What is a Sleeve Gastrectomy?
Sleeve gastrectomy, also referred to as vertical sleeve, gastric sleeve or tube gastrectomy, is a combined restrictive and metabolic type of weight loss surgery. The size of the stomach is reduced with 75% of the stomach removed and thereby decreasing its storage capacity. There are also hormonal changes occurring through removal of (most of) the section of the stomach that produces hunger hormones and the increased speed of food being delivered to the latter part of small bowel. Besides suppression of appetite, the changes to the gut hormone profile lead to increase energy expenditure, reduced conversion of calories to fat and more effective regulation of blood sugar levels.
Indications of Sleeve Gastrectomy
Sleeve gastrectomy is indicated for morbidly obese individuals with the following criteria:
- BMI is ≥ 40
- BMI is 35-39.9 with at least one or more associated co-morbidities such as type 2 diabetes, high blood pressure, high cholesterol level, heartburn, joint problems, breathing problems (obstructive sleep apnoea), etc…
- BMI is 30-34.9 with uncontrolled or poorly controlled type 2 diabetes with multiple anti-diabetic medications (including insulin)
Why choose to have this surgery?
The sleeve gastrectomy is the most common bariatric procedure carried out in Australia in recent years due to its improved efficacy for weight loss and resolution/improvement of obesity related conditions when compared to gastric banding. This is effected through the metabolic/hormonal component of the operation. When compared to a gastric bypass, there may be lower long-term complications including malnutrition and vitamin deficiencies.
It is a more appropriate procedure option for those who are in a higher obesity severity category with obesity related conditions such as diabetes.
The excess weight loss is expected to be around 50-60%.
Advantages of Sleeve Gastrectomy
The advantages of sleeve gastrectomy include:
- Reduced stomach size and hunger hormone (Ghrelin) allow better satiety control (feeling less hungry all the time)
- Better weight loss efficacy than gastric band
- Higher rate of resolution/improvement of obesity-related conditions than gastric band
- Less follow-up visits than gastric band and gastric bypass overall
- Likely lower long-term complications than gastric bypass (such as Malnutrition/vitamin deficiencies and others)
- No implant device in the body
Disadvantages of Sleeve Gastrectomy
- Higher early complication rate than gastric band (ie. staple line leak)
- Risk of heartburn
- Lower diabetes remission rate than gastric bypass (but higher than gastric band)
Sleeve Gastrectomy Procedure
The procedure is performed laparoscopically (key-hole surgery) under general anaesthesia. The surgeon makes 5 small incisions in the abdominal wall through which a camera and surgical instruments can be inserted into. About 75-80% of the stomach is removed by a stapling/cutting device to create a thin tube-shaped stomach. If there is weakness in the diaphragmatic muscles around the top of the stomach or herniation of part of the stomach into the chest, this will be corrected and repaired during the same operation tom prevent heartburn/reflux. The resected stomach is then removed via one of the key-hole incisions at the end of the procedure.
Post-operative care for Sleeve Gastrectomy
After the surgery, you will likely be staying in the hospital for about 3-4 days. Your doctor will prescribe pain-killers and anti-nausea medications to keep you comfortable following the procedure. Your nurse will help you to move at the earliest after the surgery to prevent blood clots, respiratory problems and bedsores. The swelling in your stomach after the operation can make it difficult to drink which is a normal process. However, it is important to remember to sip water throughout the day to avoid dehydration (especially in the first 1-2 weeks).
You will be kept on a liquid diet for the first 2 weeks post-op and then transition to puree diet and then soft diet at every 2 weeks afterwards. Your surgeon or dietician will give you a specific diet plan and instructions to follow after the surgery. You will be advised to take medication to reduce the amount of acid produced by your stomach for the first 3 months. You will also need to start taking multi-vitamins which will continue for life.