Gastric Sleeve

Sleeve Gastrectomy

 

Sleeve Gastrectomy is one of the new obesity surgery procedures which has become very popular across the world in recent years because of very good weight loss results that patients have been able to achieve. Sleeve Gastrectomy forms a part of the procedure of duodenal switch. In super obese patients, performing complex operations like duodenal switch carries significant risks. To reduced this risk surgeons in 1990s started doing the Sleeve Gastrectomy part of the duodenal switch operation as a first operation. A completion operation was performed 6 to 12 months later when patients had lost some weight and so reducing the risk. It soon became clear that patients were losing a large amount of weight following Sleeve Gastrectomy very quickly and many patients didn't go on to have full operation. Because of such a good result since the turn of the century, many surgeons across the world started doing Sleeve Gastrectomy as the sole weight loss procedure.

What is the Sleeve Gastrectomy operations?

Sleeve Gastrectomy is an operation in which the stomach is converted to a narrow tube with the removal of the bag part of the stomach. As a result, the capacity of the stomach to receive food as we eat is reduced by up to 80%.

How is the Sleeve Gastrectomy operations performed?

Sleeve Gastrectomy operations are performed using keyhole technique and the operation is called laparoscopic Sleeve Gastrectomy. Five 0.5 to 1 cm incisions are made in the upper part of the abdomen. Through these incisions, a keyhole camera and instruments are inserted in to the abdomen and the bag part of the stomach is resected using a cutting and stealing device. At the end of the procedure a leak test is performed to make sure that the cut edge of the stomach tube is sealed and water tight. The operation usually takes an hour to hour and a half to perform. Within a few hours after the operation when the patient is back in the ward and the effect of the anaesthesia has worn off, they are assisted to get out of bed and start moving about. The patient will be started on a small amount of clear fluid immediately and oral fluid intake will be increased gradually over the next 24 hours. Most patients go home between 24 to 48 hours after operation.

How does the Sleeve Gastrectomy produce weight loss?

After Sleeve Gastrectomy, patients could loose more than 60% of their excess body weight in two years. It is believed that Sleeve Gastrectomy produces this weight loss by three different effects. Physically it restricts the food intake by drastically reducing the size of the stomach. The patient feels full after eating a small amount of food and is unable to eat large meals. Also after Sleeve Gastrectomy the level of the hunger hormone Gherlin falls, giving a reduced desire for food.

Who is suitable for the Sleeve Gastrectomy?

Any patient who qualifies for Bariatric Surgery on the basis of NICE guidelines could have a Sleeve Gastrectomy. It is the preferred operation for patients who may be chronically anaemic, have inflammatory bowel disease or coeliac disease. For patients who may have had previous  abdominal operations, Sleeve gastrectomy is a safer choice compared to gastric bypass.

What are the risks of the Sleeve Gastrectomy?

Though Sleeve Gastrectomy is performed laparoscopically and patients recover quickly, it is a major operation which caries a potential risk of complications. The risks associated with Sleeve Gastrectomy are of two types:

  1. Risk associated with morbid obesity and associated conditions like diabetes, heart disease asthma.  Obese patients carry a higher risk of getting deep vein thrombosis, pulmonary embolism, chest infection or wound infection following operations. These risks can be reduced by better preparation before the operation and taking appropriate measures after surgery. In my practice all patients are seen by a Bariatric specialist nurse, dietitian and specialist physiotherapist. They all work with the patient to prepare them for surgery in the best way. Patients are put on a special pre-operative diet, are advised to stop smoking and to exercise to improve general fitness. After the operation, patients are given very effective pain relief and are mobilised as soon as possible. We also give all patients blood thinning injections from the time of start of the anaesthesia for 7 days after operation. This measure has reduced the risk of DVT and pulmonary embolism to a very low level and in my own practice I have had no patients develop pulmonary embolism after an obesity operation.
  2. Sleeve Gastrectomy procedure related complications. Like any keyhole operation, Sleeve Gastrectomy carries the risk of bleeding, wound infection and injury to abdominal structures during the operation. In addition, the patient can develop potentially serious complications of leakage from the staple line. This is uncommon but a serious complication. I have never had any patients develop leaks after a Sleeve Gastrectomy operation. This, again, is a treatable complication and often requires a re-operation.

How much weight will I lose?

The amount of the weight-loss achievable with this procedure after 2-3 years is favourably comparable with the gastric bypass (on average, approximately 60-70% of the excess weight is initially lost). Like with a gastric bypass, weight-loss starts soon after operation and the majority of weight-loss occurs during the 1st year.

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