Dr.Weight // Bariatric surgery // Operations aimed at narrowing the stomach // Sleeve gastrectomy

• Laparoscopic gastric banding
• Sleeve gastrectomy
• Laparoscopic Anti-Reflux Sleeve Gastroplasty (ASG)
• Laparoscopic gastric bypass

Sleeve gastrectomy

Laparoscopic sleeve gastrectomy

Bariatric Surgery - DoctorWeight.com – 2008

As mentioned above, the sleeve gastrectomy is also based on the restrictive principle (figure 5). During the operation the stomach is greatly reduced in volume, and a very small amount of food can activate the satiety receptors, as with gastric banding.

This relatively new surgical procedure is rapidly gaining popularity in the bariatric community. The name of the procedure very well describes the resulting form of the stomach. During the operation the stomach is converted into a very narrow and long tube, resembling a sleeve.

This operation is an offspring of the Hess biliopancreatic bypass. When surgeons were performing this operation on super-obese patients (200 kg and more), they were sometimes forced to stop after performing the first part of the procedure (converting the stomach into a tube) because the enormous amount of internal fat rendered the organs (intestines) practically immovable. They planned to perform the second part of operation (intestinal dividing) after some primary weight loss, but to their surprise this was not necessary because the degree of weight loss was similar to that of a complete Hess procedure. Many bariatric institutions reported in medical journals and surgical congresses that the mean effect of sleeve gastrectomy was the loss of 80-90% of excessive weight. This was an unexpected and significant achievement. Furthermore, as the intestinal tract of the patients was left intact, there was no risk of deficiency in vitamins, minerals, proteins, iron and other elements.

Figure 6: Left scheme – before operation; right scheme – after the operation

THE PLACE OF SLEEVE GASTRECTOMY AMONG OTHER BARIATRIC PROCEDURES

The success of a surgical procedure neither makes it universally appropriate nor outdates all others that preceded it. Along with other operations, sleeve gastrectomy has its advantages and disadvantages.

Disadvantages

1. A surgeon tries for best results to make the tube as narrow as possible. Consequently the patient feels significant discomfort in the passage of food during the first 2-3 months. Later the tube distends to some extent, and the discomfort subsides.
2. The surgical risk of sleeve gastrectomy is higher than that of gastric banding. This risk lies in the stapling, suturing and removal of the part of the stomach. It also requires a longer hospital stay (4 days, in comparison to 1 day for gastric banding).
3. Many patients (approximately 30%) who undergo sleeve gastrectomy develop heartburn in the postoperative period. During this operation the valve mechanism between the esophagus and the stomach is destroyed, as this part of the digestive tract is converted into a direct tube. For this reason, care must be taken when we operate on patients who suffer heartburn before the operation, as these symptoms could worsen afterwards. Patients undergoing sleeve gastrectomy generally receive acid-reducing drugs.
4. World clinical experience for this procedure is still limited, as is the availability of long-term results.

Advantages

1. The mean effect of sleeve gastrectomy is greater than that of gastric banding. This may reflect the reduced influence of a patient’s discipline level on the process of weight loss.
2. It is not necessary to make adjustments in the postoperative period.
3. The absence of foreign bodies in the organism.
4. If the operation is not sufficiently effective, it can be easily transformed into a classical gastric or biliopancreatic bypass. To achieve this, only the “intestinal stage” of the operation is required.

It can thus be seen that the sleeve gastrectomy takes its place between gastric banding and gastric bypass.

• Operations aimed at decreasing absorption of nutrients in the digestive tract
• Operations aimed at narrowing the stomach
• Operations aimed at reducing appetite
• Intragastric balloon for loss of excessive weight