Gastric sleeve surgery, or sleeve gastrectomy, is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgically removing a large portion of the stomach. The open edges are then attached together (typically with surgical staples, sutures, or both) to leave the stomach shaped more like a tube or banana. The procedure permanently reduces the size of the stomach and most patients can expect to lose 30% to 50% of their excess body weight over a 6-12 month period with the sleeve gastrectomy.
This procedure generates weight loss by restricting the amount of food (and therefore calories) that can be eaten by removing 85% or more of the stomach without bypassing the intestines or causing any gastrointestinal malabsorption.
Individuals who should consider gastric sleeve surgery include:
- Those who are concerned about the potential long term side effects of an intestinal bypass such as intestinal obstruction, ulcers, anemia, osteoporosis, protein deficiency and vitamin deficiency.
- Those who are considering a Lap Band or Realize band but are concerned about a foreign body, worried about frequent adjustments or finding a band adjustment physician.
- Those who have other medical problems that prevent them from having gastric bypass surgery such as anemia, Crohn’s disease, extensive prior surgery, severe asthma requiring frequent steroid use, and other complex medical conditions.
Advantages and disadvantages of vertical sleeve gastrectomy
Advantages of gastric sleeve surgery
- Reduces stomach capacity but tends to allow the stomach to function normally so most food items can be consumed, albeit in small amounts.
- Eliminates the portion of the stomach that produces the hormones that stimulates hunger (Ghrelin).
- Dumping syndrome is avoided or minimized because the pylorus is preserved.
- Minimizes the chance of an ulcer occurring.
- By avoiding the intestinal bypass, the chance of intestinal obstruction (blockage), anemia, osteoporosis, protein deficiency and vitamin deficiency are significantly reduced.
- Appealing option for people with existing anemia, Crohn’s disease, irritable bowel syndrome, and numerous other conditions that make them too high risk for intestinal bypass procedures.
- Appealing option for people who are concerned about the foreign body aspect of Banding procedures.
- Can be done laparoscopically in patients weighing over 500 pounds, thereby providing all the advantages of minimally invasive surgery; fewer wound and lung problems, less pain, and faster recovery.
Disadvantages of vertical sleeve gastrectomy
- Potential for inadequate weight loss or weight regain. While this is true for all procedures, it is theoretically more possible with procedures that do not have intestinal bypass.
- Soft calories such as ice cream, milk shakes, etc. can be absorbed and will slow weight loss.
- This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur.
- Comparison to prior gastroplasties (stomach stapling of the 70s-80s)
Gastric sleeve surgery is a significant improvement over prior gastroplasty procedures for a number of reasons:
- Rather than creating a pouch with a ring or mesh, the sleeve gastrectomy actually re-sects or removes the majority of the stomach. During the gastric sleeve surgery the portion of the stomach which is removed is responsible for secreting Ghrelin, and other hormones are responsible for appetite and hunger. By removing this portion of the stomach rather than leaving it in place, the levels of hormones are reduced, actually causing loss of or reduction in appetite. Currently, it is not known if levels increase again after one to two years. Patients do report that some hunger and cravings do slowly return.
- The removed section of the stomach is actually the portion that “stretches” the most. The long vertical tube shaped stomach that remains is the portion least likely to expand over time and it creates significant resistance to volumes of food. Remember, resistance is greatest the smaller the diameter and the longer the channel. Not only is appetite reduced, but very small amounts of food generate early and lasting satiety (fullness).
- Finally, by not having rings or mesh wrapped around the stomach, the problems which are associated with these items are eliminated (infection, obstruction, erosion, and the need for synthetic materials).
Alternative to a Roux-en-Y Gastric Bypass
The Sleeve Gastrectomy is a reasonable alternative to a Roux-en-Y Gastric Bypass for number of reasons:
- Because there is no intestinal bypass, the risk of malabsorptive complications such as vitamin deficiency and protein deficiency is minimal.
- There is no risk of marginal ulcer which occurs in over 2% of Roux-en-Y Gastric Bypass patients.
- The pylorus is preserved so dumping syndrome does not occur or is minimal.
- There is no intestinal obstruction since there is no intestinal bypass.
- It is relatively easy to modify gastric sleeve surgery to an alternative procedure should weight loss be inadequate or weight regain occur.
Please call us at (727) 289-7137 to learn more about surgical weight loss options and how Sun Coast Bariatrics can help you today.