The Sleeve Gastrectomy – often called the vertical or Gastric Sleeve – is performed by removing approximately 80 percent of the stomach. The remaining stomach is a long slender pouch that resembles a sleeve-like tube. The stomach capacity is greatly reduced, leaving you feeling full after eating only a small portion, which results in weight loss. No other part of the intestine is altered with this procedure. As with the gastric bypass, sleeve gastrectomy can be performed laparoscopically, and Drs. Averbach and Hamdallah will work with you to see if this option is right for you.
This sleeve gastrectomy procedure works in two ways. First, the new stomach holds a considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food (and thus calories) that can be consumed. The surgery also affects gut hormones that control hunger, satiety, and blood sugar control. The complication rates of the sleeve are lower than those of the roux-en-y gastric bypass.
Perhaps the greatest advantage of the gastric sleeve lies in the fact that it does not involve any bypass of the intestinal tract and patients do not therefore suffer the complications of intestinal bypass such as intestinal obstruction, anemia, osteoporosis, vitamin deficiency and protein deficiency. It also makes it a suitable form of surgery for patients who are already suffering from anemia, Crohn’s disease and a variety of other conditions that would place them at high risk for surgery involving intestinal bypass.
For patients with a particularly high body mass index (typically 50+) many forms of weight loss surgery are either difficult to perform or present increased risk. As a result, a vertical sleeve gastrectomy is sometimes performed as the first of a two-part weight loss procedure – Duodenal switch.
For obese patients with a relatively low body mass index the vertical sleeve gastrectomy can also prove a good choice, especially where existing conditions (such as anemia or Crohn’s disease) prevent them from having other forms of bariatric surgery. In addition, patients may choose this form of surgery if they are concerned about the long-term affects of bypass surgery or object to having a ‘foreign’ body implanted into their body, as is the case with lap band surgery.
- Low mortality rate (0.1%)
- Preservation of normal continuity of GI tract
- Patients typically achieve weight loss comparable to that of gastric bypass and exceeding adjustable gastric banding
- Reduced risk of nutritional deficiencies
- No risk of marginal ulcer or intestinal obstruction
- No risk of the band device malfunctioning
- Possible in patients with contraindications to gastric bypass or banding.
- Potential for inadequate weight loss in sweet eaters or “grazers”
- Patients with high BMI may need an additional procedure to achieve adequate weight loss
- Potential complications exist with long staple line, including leaks and infection
- Potential excessive narrowing of the sleeve with worsening or development of new reflux symptoms in 15% of patients
- Puts you at higher than normal risk of developing gallstones and gallbladder disease
- The smaller portion of the stomach may stretch.
- Foods that you eat now may cause discomfort, nausea or vomiting after your surgery
Prevention of Reflux/GERD after Gastric Bypass (Gastric Sleeve)
Morbidly obese patients prior to bariatric surgery suffer from a higher frequency of reflux symptoms compared to the general population. To minimize risk of significant GERD after bariatric surgery, we actively screen patients for symptoms of reflux and hiatal hernia. If detected, we repair it at the time of bariatric procedure. This approach minimizes risk of possible delayed surgery for this condition which might be needed in about 10% of patients and greatly improve their quality of life after bariatric surgery.
Prevention of Gall Bladder disease after Bariatric Surgery
Morbidly obese patients are known to have a higher frequency of Gall Bladder disease both prior to and after bariatric surgery compared to the general population. Asymptomatic gall stones can cause acute inflammation with significant weight loss after bariatric surgery in 30-40% of patients. It is our policy to actively screen patients for gall bladder problems prior to surgery and if anything is detected (gall stones, chronic cholecystitis due to dyskinesia, cholesterol polyps), removal of the gall bladder would be recommended at the time of main bariatric procedure. Consequently, risk of repeat surgery for gall bladder surgery later on is avoided. If no problems with the gall bladder are detected, after bariatric surgery patients are treated with Ursodiol or Actigall for first six months after bariatric surgery to prevent problems with the gall bladder. With that preventive treatment chances of developing that problem are reduced from 30-40% down to 2-5%.