Bariatric Surgery

Sleeve Gastrectomy

How a Sleeve Gastrectomy Works

How a sleeve gastrectomy works to help you lose weight

During this procedure, a thin vertical sleeve of stomach is created using a stapling device, and the rest of the stomach is removed. The sleeve is about the size of a banana. This procedure limits the amount of food you can eat and helps you feel full sooner. It allows for normal digestion and absorption. Food consumed passes through the digestive tract in the usual order, allowing it to be fully absorbed in the body.

The sleeve gastrectomy procedure

The majority of weight loss sleeve gastrectomies performed today use a laparoscopic technique, which is considered minimally invasive. Laparoscopic surgery usually results in a shorter hospital stay, faster recovery, smaller scars, and less pain than open surgical procedures.

The length of time of the surgery varies. One study found that the average operative time was 1.5 to 3.5 hours and the average hospital stay was 2 to 5 days.14 Patients usually return to normal activities in 2 weeks and are fully recovered in 3 weeks.

Laparoscopic sleeve gastrectomy can be the first step before gastric bypass or it can be a single procedure for weight loss. If a sleeve gastrectomy is used as part of a two-step procedure, the first step is for the surgeon to create the small stomach "sleeve." After a period of time determined by the surgeon, another procedure would be done in which the surgeon attaches a section of the small intestine directly to the stomach pouch. This allows food to bypass a portion of the small intestine. Doing so enables your body to absorb fewer calories, in addition to consuming less food. This two-step procedure may be done because patients may not be able to tolerate both procedures during a single operation. Studies show that the two-step procedure has been used successfully in patients with a body mass index greater than 50 or in high-risk patients.

Educational Video for Sleeve Gastrectomy:

Patients who should consider this procedure 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® but are concerned about a foreign body inside the abdomen.
Those who have medical problems that prevent them from having weight loss surgery such as anemia, Crohn's disease, extensive prior surgery, and other complex medical conditions.
People who need to take anti-inflammatory medications may also want to consider this. Usually, these medications need to be avoided after a gastric bypass because the risk of ulcer is higher.

It might also be a good option if patients have a problem with their lap band requiring revision, have already lost a lot of weight and don't want a full bypass. The weight loss seems to be a little better and more rapid than the lap band (60 - 70% EWL) over two years. There is still no long-term data.

What advantages does it have?

It does not require disconnecting or reconnecting the intestines (no dumping syndrome).
There is no malabsorption of nutrients therefore avoiding anemia, osteoporosis, protein deficiency and vitamin deficiency.
Only surgery that substantially removes the "hunger hormone" Ghrelin.
It is a technically a much simpler operation than the gastric bypass or the duodenal switch.
There is no foreign body inside of you.
It does not need adjustments or fills (adjustable band patients must come back for fills).
Preserves the pylorus (most patients should not get dumping syndrome).
It may be a safer operation for patients with a body mass index (BMI) more than 60. It may be used as the first stage of a 2-stage operation.

Disadvantages are:

Some higher BMI patients may need to have a second stage procedure later to help lose the rest of the weight.
Because the stomach is removed, it is not reversible.

Potential complications are:

Like any surgical operation, sleeve gastrectomy has possible complications, such as leakage, dilation of the sleeve (which allows for more food intake) and other usual complications associated with bariatric surgery, though the risks are known to be much lower than the gastric bypass and duodenal switch.