Gastric sleeve surgery is a weight-loss procedure that removes up to 75% of your stomach so you can eat smaller food portions and lose excess weight. Also known as sleeve gastrectomy, this surgery reduces your stomach to a narrow stomach pouch that resembles the size and shape of a banana. Gastric sleeve surgery is a restrictive procedure — meaning your stomach is made smaller for the sake of restricting the amount of food you eat. There is no re-routing of the small intestine like that involved with gastric bypass surgery to pose a risk for malabsorption.
How does gastric sleeve surgery work?
Gastric sleeve surgery helps you lose excess weight by restricting the amount of food you can eat in one sitting. This surgery also involves the removal of the portion of your stomach that produces ghrelin — a hormone that stimulates appetite. Without ghrelin, your body will experience fewer hunger pangs and a reduction in appetite that stimulates excess weight loss.
Gastric sleeve surgery is generally performed as a minimally invasive laparoscopic procedure. A laparoscope is a thin, tiny camera inserted into your abdominal cavity during surgery to help your doctor view and perform the procedure without having to make large incisions such as that with open surgery. The incisions made during laparoscopic sleeve gastrectomy are tiny and require less healing time than larger incisions. Compared to open surgery, laparoscopic sleeve gastrectomy is far safer and results in less downtime and a faster recovery.
What happens during laparoscopic gastric sleeve surgery?
Laparoscopic gastric sleeve surgery takes between one and two hours to complete and requires a hospital stay of between one and two days. This surgery is performed under general anesthesia so you can sleep comfortably for the duration of your procedure.
First, your doctor makes about six tiny cuts on your abdomen to allow for the insertion of the laparoscope and tiny surgical instruments used to remove part of your stomach. Roughly 75% of your stomach will be removed to leave behind a small stomach pouch that holds up to five ounces of food. Following the removal of a portion of your stomach, the remaining stomach pouch will be stapled shut. Most laparoscopic sleeve gastrectomy patients experience mild pain and soreness in their stomach region for a few days after surgery, which can be relieved using ibuprofen, aspirin, and other over-the-counter pain relievers.
Sleeve gastrectomy educational video
Video Description and Transcription
Sleeve Gastrectomy Educational Video
This educational video will explain the normal process of digestion, the sleeve gastrectomy procedure, and how weight loss will occur upon completion of the surgery.
Currently, your stomach can hold about 40 ounces of food. Once in your stomach, the food combines with digestive juices containing acids and enzymes that help break it down into smaller particles. Once broken down, the small particles are slowly released into the first part of your small intestine, the duodenum, by a muscle called the pyloric valve. The pyloric valve is a ring of muscle between your stomach and your duodenum.
Most of the nutrients from the broken-down food are absorbed in the duodenum and the jejunum, which is the second part of the small intestine.
There are 3 main steps in the sleeve gastrectomy. The first step is disconnecting the tissue between your stomach and your abdomen. The second step is dividing your stomach into two sections. The third step is removing the upper rounded left part of your stomach.
In the first step, the tissue between your stomach and your abdomen is disconnected. Your surgeon will separate the tissue that connects the left side of your stomach to your abdominal organs, such as the spleen and the colon.
The second step is dividing your stomach into two sections. Your surgeon will divide your stomach using an endoscopic stapler. Your surgeon may also use traditional stitches, or a combination of both staples and stitches, to seal each section of your stomach. The seal is called the suture line.
The third step in the sleeve gastrectomy is removing part of the stomach. Your surgeon will remove the left part of the stomach, which includes the fundus. The fundus is one of the areas of the stomach that produces the hormone that controls your appetite. The remaining portion of your stomach will be about the size and shape of a banana.
Once you have healed from the surgery, weight loss will occur because of two reasons. First, your new stomach size will force you to decrease the amount of food you can comfortably eat. Secondly, the sleeve gastrectomy will cause your body to decrease or eliminate the release of a hormone that stimulates the appetite.
What are the advantages of sleeve gastrectomy?
The largest advantage to sleeve gastrectomy is finally being able to lose the excess weight you may have struggled to lose previously with just diet and exercise alone. This form of bariatric surgery is shown to help people lose up to 50% of their excess weight within the first two years of their procedure.
Here are other advantages of gastric sleeve surgery.
Losing excess weight with sleeve gastrectomy can make you feel better physically and improve your mental well-being. Weight loss in general can help you feel more energetic, more confident, and happier since you’ll be able to engage in more activities and accomplish more life goals without excess weight holding you back. Weight loss can also help regulate your hormones and brain neurotransmitters to reduce anxiety and improve mental health disorders like depression and bipolar disorder.
