WHAT IS GASTRIC SLEEVE RESECTION?
One of the newest weight-loss surgeries available, the gastric-sleeve procedure involves removing approximately two-thirds of the left side of the stomach. The result is a tube- or sleeve-shaped stomach. After undergoing a gastric-sleeve procedure, patients feel full with smaller food portions, and their feeling of hunger is greatly reduced, according to the National Institutes of Health.
Other names for gastric sleeve resection are sleeve gastrectomy, vertical sleeve gastrectromy, tube gastrectomy and laparoscopic sleeve gastrectomy.
HOW DOES GASTRIC SLEEVE RESECTION WORK?
During this procedure a bariatric surgeon removes about 60 percent of the stomach so that it takes the shape of a tube or sleeve.
This operation is performed laparoscopically, meaning that the surgeon makes small incisions as opposed to one large incision. He or she inserts a viewing tube with a small camera (laparoscope) and other tiny instruments into these small incisions to remove part of the stomach. The tube-shaped stomach that is left is sealed closed with staples.
It is often followed by a gastric bypass or duodenal switch after the patient has lost a significant amount of weight. Called a "staged" approach to weight loss surgery, this makes the second procedure less risky than it would have been had it been the first and only procedure.
The timing of the second surgery varies according to the degree of weight loss. It usually occurs within six to 18 months.
WHO IS A GOOD CANDIDATE FOR GASTRIC SLEEVE RESECTION?
No reliable statistics exist yet for how many of these procedures have been done, but gastric sleeve resection is typically reserved for people who are super-super obese, meaning they have a body mass index (BMI) of more than 60, or for those who are not in appropriate physical condition to undergo gastric bypass surgery or other more radical weight loss surgeries.
A BMI takes height and weight into account to measure body fatness, and a BMI of 30 or higher in adults is considered obese.
Gastric sleeve surgery may be appropriate also for people who can't return for the follow-up visits required by gastric banding.
The body mass index range for adults 20 and over is shown here:
Below 18.5 Underweight
- 18.5 - 24.9 Normal
- 25.0 - 29.9 Overweight
- 30.0 and above Obese
PREPARING FOR GASTRIC SLEEVE RESECTION
Regardless of the surgical method chosen, preparing for weight loss surgery starts with making a lifelong commitment to the dietary and lifestyle changes necessary for success. Weight loss surgery is not a quick fix, nor is it a decision to enter into lightly. Once you have made the decision together with your surgeon and your family members, the preoperative evaluations can begin. These include:
- Meeting with a registered dietician to discuss how the diet needs to change both before and after weight loss surgery.
- A comprehensive psychological evaluation.
- An upper endoscopy exam or barium swallow to make sure there are no polyps, tumors, ulcers or bacteria that cause ulcers in the stomach.
- Additional pre-operative evaluations for the heart and lungs, if deemed necessary.
It's wise to tell your surgeon about any medications you are taking or plan to take throughout recovery. Vitamins, minerals and herbs also interact with medications. Don't leave anything out.
Some of your lifestyle changes will begin before surgery. They include:
- Quitting smoking for at least 30 days before and after weight loss surgery. Smoking can increase the risk of complications, including potentially fatal blood clots. What's more, smoking also increases the risk of pneumonia and other lung problems after surgery. Smoking can also affect healing of the incisions and increase the risk of infection.
- Not drinking alcohol for at least 48 hours before weight loss surgery.
- Losing 5 to 10 percent of excess body weight. People who lose a moderate amount of weight before weight loss surgery have a shorter hospital stay and more rapid postoperative weight loss, according to a study in Archives of Surgery.
- Practicing eating slowly, which includes chewing each morsel of food 15 times and putting the fork down between bites.
WHAT TO EXPECT AFTER GASTRIC SLEEVE RESECTION
The non-reversible surgery is performed under general anesthesia and takes about one to two hours. Afterward you would probably stay in the hospital for one or two days, and recovery from gastric sleeve surgery may last a few weeks.
The abdomen is often swollen and sore for several days. Your surgeon may prescribe pain medication for the discomfort. Some scarring may occur, but this can be covered with clothing.
You would need to become re-used to eating solid foods. Normally this starts with two weeks on a liquid-only diet, two weeks of semi-solid, pureed foods and then solids.
As far as weight loss goes, most people who have gastric sleeve surgery lose 30 to 50 percent of their excess body weight over six months to one year. Studies have shown that after the gastric sleeve resection procedure people show improvement in diabetes, high blood pressure, high cholesterol and sleep apnea within one to two years. These improvements are comparable with those seen after other weight loss surgeries.
As this is a relatively new procedure, no data is available yet on long-term weight loss or overall health improvements.
Certain lifestyle changes and follow-up care occur afterward; people who have gastric sleeve surgery must:
- Exercise regularly.
- Learn behavior modification techniques.
- Follow very specific dietary instructions, including eating very slowly, consuming only small quantities of food at a time, chewing thoroughly and swallowing food only when it is mashed, and not eating and drinking at the same time.
WHAT ARE THE RISKS AND COMPLICATIONS OF GASTRIC SLEEVE RESECTION?
Risks and complications include:
- Leaking of the sleeve. The operation requires staples to be inserted into the stomach, and there is always a chance that the staples will tear apart, resulting in a leak. The leaking stomach acids frequently become infected and can cause serious problems that may require another operation or a drainage tube.
- Blood clots
- Weight may be regained over time, because the stomach can stretch.
- Unlike gastric banding surgeries, no foreign objects are left in the body during the procedure. With gastric banding, the band may slip, erode or become infected.
- Unlike gastric bypass or duodenal switch, there is no bypass of the small intestines with the gastric sleeve, so all nutrients are absorbed and very little chance exists of absorption issues.
- Wound infection
Since this procedure is relatively new, long-term risk and benefits are not known.
WHAT ARE THE ADVANTAGES OF GASTRIC SLEEVE RESECTION?
Compared with other types of weight loss surgery, adjustable gastric banding has these advantages:
- Less invasive
- Less operating time
- Can be done on an outpatient basis
- Does not interfere with absorption, so vitamin deficiencies are less likely to occur.
- Lower risk of dumping syndrome, which occurs when the undigested stomach contents are "dumped" into your small intestine too quickly. It is marked by abdominal cramps and nausea.
- Improves health problems related to excessive weight, including type 2 diabetes, high cholesterol, sleep apnea, high blood pressure and asthma.
- Slow and steady weight loss