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Sleeve Gastrectomy

In a sleeve gastrectomy, also known as a  vertical sleeve gastrectomy or gastric sleeve procedure,   the outer margin of the stomach is removed to restrict food intake, leaving a sleeve of stomach, roughly the size and shape of a banana, and the pylorus, the muscle that controls emptying of food from the stomach into the intestine. A sleeve gastrectomy is a purely restrictive procedure.

The sleeve gastrectomy, by reducing the size of the stomach, allows the patient to feel full after eating less and taking in fewer calories. The surgery removes that portion of the stomach that produces a hormone that can makes a patient feel hungry

How is Sleeve Gastrectomy Performed?

Most sleeve gastrectomies performed today are performed laparoscopically. This involves making five or six small incisions in the abdomen and performing the procedure using a video camera (laparoscope) and long instruments that are placed through these small incisions.

Sleeve gastrectomy is a restrictive form of operation in which approximately 2/3rd of the left side of the stomach is removed laparoscopically using endoscopic staplers. The stomach thus takes the shape of a hockey stick or sleeve. It can be performed as either first stage of a two-stage procedure for super obese (BMI >60) where it can be followed with malabsorptive surgery or as a single stage procedure by itself.

The capacity of the stomach ranges between 60 – 100 cc. Unlike many other forms of bariatric surgery, the outlet valve and the nerves of the stomach remains intact while only the stomach size is drastically reduced. Though a non-reversible procedure, the part of the stomach that contains Ghrelin, the hormone for hunger is removed; it drastically reduces your appetite and hormones that controls diabetes.

The hour glass configuration only constricts the upper stomach thus acting as a pure restrictive operation. Since the outlet is small, food stays in the pouch longer and one also feels satiated for a longer time. Scheduled follow-up visits will be at 6 weeks, monthly for the first six months and yearly thereafter or as and when medically required.

The Procedure

This procedure works by several mechanisms. First, the new stomach pouch holds a considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food (and thus calories) that can be consumed. The greater impact, however, seems to be the effect the surgery has on gut hormones that impact a number of factors including hunger, satiety, and blood sugar control.

Short term studies show that the sleeve is as effective as the roux-en-Y gastric bypass in terms of weight loss and improvement or remission of diabetes. There is also evidence that suggest the sleeve, similar to the gastric bypass, is effective in improving type 2 diabetes independent of the weight loss. The complication rates of the sleeve fall between those of the adjustable gastric band and the roux-en-y gastric bypass.

Advantages

  1. Restricts the amount of food the stomach can hold
  2. Induces rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass. Weight loss of >50% for 3-5+ year data, and weight loss comparable to that of the bypass with maintenance of >50%
  3. Requires no foreign objects (AGB), and no bypass or re-routing of the food stream (RYGB)
  4. Involves a relatively short hospital stay of approximately 2 days
  5. Causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve satiety

Gastric Sleeve Surgery brings profound changes to life!

  • Overall improved quality of life
  • Excess weight loss of about 60-70% within one year of surgery
  • Remission or improvement of obesity related health conditions such as diabetes mellitus type II, hypertension, sleep apnea, fatty liver disease, joint pain, and hyperlipidemia
  • Desire to eat decreases
  • Reduction in hunger sensation

Improvement of Obesity Related Health Problems

  • Large clinical trials and studies have proven gastric sleeve surgery lead to resolution or improvement of many obesity related health problems such as:
    • Type 2 diabetes: Most studies indicated that 60-80% of patients with type 2 diabetes could achieve disease remission or improvement after gastric sleeve surgery
    • Hypertension
    • Fatty liver disease
    • High cholesterol
    • Sleep apnea
    • Decreased cancer risk
    • PCOS
    • Asthma
    • Migraine
    • Join pain
    • Depression and other psychosocial problems
    • Infertility
    • Low testosterone: Gastric sleeve can naturally lead to increased testosterone level
    • Urinary incontinence
    • Gout

Diet after Gastric Sleeve Surgery 

  • Day 1: Clear liquid diet. Some surgeons allow patients to drink water a few hours after surgery
  • Day 2-14: Full liquid diet including protein shakes, yogurt, broth, milk, and juice
  • Weeks 3-5: Soft food diet
  • Patients can begin introducing regular food 5 weeks after surgery. They are encouraged to eat a small amount of food each time and have meals that are more frequent.
  • All patients must take multi-vitamin and B complex after surgery

How much weight will I lose after the Gastric Sleeve?

  • On average, people lose about 60-70% of their excess weight 
    • The first 2 weeks: 10-20 pounds; most patients lose about one pound a day
    • The first 3 months: 35-45% of excess weight loss
    • The first 6 months: 50-60% of excess weight loss
    • The first year: 60-70% of excess weight loss
  • Most people reach their lowest weight 12-24 months after surgery
  • The Gastric Sleeve success rate is approximately 80-90%