that are placed through these small incisions. The camera is connected to a video monitor in the operating room to see inside the abdomen.

Desired weight loss occurs at slower pace than gastric bypass surgery and it may continue for up to 2-3 years after the operation.
The bariatric surgeon will remove most of the stomach (about 80 – 85%) and the remaining portions of the stomach are joined together using staples, this creates a long vertical tube or banana-shaped stomach.

Gastric sleeve surgery does not involve cutting the sphincter muscles that allow food to enter or leave the stomach, and it may take only 60 – 90 minutes in the hands of a very experienced weight loss surgeon.

When patients begin to eat after having gastric sleeve surgery, the newly created small pouch will fill up quickly, giving the feeling of being full after eating just very small portions of food.

Sleeve gastrectomy surgery may increase the risk of gallstones and doctors may recommend having a cholecystectomy (surgery to remove the gallbladder) before the operation.

Indications and suitable candidates for sleeve gastrectomy

Each patient should be treated individually and an initial personal assessment with a bariatric surgeon is absolutely necessary to identify whether this type of bariatric surgery is the best suited for the patient.  Those suffering from obesity for 5 years or more (which is not under control through diet and exercise) may qualify for sleeve gastrectomy.
Patients who are ready to make lifestyle changes and follow diet as well as exercise regimes, even after surgery, will benefit the most and will maintain the weight loss achieved. It is very important that the patient is mentally stable and a psychological assessment may also be recommended by the surgeon.
No dependence or addiction to alcohol or illegal drugs is crucial for anyone thinking to undertake this type of obesity surgery.

Sleeve gastrectomy is usually recommended when:

BMI (Body Mass Index) is 40 or above.
BMI is 35 or more, and suffering from a serious medical condition such as sleep apnea, type 2 diabetes, high blood pressure or heart disease.

Vertical sleeve gastrectomy has most often been done on patients who are too heavy to safely have other types of weight loss surgery such as gastric bypass or duodenal switch surgery. Some obese patients may eventually need a second weight loss procedure done, so it is very important to follow up and maintain an open, honest and frequent communication with the bariatric consultant and the medical team in charge, in order to assess progress and specific adjustments.


Some risks and considerations of sleeve gastrectomy

Risks of anesthesia:

Allergic reactions to medicines.
Breathing problems.

Risks associated with other types of bariatric surgery may be:

Blood loss.
Blood clots in the legs that may travel to the lungs.
Heart attack or stroke during surgery.
Infection of incision, lungs (pneumonia), bladder or kidney.

Risks of vertical sleeve gastrectomy may be:

Gastritis, heartburn, or stomach ulcers.
Injury to stomach, intestines, or other organs during surgery.
Leak from the site of stapling of stomach.
Poor nutrition.
Scarring in the stomach which can lead to a blockage in the bowel in future.
Vomiting if the patient eats more than the stomach pouch can hold.

Before sleeve gastrectomy

The following is to be done before sleeve gastrectomy surgery:

Complete medical history and physical examination of the patient.
Blood tests.
Nutritional as well as mental counseling.
Consulting the bariatric physician about other medical problems such as diabetes, high blood pressure, and lung or heart problems, and their control.
Quit smoking as it can slow the recovery and can increase risks.
Patient should inform whether she is or might be pregnant.
If the patient is taking any blood thinning agents such as warfarin, aspirin; they should be stopped a week before the surgery.

On the day of surgery:

Do not eat or drink anything after midnight the night before the surgery.
Follow doctor orders and take the medicines prescribed.
A consent form regarding the surgery is signed by the patient.

After the procedure:

Patients may usually go home just 2 days after the surgery, they may be advised to drink only clear liquids on the day after the operation, and then follow a pureed diet by the time the patient is going home. At home, pain relievers and acid blocking medications are typically prescribed.

The bariatric surgeon in charge or a dietician will design a diet for you, meals should be small to avoid stretching the remaining stomach.

Typical results of sleeve gastrectomy

The final weight loss may take longer time to achieve and it may not be as large compared with gastric bypass surgery, however this may be enough for many patients depending on specific needs, requirements and individual metabolism. Sleeve gastrectomy surgery may also improve or even resolve weight related co-morbidities.

Health Links:

ASMBS – American Society for Metabolic and Bariatric Surgery.

Compare Sleeve Gastrectomy Estimated Cost.



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