Gastric Sleeve Surgery Overview
Bariatric surgery (surgery for obesity) includes several different types of operations. Laparoscopic sleeve gastrectomy or gastric sleeve is a relatively new weight loss procedure that reduces the size of the stomach from a sac to a narrow tube. Weight is lost because of early satiety (the feeling of fullness after eating), largely due to the smaller size of the stomach. Also, some appetite stimulating hormones normally produced by the stomach are reduced by the procedure. Apart from this, the stomach digests calories and nutrients in an almost normal way.
This operation has evolved from other procedures performed in the past. One of these operations, the vertical banded gastroplasty (also known as “stomach stapling”), was abandoned due to poor long-term outcomes. These poor results were due to staple line breakdown or blockage at the tight ring placed around the stomach to narrow the outlet. The sleeve gastrectomy is newer, and constructed differently to avoid these problems. It avoids the use of a restrictive ring, and is not prone to the late staple line problems associated with vertical banded gastroplasty.
The sleeve gastrectomy was first used as an intermediate step toward gastric bypass or duodenal switch. These are more complicated operations with higher risks of complications when done in very obese patients (i.e. BMI > 50-55). The sleeve would be performed first, and then several months after this, when the patient had lost weight, a second operation converted the sleeve to a bypass or duodenal switch. Surgeons using this strategy to reduce risk soon noticed that patients often didn’t need a second operation because they were very happy with the weight loss results achieved by the sleeve alone. More recently, the sleeve gastrectomy has been used as a “stand alone” procedure for weight loss, and in recent years it has become a commonly performed operation for weight loss in New Zealand and around the world.
After surgery, patients start on liquids before moving to a pureed diet while the stomach heals. Several weeks after gastric sleeve surgery patients progress to eating three small meals a day of normal consistency food. Entree sized meals are enough to produce a sensation of fullness, making it easier for patients to limit the amount they eat.
The sleeve gastrectomy is done by laparoscopic surgery, which involves several very small incisions, rather than open surgery, which uses one large incision. Harmless CO2 gas is introduced into the abdomen, inflating it, and creating a space for the surgeon to work. The surgeon introduces a long narrow camera and surgical instruments, and uses these to perform the procedure.
Laparoscopic procedures have the advantages of less pain, a shorter hospital stay, and a quicker recovery, as well as a significantly reduced risk of wound infection or wound hernias. If, for some reason, your surgeon cannot complete the procedure laparoscopically, he can switch safely to the open procedure. The chance of this happening is low and would only be done in your best interests.
Bariatric surgery reduces the risk of death from obesity. Many obesity-related conditions, such as type II diabetes, obstructive sleep apnoea, joint pain from arthritis, high cholesterol and high blood pressure, are either completely resolved or substantially improved.
Long Term Weight Loss
Most patients achieve good to excellent weight loss results following gastric sleeve surgery; typically this is 60 to 70 per cent of excess weight. Patients lose most of their excess weight in the first year and can lose more weight over the next six to 12 months. Weight will usually stabilise after this. There can be some weight regain, but this is usually minor. There is no amount of weight loss that is guaranteed.
Healthy lifestyle changes, with improved diet and regular exercise, lead to a better outcome after the surgery. The laparoscopic gastric sleeve procedure is best seen as a tool that makes these lifestyle changes achievable for most patients.