What is Sleeve Gastrectomy?
Sleeve gastrectomy is a type of bariatric or weight loss surgery, involving the removal of about 75% of the stomach. The remainder of the stomach is formed into a tube, also known as the gastric sleeve, resembling a banana. It is designed to reduce a person’s food consumption by making them feel full sooner, so they don’t eat as much, while still leaving them with enough functioning stomach tissue to eat regular meals.
During this laparoscopic procedure, the surgeon will use a scope to make several small incisions and insert surgical tools while imaging the area via x-ray. The large portion of the stomach is then separated, leaving only a small banana-shaped sleeve measuring about 2.5 ounces. The remainder of the stomach is then removed from the body.
Overview of Sleeve Gastrectomy
Sleeve gastrectomy is less invasive and has a quicker recovery than other bariatric surgeries. It is less radical than other bariatric surgeries and may be performed on people who are younger and/or have a lower BMI than is typically required for other procedures. It is considered a less drastic procedure than traditional gastric bypass.
Not all sleeve gastrectomy patients qualify for this procedure; all candidates must meet criteria that demonstrate that they are opted for bariatric surgery as part of an overall program to lose weight. You must be willing to make lifestyle modifications, such as following a nutrition plan and exercising regularly.
In order to qualify for sleeve gastrectomy, you must:
- Be obese with a body mass index (BMI) of 40 or more, or have a BMI of 35 or more and suffer from obesity-related medical conditions, like diabetes, sleep apnea, and hypertension.
- Be between 18 and 65 years of age.
- Be well informed about your procedure and willing to make lifestyle changes.
- Be medically cleared for surgery by your doctor.
Once you have been evaluated by your surgeon and deemed a good candidate for sleeve gastrectomy, they will discuss the procedure and recovery period with you in detail.
Benefits of Sleeve Gastrectomy
Sleeve gastrectomy offers many benefits for the right patient:
- Reduces hunger hormone – Ghrelin, which suppresses appetite and cravings
- Promotes long-term weight loss and keeps it off
- Reduces obesity-related health risks such as type 2 diabetes, high blood pressure, and more
- Requires no permanent incisions, staples, or foreign bodies
- Much shorter recovery time than other bariatric surgeries
Expected Results of Sleeve Gastrectomy
On average, people who have a sleeve gastrectomy lose between 50 and 70% of their excess body weight within two years. Research shows that the procedure is also successful at reducing or resolving weight-related health conditions, such as high blood pressure and type 2 diabetes.
Unlike with other bariatric surgeries, you can expect to continue to lose weight until 24 months after the surgery. Although it is not a ‘quick fix’ for obesity, studies have shown that sleeve gastrectomy can significantly reduce long-term weight and improve related health conditions.
Nutrition after Sleeve Gastrectomy
Getting enough nutrients is essential for your recovery from sleeve gastrectomy. Consuming nutritious, well-balanced meals and snacks are important to provide vital vitamins and minerals your body needs to aid in the recovery process.
You can expect to eat more or less than what you are used to. After the surgery you may need to eat more often or in smaller portions. Your doctor may also recommend that you increase your intake of certain foods and supplements, such as protein and iron.
Exercise After Sleeve Gastrectomy
Exercise and physical activity become even more important after you have a sleeve gastrectomy. Your doctor and physical therapist may suggest a customized exercise plan for you. Before starting a fitness regime, discuss it with your doctor as certain exercises or activities may be restricted for safety reasons.
Studies have shown that incorporating at least 150 minutes of moderate-intensity exercise each week helps boost weight loss stability and keeps the weight off in the long run. Exercise is also important to reduce the risk of heart disease and other obesity-related risks.
Sleeve gastrectomy is a weight management tool for people with severe obesity, who want to reduce their food consumption and lose weight. The procedure involves removing a large portion of the stomach and forming the remainder into a small, banana-shaped tube. This limits the amount of food people can eat and keeps them feeling full much sooner.
After surgery, many patients lose between 50 and 70% of their excess body weight within two years. Studies have also shown that this weight loss is generally stable in the long run. It is also successful in reducing or resolving obesity-related medical conditions.
Sleeve gastrectomy can be a successful tool for people who are willing to make lifestyle changes to support their weight loss goals. Patients must commit to making dietary and exercise modifications before and after surgery in order to be successful.
It is important to speak with a doctor in order to determine if sleeve gastrectomy is the right weight loss option for you.
التعريف والنظرة العامة
Sleeve gastrectomy (gastric sleeve surgery) is an irreversible weight loss surgery that reduces the size of the stomach by up to 75 percent to drastically decrease food intake. With obesity becoming a global concern, this procedure, which is much less complicated compared to other types of bariatric surgery, has increased in popularity in recent years.