Lowered risk for nutritional deficiency
Compared to gastric bypass surgery, sleeve gastrectomy only reduces stomach size and doesn’t involve re-routing of the small intestine, which increases the risk for malabsorption. With gastric bypass, the small intestine is re-routed in a way that prevents your body from absorbing calories — including those from foods that contain high amounts of vitamins, minerals, and other nutrients. But sleeve gastrectomy won’t prevent your body from absorbing the nutrients it needs to stay healthy and reduce your risk for illness and disease.
After sleeve gastrectomy, you’ll experience fewer hunger pangs and reduced appetite since the portion of the stomach that produces ghrelin is removed. This helps you avoid overeating and snacking throughout the day at times you may not truly be hungry. A reduced appetite will facilitate less food intake so you can successfully lose excess weight.
Obesity is often accompanied by comorbidities that are triggered by excess weight, such as high blood pressure, type 2 diabetes, and heart disease. The excess weight you’ll end up losing after sleeve gastrectomy will help reduce the severity of these comorbidities, and may even reverse them completely. As you start losing excess weight, you’ll notice you may start sleeping better and experience fewer health problems.
Advantages of gastric sleeve video
Video Description and Transcription
The Advantages of the Gastric Sleeve
The gastric sleeve operation is relatively new as a stand-alone operation. It was developed as the first stage in a two-stage operation called a duodenal switch or a biliopancreatic diversion. This was reserved for very high-risk patients who were very obese.
The idea was that they would start with the sleeve operation, which was considered to be low-risk, and the patient would lose a considerable amount of weight. The patient would then come back later for a second operation where the intestines would be rearranged for malabsorption and further weight loss.
What happened was, the patients were found to lose a considerable amount of weight, more than expected with just the sleeve surgery.
In 2007, there was a consensus conference meeting in New York City, where a number of surgeons discussed the merits of gastric sleeve operation as a stand-alone operation. Their findings were that the sleeve itself is very effective in causing weight loss all by itself.
The advantages of the sleeve is that it’s a simple operation. We’re just narrowing the stomach down to a skinny tube from a big, baggy stomach.
It doesn’t require any foreign body to be placed, and it doesn’t require any complicated rerouting of the intestines. This gives it certain advantages compared to the other surgeries.
With regard to early complications, the gastric sleeve is intermediate between the Lap-Band operation and the gastric bypass. The bleeding rate is definitely less than the gastric bypass, as well as the leak rate.
However, the Lap-Band itself is an extremely safe operation on the day of surgery. In fact, there’s not another operation that’s any safer than the Lap-Band operation in the abdomen.
But the real advantage when it comes to complications with the gastric sleeve are in the long-term problems. The gastric sleeve is not vulnerable for ulcers. It’s not vulnerable for small bowel obstructions or internal hernias like the gastric bypass. Therefore, re-operations for these problems are avoided.
It has no foreign body. Nothing needs to be adjusted and nothing can slip or erode, as with the Lap-Band. Therefore one of the major advantages of the sleeve gastrectomy is the avoidance of long-term problems that might require an operation.
Although the gastric sleeve is a simpler operation, it also appears to provide the same amount of weight loss as the gastric bypass. This is very predictable and early weight loss. Patients can expect to lose somewhere between 2/3 and 3/4 of their extra body weight in the first year and a half after an operation.
The weight loss with the gastric sleeve with much more predictable and early compared to that with the Lap-Band. And it avoids some of the other problems that can happen with a bypass, such as vitamin and mineral deficiencies.
When it comes to curing other problems related to weight that come along with obesity, such as high blood pressure, diabetes, high cholesterol, or sleep apnea, the gastric sleeve operation appears to be almost as good as the gastric bypass.
Although the gastric bypass is the best operation for curing diabetes or getting it under control, the gastric sleeve is also very effective. Approximately 60 – 70 percent of patients who have diabetes prior to surgery will have it completely resolved with a gastric sleeve operation. The remaining patients will either have better control or the disease will be arrested in its current form.
Patients after a gastric sleeve operation will be required to take a vitamin for the rest of their lives. However, vitamin and mineral deficiencies are not very common. They can occur in the first year to year-and-a-half due to the significant weight loss that the sleeve produces. However, vitamin deficiencies are more rare and less severe than with a gastric bypass, and they are easy to treat in the long run. Most patients with a vitamin or mineral deficiency after a sleeve operation will have that resolve within the first two years.
