The sleeve gastrectomy is a restrictive procedure that works by converting the stomach into a long, thin tube by stapling it along its length and removing the excess stomach. The size of your stomach is reduced by about 75%. It is divided vertically from top to bottom, leaving a banana (or sleeve) shaped stomach along the inside curve. The pyloric valve (which regulates the emptying of the stomach into the small intestines) remains intact at the bottom of the stomach. This means that although smaller, the stomach works in the same way as before. Unlike other forms of weight loss surgery, the sleeve gastrectomy is not reversible.
Because the new stomach continues to function normally after surgery, there are fewer restrictions on the foods which patients can consume after surgery. However, because you can only eat a small meal, you should lose weight if you follow a diet that is low fat and low in sugar. You should also feel full faster and stay full longer due to the stomach being reduced in size. One of the advantages of removing the majority of the stomach is that it results in the virtual elimination of the hormones produced within the stomach which stimulates hunger.
What are the advantages of having a sleeve gastrectomy?
- The stomach is reduced in volume but functions normally so most food items can be consumed although in smaller portions.
- Because there is no intestinal bypass, almost eliminates the risk of intestinal obstruction (blockage), marginal ulcers, anemia ,and vitamin and protein deficiency
- Eliminates the portion of the stomach that produces the hormones that stimulate hunger (Ghrelin).
- No dumping syndrome (or minimal) because the pylorus is preserved.
- Minimizes the chance of an ulcer occurring.
- It is relatively easy to modify to an alternative procedure should weight loss be inadequate or weight regain occur.
- Very effective as a first stage procedure for high BMI patients (BMI>55 kg/m2).
- Limited results appear promising as a single stage procedure for low BMI patients (BMI 30-50 kg/m2). The limited 2 year and 6 year weight loss data available to date is superior to current Banding and comparable to Gastric Bypass weight loss data (see Lee, Jossart, Cirangle Surgical Endoscopy 2007).
- Appealing option for people with existing anemia, Crohn’s disease and numerous other conditions that make them too high risk for intestinal bypass procedures.
- Can be done laparoscopically.
- Appealing option for patients concerned about having a foreign body implanted (banding device), or are worried about frequent adjustments.
- Unlike the gastric bypass where the uses of anti-inflammatory medications are associated with a very high incidence of ulcers, the sleeve gastrectomy does not seem to have the same issues. Also, gastric banding patients are at higher risks for complications from NSAID use.
What are the disadvantages of the sleeve gastrectomy?
- Potential for inadequate weight loss or weight regain. While this is true for all procedures, it is theoretically more possible with procedures that do not have an intestinal bypass.
- Foods such as ice cream, milk shakes, potato chips, French fries, etc goes down real easy and can slow weight loss.
- This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur.
- Because the stomach is removed, it is not reversible. It can be converted to almost any other weight loss procedure.
- Considered investigational by some surgeons and insurance companies.
- Higher BMI patients will most likely need to have a second stage procedure later to help lose the rest of the weight. Two stages may ultimately be safer and more effective than one operation for high BMI patients (currently we are not performing surgery on patients whose BMI is high enough to warrant a two stage procedure).
What are the risks and complications associated with the sleeve gastrectomy?
As with any surgery, there can be complications. Risks associated specifically to this procedure may include:
- Leak (along staple lines)
- Ulceration (peptic ulcers may form along the staple line)
- Narrowing (of remaining stomach)
- Perforation of the esophagus
- Protein deficiency (from inadequate intake)
- Hair loss
- Vitamin and mineral deficiency
- Complications of pregnancy (pregnancy should not occur during the first 2 years due to rapid weight loss)
- Skin problems (loose skin, infections in skin folds)
- Depression (as a result of weight loss, dietary changes, etc)
- Failure to lose weight or weight regain
Are there any alternatives to this operation?
- Lifestyle management ( diet, exercise and behavior modification)
- Drug treatment
- Gastric banding surgery
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