Sleeve Gastrectomy

A Stomach Restrictive Procedure

The sleeve gastrectomy is also known as the gastric sleeve surgery or vertical sleeve gastrectomy (VSG). During this operation, nearly 90 percent of the stomach is removed. Stomach function remains normal because the key components of the stomach are preserved. Anatomy is not altered in any other way and there is no intestinal bypass.

How Sleeve Gastrectomy Surgery Works

The stretchy upper and outer 90 percent of the stomach is removed, leaving a small, vertically-oriented tubular stomach. The remaining stomach is shaped like a banana or “sleeve” and is approximately 6 inches long and one-half inch in diameter. Stomach capacity is reduced from about a quart (1,000 ml) to roughly 4 ounces (120 ml). Depending on the size of the tube that is created, patients generally report feeling full after eating about 4 ounces of solid food.

The important structural elements of the stomach — the antrum, the pylorus and the nerves that control stomach function — are preserved. The result is a much smaller stomach that functions similarly to a normal one. This allows patients to enjoy a relatively normal diet (albeit in much smaller quantities) without negative side effects like “dumping” syndrome. Weight loss is achieved by restricting the amount of food that can be consumed. The gastric sleeve procedure involves no intestinal bypass or malabsorption of nutrients.

Removal of the outer portion of the stomach almost completely removes the tissue that produces ghrelin, the hunger-stimulating hormone. Consequently, patients typically report a significant decrease in hunger and food consumption. Studies have reported ghrelin levels remain low in sleeve patients throughout a 5-year follow-up period. 1

Gastric Sleeve Outcomes

Weight Loss

Approximately 60 percent excess weight loss (EWL) has been reported. 2,3 Excess weight is the amount of weight over what is considered the “ideal body weight” for a person’s height.

Improvement / Resolution of Comorbidities

Improvement and/or resolution in all major coexisting medical conditions or diseases, including type 2 diabetes, sleep apnea, hypertension and high cholesterol, has been documented.

Advantages

There is very little risk of “dumping” syndrome, which occurs when a patient (who has had gastric bypass) consumes sugar or carbohydrates, or eats too quickly. Dumping syndrome causes nausea, cramping, diarrhea, sweating, vomiting and heart palpitations. The sleeve gastrectomy does not bypass the pyloric valve, allowing for a more natural emptying of solid foods from the stomach and reducing the risk of dumping syndrome. Involves no intestinal bypass or malabsorption of nutrients.

Medication Tolerance

This is a pill-friendly operation. Aspirin and other NSAIDS are well tolerated.

Suited For

This relatively low-maintenance surgery is a good option for patients with an active lifestyle and for busy professionals who travel often. This operation typically results in fast and predictable weight loss and is a good option for those who are seeking weight loss in preparation for orthopedic procedures, such as knee and hip joint replacement, as well as spine surgery. Sleeve gastrectomy is an excellent option for patients with Crohn’s disease or other intestinal conditions, patients who are on immuno-suppressants and organ-transplant candidates.

 

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References
  1. Bohdjalian A, Langer FB, Shakeri-Leidenmuhler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20:535–540.e24 ASMBS Clinical Issues Committee / Surgery for Obesity and Related Diseases 8 (2012).

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662747/

  2. vanRutte PWJ, et al. Outcome of sleeve gastrectomy as a primary bariatric procedure (span Br J Surg. 2014;101:661–668). Br J Surg. 2014;101:668. doi: 10.1002/bjs.9445.

    http://onlinelibrary.wiley.com/doi/10.1002/bjs.9447/full

  3. Diamantis T, et al. Review of long-term weight loss results after laparoscopic sleeve gastrectomy. Surgery for Obesity and Related Diseases. 2014;10(1):177–183.

    http://www.soard.org/article/S1550-7289(13)00381-X/abstract

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