Weight loss surgery or bariatric surgery is the most effective solution for dealing with severe obesity and its complications, and perhaps one of the best procedure of these is laparoscopic sleeve gastrectomy or gastric sleeve.
The popularity for gastric sleeve procedure has increased dramatically in the last decade, for example, in 2016, more than 120,000 gastric sleeve procedures were performed in the United States alone, which makes up 58% of the total weight loss surgeries that year, compared to less than 20% in the year before.
The surgical procedure of gastric sleeve involves excision of the bigger curved part of the stomach, and after this excision what remains of the stomach is a relatively small part of it, which resembles a sleeve or a thin tube, hence the name.
How Does Gastric Sleeve Operation Help You Lose Weight?
Gastric sleeve helps you lose weight through two main mechanisms:
One of them is purely mechanical (reducing the amount of food the stomach can accommodate), and the other is hormonal or chemical (appetite suppression).
Let’s speak about these two mechanisms in a nutshell.
The mechanical mechanism is basically the significant reduction of the size of the stomach after gastric sleeve procedure, which decreases the amount of food that a person can consume before feeling full.
The hormonal factor is the major change that happens to the levels of hormones that control appetite after sleeve gastrectomy, for example, a significant decline in the levels of ghrelin -which is the hunger hormones- was observed secondary to the excision of the gastric fundus. This change results in suppression of appetite.
Gastric sleeve also increases the secretion of another hormone called: glucagon-like hormone-1 or GLP-1, which increases insulin secretion and delays gastric emptying and this also reduces hunger cravings and suppresses appetite.
Who is a good candidate for gastric sleeve?
The obesity patient needs to meet some criteria to qualify for gastric sleeve, and these criteria depend upon their body mass index, according to the following:
- A body mass index of more than 40 kg/m2, whether there are complications of obesity or not.
- A body mass index of 35-40 kg/m2, with the presence of serious complications of obesity, such as diabetes, sleep disorders, snoring, high blood pressure, and coronary artery diseases, among others.
- A body mass index of 30-35 kg/m2, with difficulty controlling blood glucose levels or the presence of metabolic syndrome.
Can I have gastric sleeve surgery done if I have other chronic diseases?
According to a study conducted in 11 countries that involved more than 24 health centers, the effectiveness of this type of operation has been proven for diabetes patients, metabolic syndrome patients, and those with inflammatory bowel disease.
Sleeve gastrectomy procedure can also help improve diabetes type II symptoms, and in some cases it results in normal blood glucose levels and that means total cure of the disease.
Sleeve Gastrectomy: the technique
The surgeon staples off more than half of the stomach vertically using surgical stapler, and then takes that part out, decreasing the volume of the stomach significantly and changing its shape to become a sleeve-like thin tube, and this anatomical change in the stomach helps reduce the amount of food that the stomach can accommodate before feeling full.
The operation is performed under general anesthesia; the surgeon opens a few tiny openings, each of which is 3 cm in length, and surgical instruments are advanced through these openings, along with a camera with strong illumination device to enhance vision during the operation, and the surgeon follows what’s happening inside the abdominal cavity via an electronic screen in front of them.
The abdominal cavity is insufflated with inert carbon dioxide, and most of the stomach is isolated and then excised vertically as we mentioned earlier.
After the procedure
The patient stays in the hospital for one night after the operation.
The patient may feel some nausea or mild pain postoperatively, these complaints can be easily addressed with anti-nausea medications and/or pain killers.
A short period after the procedure the patient can drink small quantities of water and liquid foods, and those quantities can be gradually increased if the patient tolerates them without vomiting or nausea, until reaching a complete liquid diet.
Upon discharge from the hospital, the surgeon and the dietitian give the patient instructions about their diet, which includes water and fluids.
This liquid diet continues for a short period after the operation and then gets gradually converted into a regular diet after a period of about 4 weeks.
Is gastric sleeve surgery effective?
Weight loss: After two years of the procedure, the patient loses 60 percent of their excess weight, and most of patients can reach a BMI of 25-32 depending on their weight before the operation.
Type 2 diabetes and glucose control: in 66% of patients, significantly better blood glucose levels were achieved according to a study in which patients were evaluated for 13 months after the operation.
What are the possible complications associated with gastric sleeve?
- Adverse reactions to general anesthesia.
- Bleeding at the site of the operation.
- Leaks from the cut edge of the stomach in less than 1%.
- Strictures or narrowing in 1%, and this can be easily treated with oral endoscopy.
- Gastroesophageal reflux disease
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