What is gastric sleeve surgery?
Gastric sleeve surgery or sleeve gastrectomy is an irreversible gastric surgery performed with the intention of reducing the weight of the obese gastric sleeve patient. It is a type of bariatric surgery for weight loss, which can help you lose from 50 to 90 pounds.
It is a gastric restrictive procedure in which the major portion of the stomach is resected or surgically removed in order to restrict your food intake. This surgery is referred to by many names:
- Vertical sleeve gastrectomy
- Tube gastrectomy
- Laparoscopic sleeve gastrectomy
- Gastric sleeve resection
- Gastric sleeving
Obesity does adversely influence the lifespan of the obese patient. Bariatric surgery significantly reduces this risk of premature death.
According to Wikipedia, sleeve gastrectomy is the most commonly performed bariatric surgery worldwide. In most cases, sleeve gastrectomy is as effective as gastric bypass surgery in achieving weight loss and producing improvements in glucose homeostasis before considerable weight loss occurs.
Duration of Surgery: One to two hours
Duration of hospital stay: One or two days
Method of operation. Through laparoscope
The procedure of this laparoscopic surgery involves making a few small incisions on the abdomen as against one large incision, which is made in open surgery.
In this procedure, the major part of the stomach along the greater curvature is removed along with a major portion of the fundus of the stomach (upper part of the stomach).
The procedure involves a longitudinal resection of the stomach starting from the pyloric antrum (the lower portion of the stomach) at the point 5–6 cm from the pylorus and finishing at the fundus of the stomach close to the cardia (part of the stomach that is closest to the esophagus).
A major portion of the stomach (about 60% to 80%) is removed and what remains of the stomach is a narrow sleeve. After surgery, only 15% of the original size of the stomach remains.
The cut edges are then sutured or stapled with surgical staples. The surgical changes after this surgery are not reversible.
It is in the fundus that the chemical called Ghrelin is produced. Ghrelin is responsible for stimulating appetite. Your appetite, therefore, gets reduced after this surgery because the fundus of the stomach is reduced.
In this surgery, only the restrictive approach to reduce obesity is performed. The malabsorptive approach is not used as it is done in gastric bypass surgery.
It forms the first part of weight loss surgery, the second being the gastric bypass or the duodenal switch. This two-staged procedure, performed at an interval, becomes necessary to reduce the surgery risks in extremely obese patients.
The time of the second procedure will be determined by the gastric sleeve surgeon after examining the amount of weight lost. It may be performed anywhere from 6 months to 18 months after the first surgery.
The gastric sleeve itself gives a good amount of weight loss, but if weight loss ceases, the second step of the gastric bypass is performed.
Gastric sleeve or sleeve gastrectomy is reserved for extremely obese patients with a BMI of 40 or more. It is also performed in obese patients with a lesser BMI if any obesity-related complications are present.
However, in not-so-extremely obese patients where BMI is between 30 and 39, gastric sleeving alone may be sufficient with low risks. Performing gastric sleeve as a one-stage procedure in obese patients is gaining popularity among bariatric surgeons nowadays.
Before gastric sleeve: Lifestyle and diet restrictions
Start following these guidelines a few weeks before surgery.
- If you are a smoker, avoid smoking altogether. However, at least avoid it one month before and after surgery.
- Stop drinking alcohol a few weeks before surgery.
- Some surgeons advocate starting the gastric sleeve patient on a special diet, a few weeks before surgery.
Your doctor will advise the following diet a few weeks before surgery.
- Start eating smaller portions.
- Eat 3 to 4 small meals every day.
- Form the habit to chew your food well to a paste.
- Stop fast foods and stick to healthy foods at home or outside.
- Choose low-fat and low-calorie foods. Avoid fried foods.
- Avoid caffeinated and carbonated beverages.
- Stop eating sugar and sugary drinks and foods.
- Eat fruits and vegetables.
- Begin exercises regularly.
- You’ll need to stop taking aspirin, ibuprofen, and other blood thinners in the days before your surgery.
After gastric sleeve surgery: Lifestyle and diet
In this irreversible gastric surgery, as a major portion of the stomach is removed, certain changes in living and eating habits become necessary and you should follow them throughout life. Do’s and don’ts explained for the pre-operative period above, also apply to the postoperative period.
Post-operative gastric sleeve diet
- Sold foods are started only 4 to 5 weeks after surgery.
- For the first two weeks, only a liquid diet is given to the patient.
- After two weeks, pureed or grounded foods are given.
- It is only after this has been tolerated well, that solid foods are gradually introduced to the patient.
The post-operative gastric sleeve diet is low in fats and calories and high in proteins. Each meal should not be more than one to two ounces. Later, however, the meal size will increase and the long-term meal size will comprise 4 to 8 ounces (half to one cup). Read the gastric bypass diet to get details of your post-operative do’s, don’ts, and the foods to eat.
Gastric sleeve and weight loss benefit
Within six months to one year after surgery, the gastric sleeve patient loses up to 50% to 80% of his excess weight.
As with other weight loss surgeries, gastric sleeve surgery also gives comparable benefits on health complications of obesity and these are seen within one to two years after surgery. There is marked improvement in diabetes type 2, cholesterol levels, high blood pressure, and sleep apnea.
Advantage of the gastric sleeve over gastric bypass
The main advantage of gastric sleeving over gastric bypass is that there is no bypass of any portion of the intestines. Therefore, there are no malabsorption issues.
Malabsorption which develops in bypass weight loss surgeries does not develop in a gastric sleeve patient. Weight loss is achieved by restriction of food intake due to a smaller stomach and loss of appetite as explained earlier.
Advantage of gastric sleeving over lap band surgery
There is no band or foreign object left in the body as in gastric banding. Risks such as band slipping, erosion of the band into the stomach, or any infection due to the foreign body do not occur with gastric sleeve surgery.
Sleeve gastrectomy may cause some of the following complications;
- Gastroparesis (delay in the movement of food from the stomach to the small intestine)
- Infection of the wound, which in general can occur with any surgery
- Leakage of food from the stapled edges of the stomach into the abdomen (occurs in 1 in 200 patients)
- Strictures or stenosis ((occurs in 3.5 % of post-op patients)
- Formation of blood clots
- Long term, there is stretching of the gastric sleeve, which can result in more consumption of food leading to weight gain. This disadvantage can be eliminated by being disciplined in your eating habits.
- Long-term benefits on weight loss and obesity complications are yet to be ascertained as this procedure is comparatively new.
Cost of gastric sleeve surgery
Though this surgical procedure is comparatively new, insurance companies have nowadays started insuring these surgeries. In the United States, the cost of a gastric sleeve or sleeve gastrectomy is a little more than $10,000. This will cover the cost of:
- Hospital admission and room charges
- Surgeon’s fees
- Laboratory charges, and
- Radiology charges
This cost does not include treating any complications that may arise, the cost of post-operative behavior modification, or cosmetic surgery for loose skin or flabs that may arise due to weight loss.