Gastric Sleeve Surgery

Overview

What is gastric sleeve?

Gastric sleeve surgery, also known as a sleeve gastrectomy, is a form bariatric (weight-loss) surgery. This procedure reduces the size of your stomach, allowing you to only eat a small amount of food while feeling full. While the gastric sleeve can help jump-start a person’s weight loss journey, they must be willing to fully commit to healthy lifestyle changes in order to maintain their weight loss.

Is it right for you?

This procedure is usually done only after you have unsuccessfully tried to lose weight by making diet and lifestyle changes.

A good candidate for the sleeve gastrectomy has:

• A body mass index (BMI) of 40 or higher (extreme obesity)
• A BMI of 35 to 39.9, combined with serious weight-related health problems

While the main goal of a sleeve gastrectomy is weight loss, it may improve or resolve other weight-related health problems such as:

• Type 2 diabetes
• High blood pressure
• Heart disease
• High cholesterol
• Stroke
• Sleep apnea
• Infertility

Do you qualify for surgery?

In order to qualify for this surgery, your doctor may have you commit to making permanent diet and lifestyle changes beforehand. This is important, as these habits must continue after the surgery in order for it to be effective.

Contraindications for Gastric Sleeve Surgery

Gastric sleeve surgery may not be right for you if you have any of the following conditions:

• Uncontrolled bleeding disorder
• Severe psychiatric illness (e.g. depression, psychosis, etc.)
• Negative reactions to general anesthesia
• Gastroesophageal reflux disease (GERD)
• Barrett’s esophagus
• Large hiatal hernia

How does it work?

Gastric sleeve surgery involves the removal of around 80% of the stomach. This leaves a tube-shaped stomach that is roughly the size and shape of a banana.  Rapid weight loss will occur shortly after the surgery, because the stomach can only hold small amounts of food at a time and absorb very little.

Additionally, the sleeve gastrectomy removes the part of the stomach responsible for producing ghrelin, the hunger stimulating hormone. As a result, appetite is reduced for years after surgery.

Patients report losing up to 50% of their excess weight within 3 years of the procedure.

Treatment details

A sleeve gastrectomy is a surgical procedure, so you will receive general anesthesia before it begins.

1. The surgeon will begin by making 2 to 5 small incisions in your belly.
2. A small camera, known as a laparoscope, is used to guide the surgery.
3. Some of the stomach is removed, and the surgeon staples the remaining portion back together; after this, your stomach will be a vertical tube that is shaped like a banana.

Overall, the procedure takes between 60 to 90 minutes.

Recovery time

Following surgery, most patients stay in the hospital for 1 or 2 days before returning home to heal.

It is common to experience pain and swelling in the abdomen after surgery, and your doctor may prescribe pain medication.

Typically, patients return to work within 2 to 4 weeks after surgery, but strenuous exercise and heavy lifting should be avoided for 6 to 8 weeks.

There is a strict diet to adhere to after a sleeve gastrectomy, beginning with sugar-free, noncarbonated liquids for the first week (protein shakes, broth, milk, yogurt, and juice).

Fatigue is common during this time, due to the low-calorie nature of the diet. After this, you will transition to pureed foods for 3 weeks, and finally progress to eating solid foods around 4 weeks after surgery.

Since your stomach cannot absorb as much as it used to, it is important to take multivitamins and calcium to supplement your diet. A vitamin B-12 injection will also be required once a month for life.

One benefit of the sleeve gastrectomy compared to other bariatric surgeries is that most patients are able to continue eating the variety of foods they did pre-surgery; these include fibrous vegetables and meats.

How much weight will you lose?

Patients can expect to lose at least 50% of their excess body weight within 1.5 to 2 years following the surgery. Some people may even lose up to 60% to 70%.

It is common to regain some weight 2 to 10 years after bariatric surgery. Weight gain is caused by stomach stretching, which is a result of poor diet choices and overeating.

It is important to maintain diet and lifestyle changes to keep the weight off.

Cost of gastric sleeve

The average cost of a sleeve gastrectomy is $15,000. Depending on location, the surgeon, and other factors, it can range from $10,000 to $25,000.

Obesity is a known risk factor for many other health conditions, and insurance companies will typically cover the cost of bariatric surgery if you have a qualifying condition. However, many require proof of participation in medically guided weight loss programs before covering the cost of bariatric surgery.

Safety information

A sleeve gastrectomy will cause rapid weight loss in the first 3 to 6 months after surgery. As your body adapts, you may experience side effects such as:

• Feeling cold and tired, similar to flu symptoms
• Dry skin
• Mood changes
• Muscle aches and fatigue
• Hair thinning and loss

All surgeries come with risks, including:

• Excessive bleeding
• Blood clots
• Negative reactions to anesthesia
• Infections
• Lung or breathing problems

Additionally, longer term complications can arise from a sleeve gastrectomy, including:

• Hernias
• Stricture formation within the new stomach that prevents food and fluids from passing through
• Abdominal abscess
• Low blood sugar
• GERD
• Malnutrition
• Vomiting
• Gastrointestinal obstruction

Another potential complication with this procedure is leaking of the stomach sleeve. This can occur when the staples put on the stomach do not old well; as a result, stomach acid can leak into the surrounding tissues, causing infection or damage. The reported rate of leaks occurring is between 0.7 to 3%.

Alternatives to gastric sleeve

There are other surgical alternatives to the sleeve gastrectomy that can provide similar weight loss benefits. These include:

• Roux-en-Y gastric bypass (RYGB): With gastric bypass surgery, a portion of the stomach is stapled off to form a gastric pouch; the small intestine is then attached in a “Y” formation to the pouch to bypass the lower stomach and intestines.
• Adjustable gastric band: A band is placed around the upper part of the stomach to separate it from the main part of the stomach; the smaller part will fill up with food faster and empty slowly into the rest of the stomach, limiting food intake. An example is the LAP-BAND surgery.

It is important to note that the sleeve gastrectomy is a permanent procedure and cannot be undone. Other options, like the adjustable gastric band and gastric bypass, can be reversed.

Ready to take the next step?

To see if you are a candidate for gastric sleeve surgery, contact a weight loss surgeon near you.