The gastric sleeve surgery or sleeve gastrectomy has become a popular option for those patients that are looking for weight loss surgery over recent years. Do not confuse this with Gastric Bypass Surgery as they are two different procedures. Sleeve gastrectomy is indicated for patients with a Body Mass Index (BMI) over 40, which are considered high-risk patients in surgical settings meaning they would be at greater risk of complications or death when undergoing surgery.
Gastric sleeve surgery takes just about 1 hour, half the time needed for gastric bypass surgery and about one fourth of the time needed for other weight loss procedures such as the Duodenal Switch. The lower time under the knife translates in a safer procedure with less risks for the patients.
It was originally thought as the first step in a two-step procedure for weight loss, but is now successfully and routinely performed as a stand-alone surgery:
- First step is the gastric sleeve itself, which is the reduction of the size of the stomach leaving about 20-25% of its original capacity.
- Second step is an intestinal bypass performed after about one year when the patient has already lost some weight, but as said already this second step is not part of this procedure anymore.
Table of Contents
Benefits of Gastric Sleeve Surgery
- Reduction of hunger. The reduction of the appetite is related to the decrease in the production of the hormone ghrelin, an appetite-prompting hormone, by eliminating a part of the stomach responsible for its production.
- Ghrelin is also involved in blood glucose metabolism so there is often an immediate change for diabetic patients which might require less medications after surgery.
- Reduced operating time. This lowers the risks in high-risk patients
- Requires no foreign object insertion or rerouting of the intestine.
- Lower risk of developing dumping syndrome when compared to other weight-loss procedures.
Sleeve Gastrectomy Procedure
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During the surgical procedure, the surgeon removes the majority of the stomach and creates a new banana-shaped stomach known as “sleeve.” The surgery is permanent and irreversible. The surgeon will perform this procedure laparoscopically (keyhole surgery), making several small abdominal incisions. Then the bariatric surgeon will insert the cameras and instruments to remove about 75 % of the stomach and after that he stitches the remaining part of the stomach to form the sleeve.
The created sleeve will cross the original distance from the esophagus (the natural stomach opening) to the small intestine through the pyloric valve (the natural stomach outlet) which will preserve its normal physiological function lowering the risk of developing the dumping syndrome.
Gastric Sleeve Aftercare and Recovery
After sleeve gastrectomy you will have to make lifestyle and dietary changes, some of which will be temporary while others will be permanent.
From the day after surgery you’ll be able to drink clear liquids and then move to a liquid/pureed diet to which you will have to adhere for up to 4 weeks, slowly transitioning to soft and then regular foods. You will have to remember to eat smaller portions than you used to, chew the food thoroughly and slowly. Avoid drinking and eating at the same time as this might cause your stomach to overfill. . You should wait about 30 minutes after a meal to drink some water. Remember to sip slowly and not gulp. You will also need to supplement your diet for life with some vitamins and minerals daily to avoid deficiencies due to malabsorption. You surgeon and dietitian will provide you with all the required information on how, when and what to eat.
Discharge from the hospital usually occurs 1-3 days after the procedure and some discomfort or pain might be present for up to a week and for which you will be prescribed pain killers.
You will be encouraged to resume being active, such as walking, soon after surgery as this leads to a faster recovery. Avoid heavy lifting (more than 5-7Kg), pushing, pulling and in general any movement that elicits pain. After laparoscopic surgery you should be able to resume most of your activities in 2-4 weeks.
You will have a scheduled appointment with your surgeon a couple of weeks after surgery and then a few more over the course of one year.
You should expect to lose weight very quickly in the first 3-6 months and about 60% to 70% excess weight (not your total weight!) during the first 12-24 months, after which weight loss will slow down. Better results can be obtained by strictly adhering to the lifestyle and dietary changes as advised by your physician and dietitian.
Complications after Sleeve Gastrectomy
The gastric sleeve is considered a major abdominal surgery, thus it has an higher risk of complications than minor procedures. The main possible complication is the leakage of stomach content from the staple line. Other possible complications are
- vomiting from overeating
- injury to nearby organs during surgery
- scarring of the internal stomach wall which can lead to a bowel blockage
- gastritis
- thrombosis (blood clots)
- infection of the surgical wound site.
Maintenance of Results
Unlike other procedures such as the adjustable gastric band there will be no need of continuous device adjustments nor there is an high rate of re-operation.
You will have to keep following your diet as per your dietitian indications to keep losing weight and to avoid the stretching of the remaining portion of the stomach.
You will also need to keep exercising regularly, but keep in mind this doesn’t mean you have to join a gym and become a competitive athlete: a 30 minute walk each day could be enough.
References
- Carlos Hoyuela. Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity: A prospective study. World J Gastrointest Surg. 2017 Apr 27; 9(4): 109–117. Published online 2017 Apr 27. doi: 10.4240/wjgs.v9.i4.109
- Park JY, Kim YJ. Laparoscopic gastric bypass vs sleeve gastrectomy in obese Korean patients. World J Gastroenterol. 2015 Nov 28;21(44):12612-9. doi: 10.3748/wjg.v21.i44.12612.
- Lim DM, Taller J, Bertucci W, Riffenburgh RH, O’Leary J, Wisbach G. Comparison of laparoscopic sleeve gastrectomy to laparoscopic Roux-en-Y gastric bypass for morbid obesity in a military institution. Surg Obes Relat Dis. 2014 Mar-Apr;10(2):269-76. doi: 10.1016/j.soard.2012.08.012. Epub 2012 Aug 30.
- Carandina S, Maldonado PS, Tabbara M, Valenti A, Rivkine E Polliand C, Barrat C. Two-step conversion surgery after failed laparoscopic adjustable gastric banding. Comparison between laparoscopic Roux-en-Y gastric bypass and laparoscopic gastric sleeve. Surg Obes Relat Dis. 2014 Nov-Dec;10(6):1085-91. doi: 10.1016/j.soard.2014.03.017. Epub 2014 Mar 28.
- Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014 Aug 8;(8):CD003641. doi: 10.1002/14651858.CD003641.pub4.
