Sleeve Gastrectomy as the Ideal Bariatric Procedure

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Introduction: Sleeve gastrectomy as the ideal bariatric procedure

Sleeve gastrectomy has emerged as the ideal bariatric procedure has been confirmed. Today, gastric sleeve is the most commonly performed bariatric procedure. It's preferred because it's less risky and produces virtually the same amount of weight loss as gastric bypass.

What is Gastric Sleeve Surgery?

Gastric sleeve surgery, also referred to as sleeve gastrectomy, is a weight loss procedure designed to aid significant and sustainable weight reduction in individuals struggling with severe obesity. This surgery involves surgically reducing the size of the stomach to limit food intake, which prompts the body to burn stored fat for energy. It is one of the most common and effective bariatric surgeries performed.

What Does a Gastric Sleeve Do?

The gastric sleeve works by reshaping the stomach into a much smaller tube-like organ. Using minimally invasive keyhole surgery, a bariatric surgeon removes approximately 75% of the stomach, leaving only a slim “sleeve” of stomach along the major curve. This surgery reduces the stomach’s capacity from around 3 pints volume to only 3-8 ounces. The smaller stomach sleeve restricts the amount of food the stomach can physically hold at one time, creating a feeling of fullness with smaller meal portions. This prompts reduced caloric intake since less food satisfies hunger. Over months, burning more calories than consumed leads to significant fat loss.

How Common is Gastric Sleeve Surgery?

Gastric sleeve weight loss surgeries have soared in popularity over recent years given the procedure’s safety profile and success rates. According to statistics from the American Society for Metabolic and Bariatric Surgery, over 10% of weight loss surgeries performed in 2021 were gastric sleeve procedures. This reflects an overall rise in sleeve gastrectomies in response to the surgeries’ reputation for generating substantial, sustained weight reduction.

What Medical Conditions Does Gastric Sleeve Surgery Help Treat?

Beyond radical weight loss itself, gastric sleeve surgery demonstrates dramatic improvements in obesity-driven conditions, including (1):

  • Type 2 diabetes - 82% see improvement or remission
  • Hypertension - 62% improved cases
  • Dyslipidemia - 65% resolution rate
  • Obstructive sleep apnea (OSA) - 75% resolved
  • Gastroesophageal reflux disease (GERD) - 81% resolved

Such remarkable enhancements in weight-related comorbidities further cement the importance of gastric sleeves for boosting wellbeing.

Is the Gastric Sleeve Safe?

When performed by a credentialed bariatric surgeon, a gastric sleeve is considered an extremely safe procedure. Still, as with major surgeries, gastric sleeves carry a small risk of complications. Potential side effects include (2):

  • Bleeding at staple lines
  • Leaks through staple holes
  • Blood clots
  • Infection

Risks prove rare in qualified hands, but patients should comprehend concerns before undergoing invasive surgery.

What Qualifies You for Gastric Sleeve Surgery?

To qualify for weight loss surgery, one often must have:

  • Body mass index (BMI) above 40 (or above 35 with an obesity-related condition)
  • Failed prior weight loss attempts without surgery
  • No major underlying medical or psychological contraindications
  • Realistic expectations of results

Only those meeting qualification criteria get approved for surgery after thorough medical assessment given the procedure’s permanency and health implications (3).

What Happens Before Gastric Sleeve Surgery?

In the weeks prior to scheduled surgery, patients undergo (4):

  • Complete physical examination
  • Lab tests ensuring surgical fitness
  • Assessment of any substance dependencies
  • Nutrition evaluation and diet planning for post-op
  • Psychological screening

Preparing mentally and physically maximizes safety and weight loss efficiency after undergoing this major operation.

How is Gastric Sleeve Surgery Performed?

Gastric sleeve surgery involves:

  1. General anesthesia
  2. Small incisions (laparoscopic approach)
  3. Stapling and dividing stomach vertically
  4. Removal of ~75% of stomach
  5. Extracting resected portion
  6. Closing incisions

Minimally invasive techniques involve only tiny cuts rather than one long incision. This facilitates swifter healing than traditional open surgery.

What Happens After Gastric Sleeve Surgery?

Postoperatively, patients begin:

  • Clear liquid diet for 2 days
  • Pureed high protein foods ~2 weeks
  • Soft solids at ~4 weeks
  • Regular textures at 6 weeks (smaller portions)

Supporting dietary changes accelerates weight loss while allowing adjustments to new restricted stomach volume (5). Activity limited initially before resuming exercise by week 4-6. Regular check-ins monitor surgical healing and weight trends.

What Are the Possible Risks or Complications?

Complications include:

  • Bleeding (may require transfusion)
  • Infection (treated with antibiotics)
  • Blood clots (anti-coagulant medication management)
  • Leaks through staple holes (sometimes requiring another surgery)

While unlikely, risks emphasize the importance of an expert surgical team and diligent follow-up care.

What is the Recovery Time?

Patients spend 1-3 days recovering in the hospital before discharge. Most return to desk jobs within 1-2 weeks. More taxing occupations may require 4+ weeks away. Strength and stamina continually improve between weeks 4 to 12. Light walking promotes healing early on before more vigorous step counts by week 6 (6).

How Much Weight Will You Lose?