من يجب أن يخضع للنتائج المتوقعة
Sleeve gastrectomy is recommended for individuals who:
- Have a body mass index (BMI) of 40 and above, which is considered morbidly obese
- Have a BMI of at least 30 with at least one obesity comorbidity such as sleep apnea, type 2 diabetes, and مرض قلبي
- Weigh 75 pounds more than their ideal body weight
It is also typically recommended for obese individuals who have not lost weight despite drastic lifestyle modifications, whose obesity is not related to other underlying conditions like thyroid problems, and who do not prefer lap band surgery, which involves using a band to reduce the size of the stomach. Lap bands often need to be adjusted regularly, which is not only inconvenient but also increases the risk of surgical complications.
Sleeve gastrectomy may also be recommended for children, provided they have undergone comprehensive surgical screening and counseling prior to the procedure and the benefits, such as the prevention of long-term obesity-related chronic conditions, far outweigh the risks.
Also, the procedure can be performed as the first stage of gastric bypass, which requires more hours of operation that can be risky for obese patients due to the amount of anesthesia needed. Gastric sleeve surgery may be carried out first to give the patient enough time to lose considerable weight before the bypass is performed. However, due to the potential weight loss associated with sleeve gastrectomy, which is at least 60 percent, a bypass is sometimes no longer necessary.
As one of the most popular bariatric procedures (accounts for more than 42 percent of all weight loss surgeries in 2013), sleeve gastrectomy promotes significant weight loss within the next two years following the operation and the reversal of obesity-related problems. It also has minimal complications due to quicker operation time, less amount of anesthesia needed, and minimal reorganization of the digestive tract. Finally, although restrictive, the procedure does not usually result in malabsorption and deficiency of nutrients.
كيف يعمل هذا الإجراء؟
Prior to the surgery, both the surgeon and the patient will meet to discuss:
- The actual procedure including preparation, surgical time, and the team of doctors who will be involved in the surgery
- Risks and complications of the surgery
- Benefits of the surgery
- Postoperative care
- Long-term weight loss management
- Other concerns the patient may raise
- Psychological counseling
The patient also needs to undergo a series of tests including a thorough physical exam and blood test to ensure that he’s an appropriate candidate for the procedure. A consultation with an anesthesiologist is also recommended to determine how much anesthesia should be provided without increasing the risk of complications during the operation.
During the actual procedure, the patient is administered with general anesthesia and the rest of the body, except for the abdomen, is draped. The surgeon then proceeds by creating two to five small incisions in the abdominal area that provide the best access to the stomach.
A laparoscope, a long narrow tube equipped with a camera, is inserted into one of the incisions to provide a clear visual of the stomach and the nearby organs on a monitor.
Using small surgical instruments inserted through other incisions, the surgeon slowly removes a big portion of the stomach including the fundus, the upper part of the organ where the gases created during digestion and undigested food are stored, while keeping the pylorus, the lower part that promotes the emptying of stomach contents to the intestine, intact. The remaining part of the organ, which is still connected to the esophagus and the top of the small intestine, is then stapled, leaving the stomach looking like a banana.
Once the stomach size has been reduced, the instruments and the laparoscope are removed, and the incisions are stitched.
The entire procedure may take at least an hour and the patient may have to stay in the hospital for 2 to 3 days.
Before the patient is discharged from the hospital, the surgeon will check for any content leak and infection at the wound site. The doctor will also recommend a special liquid diet, which should be followed for a few weeks, to reduce stomach sensitivity.
المخاطر والمضاعفات المحتملة
Laparoscopic surgeries have been associated with lower risks and complications because of small incisions and faster operation time. Nevertheless, sleeve gastrectomy may lead to:
- Gallbladder issues
- Reactions to anesthesia including breathing problems and allergies
- Blood clots
- Septicemia (sepsis)
- Inflammation of the stomach lining (gastritis)
- Ulceration of the stomach
- Injury to the stomach and nearby organs
- Bowel blockage due to stomach scarring
Sleeve gastrectomy is only an aid to weight loss, so for patients to continue losing weight or maintain a good one, they still have to adopt a healthy lifestyle. Otherwise, there’s still a good chance they will gain the weight they lost.
Brethauer SA, et al. (2009). Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surgery for Obesity and Related Diseases, 5: 469-475.
Heber D, et al. (2010). Endocrine and nutritional management of the post-bariatric surgery patient: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism, 95(11): 4823-4843. Available online: http://www.endo-society.org/guidelines/final/upload/FINAL-Standalone-Post-Bariatric-Surgery-Guideline-Color.pdf.