What are potential cons associated with gastric sleeve surgery?
Gastric sleeve surgery comes with its own set of risks just like any other medical procedure. This weight-loss surgery is permanent, and cannot be reversed in the event you decide you want a larger stomach size. Sleeve gastrectomy is a life-changing procedure that requires your utmost commitment to a healthier lifestyle that includes regular exercise and good nutrition.
Here are potential disadvantages of sleeve gastrectomy.
Those who fail to adopt healthier lifestyles following gastric sleeve surgery may gain back the excess weight they initially lost within the first two years. Evidence suggests that sleeve gastrectomy patients end up regaining up to 75% of the excess weight they lost by the 6-year mark after surgery. Weight regain can happen due to lack of exercise, poor nutrition choices, re-stimulation of ghrelin production, and eating larger portions that gradually dilate the stomach pouch. However, eating highly nutritious foods, sticking with small portion sizes, and exercising regularly can help you avoid weight regain following sleeve gastrectomy.
Early complications that may occur immediately after sleeve gastrectomy include bleeding, leaking at the staple line of the stomach, and abscess. Delayed complications from sleeve gastrectomy may include obstruction in the stomach pouch, gastroesophageal reflux disease, and nutritional deficiencies due to eating foods that lack nutrition. If you suspect something is wrong with your stomach or health following sleeve gastrectomy, contact your doctor immediately for an evaluation and to receive a possible revision surgery to correct the problem.
How should I prepare for sleeve gastrectomy?
Before having sleeve gastrectomy, your doctor will perform a series of evaluations to make sure you’re physically and mentally prepared for this permanent, life-changing procedure. You may also be required to receive nutritional counseling and education, and begin a fitness routine so you can lose as much excess weight as possible before your surgery.
Here are additional ways you can prepare for gastric sleeve surgery:
- Stop smoking as far ahead of your surgery as possible to avoid delayed healing and complications during surgery.
- Make pet and childcare arrangements for the time you’ll spend in surgery and recovering at the hospital.
- Stock your home with doctor-approved liquids and pureed foods to eat during the weeks following your surgery.
- Set up a cozy spot in your living room or bedroom where you can recover comfortably from your procedure.
- Talk to your doctor about any medications or supplements you’re currently taking to ensure they’re safe to continue using before and after surgery.
Ask your doctor about any other steps you should take to prepare for sleeve gastrectomy so you can stay safe and experience a comfortable, successful recovery.
What happens after gastric sleeve surgery?
Before your release from the hospital, your surgeon will give you wound care instructions for your incisions, along with a list of approved foods you can eat as your stomach is healing. You’ll be restricted to liquids only for the first week or two after sleeve gastrectomy, followed by soft, pureed foods. These foods will help your stomach properly adjust to its smaller size and won’t negatively interfere with the healing process.
Exercising regularly and practicing optimal nutrition are two important lifestyle changes you must make after having gastric sleeve surgery. These behaviors will help you lose and keep off excess weight for years to come. Exercise and good nutrition will also help you improve comorbidities like type 2 diabetes and hypertension as you continue to lose excess weight. Avoid being sedentary and eating sugary, processed foods such as fast foods, sweet pastries, and candy. These unhealthy behaviors may increase your risk for complications like weight regain and nutritional deficiencies.
Am I an ideal candidate for sleeve gastrectomy?
Gastric sleeve surgery may be ideal for you if you have a BMI between 35 and 45 and need help losing excess weight. You may also be a candidate for sleeve gastrectomy if you have a high BMI and haven’t been able to keep excess weight off long-term using conventional methods like diet and exercise. If you have a BMI of 70 or higher, your doctor may recommend having sleeve gastrectomy as a staged procedure before another weight-loss surgery such as gastric bypass or duodenal switch.
Sleeve gastrectomy is also ideal for those with a high BMI who suffer comorbidities like obstructive sleep apnea, type 2 diabetes, gallbladder disease, and heart disease. Losing excess weight with sleeve gastrectomy can help you improve or reverse one or more of these serious health conditions.
To find out if you or a loved one qualifies for sleeve gastrectomy, use our directory to locate qualified, licensed bariatric surgeons who can help you meet your weight-loss goals.
Most people who need to lose 65 or more pounds have tried multiple times to lose the weight on their own. While they may have some success at first, less than five percent of people keep the weight off for five years or more.
– Philip Schauer, MD, bariatric surgeon and Director of Cleveland Clinic’s Bariatric and Metabolic Institute
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