Gastric Sleeve (Sleeve Gastrectomy)

Gastric Sleeve Surgery

The Sleeve Gastrectomy (or the gastric sleeve) is a bariatric surgery procedure which is performed laparoscopically (keyhole surgery) under a general anaesthetic.

Your stomach normally holds approximately 1L and empties solid food within 10-30minutes and fluids within 5-10mins.  During the sleeve gastrectomy surgery 80-90% of your stomach is cut and permanently removed from your body.  This leaves a ‘tube’ or ‘banana’ shaped stomach behind which is your new, smaller ‘sleeve’ stomach.  Your sleeve stomach holds approximately 150mls initially after surgery and the route of food through your sleeve stomach, and onwards into your bowel, remains unchanged.  After about 12 months you should be able to comfortably eat approximately 1 cup of normal food as a meal.

Studies show that after a sleeve gastrectomy people lose between 60-80% of their excess body weight over the first 12-24 months.  It must be noted that this surgery, along with any other bariatric procedure, is only ever a ‘tool’ to help you control your weight.  Weight loss success relies upon you optimising the use of your ‘tool’ and varies due to a number of factors such as age, starting weight, concurrent medical or psychiatric illnesses, ability to exercise, meal planning/routine as well as perseverance. It is virtually impossible to lose too much weight after a gastric sleeve.  Most people get to the point where further weight loss comes at the cost of excessive effort and they therefore settle at the weight that suits them.

How does the sleeve work?

All of the actual mechanisms resulting in weight loss after a sleeve gastrectomy are still not completely understood.  We do know that people feel full on smaller portions of food and there is a reduction of hunger promoting hormones produced which assists in reducing food intake. Often people also report taste changes which decrease the appeal of fat and sugar rich foods. Obviously all of these factors result in a reduction of calorie intake which therefore facilitates weight loss.

Advantages

  • Easier surgical procedure compared to the gastric bypass.
  • The pyloric sphincter of the stomach is unaffected by the surgery reducing the risk of dumping syndrome.
  • Less multivitamin supplements are needed to be taken for life as compared to the gastric bypass.
  • No foreign body (like the lap band) is used which decreases the chance of complications such as infection, migration or erosion.
  • Follow up is not as intensive as those with a lap band therefore the sleeve is considered more suitable for people living distances away.
  • The sleeve can be converted to a gastric bypass in the case of any complications (eg uncontrolled reflux).
  • The sleeve has been shown to reduce the incidence of diabetes, high cholesterol, joint pain and hypertension and also lowers the dosage, or negates the use altogether, of medications used to treat lifestyle diseases.

Disadvantages

  • The sleeve may cause reflux or make existing reflux worse. This is not always the case.  Some people will have reflux for a short amount of time post surgery only while others may not suffer from it at all.
  • It is possible to stretch the sleeve by overeating repetitively. This will not be a comfortable process.  If your sleeve becomes stretched to allow for the consumption of more food it will result in weight gain.  Keep in mind that most weight gain years after surgery is likely to be due to poor food and lifestyle choices rather than increased sleeve volume.
  • Multivitamins are required to be taken daily for life. Due to the reduced volume of food eaten,  especially if poor food choices are being made, there is a risk of nutritional deficiencies if supplements are not being taken as directed. Some of these deficiencies can have irreversible and severe complications such as neurological injury and permanent dementia.
  • Being a newer surgery, performed in Australia only since 2004, all longer term weight loss results are not yet fully known.

Risks

  • During surgery the stomach is cut and stapled. It is possible that during this process a leak along the staple line will form which then allows stomach contents to leak out into the abdomen.  There is generally a 1% risk of this occurring and if detected early it can resolve quickly with minimal intervention.  At worst sleeve leaks can require intensive hospital based treatment lasting approximately 6-12 weeks or longer.
  • As with many weight loss operations, rapid weight loss can lead to gallstone formation in 20-30% of patients.
  • Other complications include staple line bleeding, narrowing of the new stomach, haemorrhage, bowel injury, wound infection, hernia, post operative abscess, deep vein thrombosis, pulmonary embolism, reactions to anaesthesia/medications. This is not a complete list of all risks, please discuss any specific concerns further with Dr your surgeon during your personal consultation.

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