A gastric sleeve, or sleeve gastrectomy, is a restrictive surgery that permanently reduces the size of the stomach by about 85 percent. Like other gastric surgeries, this reduces the food intake of the patient, leading to weight loss. This procedure is helpful for patients who wish to lose weight but have health conditions that make combined restrictive/malabsorptive surgery less safe. These patients may want to consider a malabsorptive procedure like duodenal switch (DS) later to lose more weight.
Gastric sleeve may be a safer and more effective option than gastric bypass for patients with a very high BMI, extensive prior surgeries, or medical problems like anemia, Crohn’s disease, osteoporosis, and other complex medical conditions. It also avoids “dumping syndrome,” a collection of unpleasant gastrointestinal symptoms that accompany gastric bypass surgery. Unlike gastric lap banding, gastric sleeve surgery actually removes the part of the stomach that secretes the ghrelin hormone (which signals hunger). It requires more hospital time than a gastric lap band surgery, and is permanent.
Who is a candidate?
Candidates tend to have a BMI over 40, or a BMI between 35 and 40 also with accompanying diseases such as diabetes, sleep apnea, cardiomyopathy (heart damage) or severe joint degeneration and pain. They should have a long record of failed previous non-surgical weight loss interventions before considering gastric sleeve surgery.
Gastric sleeve is preferred to gastric bypass surgery in some patients because of the shorter procedure time (2 hours versus 4 hours), which reduces the risk of complications related to anesthesia in patients who may be morbidly obese or suffering from severe obesity-related disease (these conditions result in a higher overall risk of surgery complications). Unlike the lap band, gastric sleeve surgery produces results faster, with most patient taking up to 2 years to see rapid weight loss in comparison to 3 years for the gastric lap band. Additionally, unlike the gastric lap band, issues such as band slippage and access port problems, which may occur with lap bands, are not an issue (since no band is placed).
Who is not a candidate?
Patients who abuse drug and alcohol, have a history of binge eating, untreated major depression or psychosis, severe cardiac disease, or disorders that interfere with healing such as blood clot disorders are not good candidates for gastric sleeve. Gastric sleeve surgery should not be considered a first-line option for weight loss and should be considered only after first exhausting non-surgical weight loss options.
Depending on your physician, you may be asked to change your diet, lose or maintain a stable weight, or alter your dietary habits (i.e. eating smaller meals throughout the day). This increases the chance of successful, sustained weight loss after the surgery. Like other surgeries, gastric sleeve may require you to undergo certain general surgery procedures such as preoperative blood testing, medications, and cessation of smoking or use of pain relievers and anti-inflammatory drugs.
Recovery is a slow and gradual healing and readjustment process as adjust to eating smaller portions of food. Pain in the first 2-3 days after surgery in the upper left part of the abdomen is common, but can be managed with pain relievers, and should be minimal to nonexistent by 2-3 weeks from the surgery. Although light walking is suggested soon after surgery, strenuous exercise should be avoided for the first few weeks.
Patients should stick to an all-liquid diet for the first week, before gradually easing into soft foods and eventually, back to normal. However, portion sizes should be heavily restricted and patients should eat slowly in order to accurately gauge their satiety and fullness. Lifestyle changes implemented before the surgery should be maintained long-term.
The most common complication from gastric sleeve surgery is infection at the wound site. As with any surgery, there is a risk of complications related to infection or reaction to anesthesia. A proper assessment of every patient, along with complete lab work, will help in the prevention of postoperative complications. After healing, scars are handled with special treatments to minimize their appearance. Other risks include leakage, stricture (inflammation or blockages), and blood clotting, though these occur in only 2 to 4% of patients.
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