Sleeve Gastrectomy (Gastric Sleeve)

Sleeve Gastrectomy (Gastric Sleeve)

The Gastric Sleeve Surgery (or Vertical Sleeve Gastrectomy) is a bariatric procedure that removes 75-80% of the stomach. It is now the most commonly performed bariatric procedure in United States and worldwide. 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

 

How Gastric Sleeve surgery is performed

- Small incisions are made in the abdominal wall for the insertion of small trocars ( mm is millimetre. A 15mm trocar has a diameter of 15 millimetre, or 0.6 inch).

- The stomach is inspected. The blood vessels to the lateral side of stomach are divided.

- A Bougie tube is inserted into the stomach and serves as a sizer for the size of the new stomach.

- Starting from 4-6 cm (1.5-2.5 inches) from pylorus (the valve between stomach and small intestine), the stapler is used to divide the stomach into two parts. At the beginning, the stapler is slightly far away from the Bougie tube to avoid causing a stricture.

- Continuous firing of the stapler is used to divide the stomach. After the first fire, the stapler is very close to the Bougie tube and make a small banana shaped new stomach.

- The stomach is completely divided into two parts. The removed larger part has about 75-80% of the original stomach volume. Once this part of stomach is decompressed, it can be removed through a very small incision (the 15mm trocar site). Some scientists believe that the removed upper part of the stomach (fundus) has the function of secreting hunger hormones. Once this part of stomach is removed, many patients don’t feel hungry after surgery.

- The new banana shaped stomach has about 20-25% of original stomach volume. Almost all patients eat much less after surgery because they feel full much easier.

 

How does the Gastric Sleeve surgery work?

- There is a reduction in stomach volume, causing people to feel full much quicker after the surgery

- Hormonal changes such as reduced secretion of hunger hormones cause people to feel less hungry

- Increased stomach motility, which allows food to pass stomach and intestine quicker 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%

 

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, Joint pain, Urinary incontinence, Depression and other psychosocial problems, Infertility, Gout. Low testosterone: Gastric sleeve can naturally lead to increased testosterone level.

 

Recovery after Surgery

 - The surgery takes approximately 40-70 minutes

- Discharge from hospital typically occurs after 1-2 nights

- All patients are encouraged to walk as early as 3-4 hours after surgery

- In general, the pain is easily manageable after surgery. Most patients take less than the recommended pain medication

- Most patients go back to work and/or school after 2-4 weeks. Fatigue is common the first 2 weeks due to low calorie intake from liquid diet. However, the majority of patients do not feel hungry during this stage of the diet. The energy level improves quickly after the introduction of the soft diet, which is approximately 2 weeks after surgery. On occasion, we allow patients to work from home 2-3 days per week after surgery.

- Patients can begin exercising 4 weeks after surgery

 

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 multivitamin and B complex after surgery

 

Advantage of Gastric Sleeve versus Gastric Bypass Surgery

- Technically, the Gastric Sleeve is a much simpler surgery. The operating time for gastric sleeve is usually 40-70 minutes, while gastric bypass surgery takes approximately 2-3 hours to complete.

 - There is a much lower chance for nutrient or vitamin deficiency with the Gastric Sleeve procedure. In addition, there is no malabsorption for Gastric Sleeve patients.

 - Some long-term complications could occur with the Gastric Bypass patients including bowel obstruction, marginal ulcer, and internal hernias. The chance of Gastric Sleeve patients developing these complications is exceedingly rare.

 

Complications and Risks

- Over the past decade, with the improvement of surgical techniques and surgeons’ experience, the gastric sleeve has become an overall safe bariatric surgical procedure. However, complications can still occur during and after surgery. Below are the main complications and risks of the gastric sleeve surgery:

- Leakage from the staple line – this is a rate complication of the gastric sleeve surgery. The stable line opens after surgery. Most leaks can be treated with endoscopic procedure.

- Stricture/stenosis – another rare complication with narrowing of the stomach after sleeve gastrectomy. Most stricture/stenosis can be treated with endoscopic dilation.

- Bleeding

- Blood Clot

- Heart Burn :This is a very controversial topic in bariatric surgery and the data from different centers is inconsistent. In our experience, most patients with heartburn before surgery see improvement of symptoms after surgery due to weight loss. Some patients may develop new heartburn, which is treatable with over-the-counter anti-acid medications, in most cases.

- Nutrient or vitamin deficiency

- Weight Regain : After 1-2 years, slight weight regain is common among all bariatric procedures and about 10-20% of patients can have significant weight regain after gastric sleeve surgery. After 5 years of follow up, many centers collected data to show that the majority of patients can maintain their weight loss after the Gastric Sleeve Surgery.

 - Excess skin, in some cases, insurance will cover excess skin removal