Average patients lose ~60-80% of excess body weight in 12-18 months (7). Many obese patients shed 100+ pounds if diligently following postoperative plans. The small stomach sleeve promotes profound appetite reduction and accelerated weight loss results.

What If It Doesn’t Work?

Over 80% of patients meet weight loss milestones through 18 months post-op (8). Plateaus sometimes do occur. Revisiting dietary strategies, activity levels, and behavioral patterns with the bariatric team identifies potential setbacks. Some pursue revision surgeries if satisfactory loss proves unsustainable long-term via sleeve alone.

Fewer surgical risks

Surgery always represents a potential risk for every patient, but when you're obese, your risk is higher. And the longer you're under general anesthesia, the riskier it becomes.

The length of your surgery is directly related to the chance of developing complications such as deep vein thrombosis (a blood clot in the deep veins of your body, usually in your legs) or other concerns like postop infections.

During a gastric sleeve procedure, your bariatric surgeon will remove up to 80% of your stomach. By removing the extra space in your stomach and creating a slender sleeve, you will become full faster and eat less, resulting in weight loss. Because this procedure is less invasive and complex than a gastric bypass, the procedure and downtime will much be faster.

With a sleeve gastrectomy, the connections at each end of your stomach, between the esophagus and small intestine, stay the same as they were before surgery. Only the size of the stomach is changed.

By comparison, a gastric bypass involves cutting the stomach, removing the top from the bottom portion, then cutting the small intestine and reconnecting both loose ends of the small intestine to different places.

In other words, your time in surgery is much less with sleeve gastrectomy compared to gastric bypass. As a result, gastric bypass has double the risk of complications compared to sleeve gastrectomy. Safer surgery is an important reason why sleeve gastrectomy is a great choice for weight loss surgery.

Similar overall weight loss

With advancements in medicine, you're now able to receive comparable results to a gastric bypass with a less-complex procedure called the Sleeve gastrectomy. Within the first year after undergoing the gastric sleeve procedure, you will experience rapid weight loss followed by steady and continuous weight loss for the next 3-5 years.

Impact on Hunger

Patients who have sleeve gastrectomy immediately notice the impact it has on their hunger, with some saying they simply don't feel hungry. Sleeve gastrectomy has a big impact on hunger because the procedure removes the portion of your stomach that produces ghrelin.

Ghrelin is a hormone made in your stomach that stimulates your appetite and makes you feel hungry. Reducing the amount of ghrelin is one of the keys to successful weight loss.

Lower risk of nutritional deficiencies

After you undergo any type of weight loss surgery, you're continuously monitored for nutritional deficiencies. With a smaller stomach, you eat less food, so you may not get the essential vitamins and minerals you need to stay healthy.

When it comes to getting optimal nutrients from the food you eat, sleeve gastrectomy has the advantage because it keeps your small intestine intact. On the other hand, after gastric bypass surgery, the food you eat truly bypasses part of the small intestine.

Why is your small intestine so important? Because that's where nutrients are absorbed. Bypassing the small intestine makes you more susceptible to nutrient deficiencies.

Although you'll need supplements with both sleeve gastrectomy and gastric bypass, there's less chance of significant nutrient deficiencies with a sleeve gastrectomy.

Treat Type 2 diabetes

It's estimated that 90% of those with Type 2 diabetes are overweight or obese, so it's good to know that sleeve gastrectomy lowers your blood sugar. In some patients, blood sugar returns to normal after sleeve gastrectomy, and diabetes goes into remission in more than 60% of patients who get a sleeve gastrectomy.

Many patients who take medication find they can reduce the dosage or stop taking it. You may also find that diabetes-related health problems improve, too.

Fewer long-term complications

Long-term complications due to any type of weight loss surgery only develop in a small percentage of patients, but this is another area where sleeve gastrectomy has an advantage. The primary problem following sleeve gastrectomy is heartburn. Patients who under gastric bypass are more likely to develop problems such as ulcers, bowel blockage, dumping, and micronutrient deficiencies.

Gastric sleeve surgery catalyzes impressive weight reduction, but understands the procedure’s permanent ramifications. When non-surgical options fail those with extreme obesity and comorbidities, it proves a life-changing intervention under expert guidance.

References

  1. American Society for Metabolic and Bariatric Surgery. Bariatric surgery procedures. Updated June 2021. Accessed November 29, 2023. https://asmbs.org/patients/bariatric-surgery-procedures#types
  2. Johns Hopkins Medicine. Risks of bariatric surgery. Accessed November 29, 2023.
  3. American Society for Metabolic and Bariatric Surgery. Am I a candidate?. Accessed November 29, 2023.
  4. American Society for Metabolic and Bariatric Surgery. Preparing for bariatric surgery. Accessed November 29, 2023.
  5. American Society for Metabolic and Bariatric Surgery. Life after bariatric surgery. Accessed November 29, 2023. https://asmbs.org/patients/life-after-bariatric-surgery
  6. Cleveland Clinic. After bariatric surgery. Updated June 8, 2022. Accessed November 29, 2023.
  7. American Society for Metabolic and Bariatric Surgery. Bariatric surgery procedures. Updated June 2021. Accessed November 29, 2023. https://asmbs.org/patients/bariatric-surgery-procedures
Dr. Babak Moeinolmolki
April 30, 2019
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