Sleeve gastrectomy is a surgical procedure that induces weight loss by restricting food intake. With this procedure, which is usually performed laparoscopically, the surgeon removes approximately 75-80 percent of the stomach. This results in the stomach taking on the shape of a tube or “sleeve” which holds much less food. Although originally devised as the first stage of a two stage procedure for superobese or high-risk patients, the sleeve gastrectomy is now commonly and successfully used as a destination procedure for weight loss in persons with BMI greater than 40.
Statistically the reported weight loss for this procedure ranges from 60%-70% of the excess weight in the first year;most people reach their lowest weight 12-24 months after surgery. The gastric sleeve succes rate is approximately 80-90%.
Removing a portion of the stomach reduces the body’s level of a hormone called ghrelin, which is commonly referred to as the “hunger hormone.” Thus, many people find that they are much less hungry after the sleeve gastrectomy. Ghrelin also plays a role in blood sugar metabolism, so people with type II diabetes often see an immediate decrease in their need for diabetes medications (especially oral medications) after the sleeve gastrectomy.
Recovery after Sleeve Gasstrectomy
- 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
Sleeve Gastrectomy – 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:
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- Leakage from the staple line – this is a rate but serious complication of the gastric sleeve surgery. The reported leak rate is between 0.7-3 percent.
- Stricture/stenosis -.
- 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.
Sleeve Gastrectomy- Diet
- Day 1: Clear liquid diet.
- 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
Comparison of Gastric Sleeve to other Types of Bariatric Procedures
- Laparoscopic gastric banding (Lap-band) was once very popular. However, due to its high rate of long term complications and inferior weight loss, the number of Lap-band surgeries went down every year in the US and worldwide. Most of the US large academic Bariatric Surgery Centers rarely perform the Lap-band procedure at this time.
- Laparoscopic Roux-en-Y Gastric Bypass Surgery is the gold standard of bariatric surgery. However, Gastric Sleeve has replaced the Gastric Bypass Surgery as the most popular bariatric surgery in recent years due to its technical simplicity and fewer long-term complication rates.
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 mal-absorption 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.
