Sleeve Gastrectomy

During the sleeve gastrectomy procedure, a thin vertical sleeve of stomach is created using a stapling device. The sleeve is about the size of a banana. As a result, patients feel fuller sooner and stay satisfied longer. Sleeve gastrectomy allows for normal digestion and absorption.

After surgery, the food you swallow is still allowed to pass through this new sleeve and into the small intestines as this connection has not been altered.  Removal of this portion of the stomach aides in weight loss by reducing the volume of food one can eat and by debulking a portion of the stomach that releases hormones that can drive hunger and appetite.

Highlights

Weight-loss surgery may be an option if you are very obese and have not been able to lose weight through diet and exercise.

Vertical sleeve gastrectomy is not a quick fix for obesity. It will greatly change your lifestyle. After this surgery, you must eat healthy foods, control portion sizes of what you eat, and exercise. If you do not follow these measures, you may have complications from the surgery and poor weight loss.

THIS PROCEDURE MAY BE RECOMMENDED IF YOU HAVE

• A body mass index (BMI) of 40 or more. Someone with a BMI of 40 or more is at least 100 pounds over their recommended weight. A normal BMI is between 18.5 and 25.
• A BMI of 35 or more and a serious medical condition that might improve with weight loss. Some of these conditions are obstructive sleep apnea, type 2 diabetes, and heart disease.

Vertical sleeve gastrectomy has most often been done on people who are too heavy to safely have other types of weight-loss surgery. Some people may eventually need a second weight-loss surgery.

This procedure cannot be reversed once it has been done.

Risk Factors

RISKS FOR ANESTHESIA AND SURGERY IN GENERAL ARE

• Allergic reactions to medicines
• Breathing problems
• Bleeding, blood clots, infection

RISKS FOR VERTICAL SLEEVE GASTRECTOMY ARE

• Gastritis (inflamed stomach lining), heartburn, or stomach ulcers
• Injury to your stomach, intestines, or other organs during surgery
• Leaking from the line where parts of the stomach have been stapled together
• Poor nutrition, although much less than with gastric bypass surgery
• Scarring inside your belly that could lead to a blockage in your bowel in the future
• Vomiting from eating more than your stomach pouch can hold

Treatment

You will receive general anesthesia before this surgery. This is medicine that keeps you asleep and pain-free.

The surgery is usually done using a tiny camera that is placed in your belly. This type of surgery is called laparoscopy. The camera is called a laparoscope. It allows your surgeon to see inside your belly.

IN THIS SURGERY

• Your surgeon makes 2 to 5 small cuts (incisions) in your belly.
• The scope and instruments needed to perform the surgery are inserted through these cuts.
• The camera is connected to a video monitor in the operating room. This allows the surgeon to view inside your belly while doing the operation.
• Your surgeon removes most of your stomach.
• The remaining portions of your stomach are joined together using surgical staples. This creates a long vertical tube or banana-shaped stomach.
• The surgery does not involve cutting or changing the sphincter muscles that allow food to enter or leave the stomach.
• The scope and other tools are removed. The cuts are stitched closed.

The surgery takes 60 to 90 minutes.

Weight-loss surgery may increase your risk of gallstones. Your surgeon may recommend having a cholecystectomy. This is surgery to remove the gallbladder. It may be done before the weight-loss surgery or at the same time.

Recovery

The final weight loss may not be as large as with gastric bypass. This may be enough for many people. Talk with your surgeon about which procedure is best for you.

The weight will usually come off more slowly than with gastric bypass. You should keep losing weight for up to 2 to 3 years.

Losing enough weight after surgery can improve many medical conditions you might also have. Conditions that may improve are asthma, type 2 diabetes, arthritis, high blood pressure, obstructive sleep apnea, high cholesterol, and gastroesophageal disease (GERD).

Weighing less should also make it much easier for you to move around and do your everyday activities.

This surgery alone is not a solution to losing weight. It can train you to eat less, but you still have to do much of the work. To lose weight and avoid complications from the procedure, you will need to follow the exercise and eating guidelines that your surgeon and dietitian give you.

After surgery, you will be required to follow a strict diet and significant lifestyle changes.

For approximately 4 weeks, you will need to eat foods in a liquid or pureed state.  Eating solid foods too soon will put pressure on the staple line and may cause serious complications such as a leak.  It is important that, during this time, all the food you eat be the consistency of thin, smooth, applesauce. During this time you will need to eat 5-6 times a day. Each meal will be 2-4 oz (1/4 to ½ cup of food).

With your doctor’s approval at 4 weeks after surgery, you may advance to semi-solid, or soft foods. You will need to eat 4-6 times a day. Each meal will be 4-6 ounces (½ – ¾ cup of food).  Care should be taken not to snack or graze between these meals.

Around 12 weeks after surgery with your doctor’s approval, you may begin to try raw vegetables and tougher meats. You will need to try foods one item at a time to test your tolerance to them.  Do not worry if you cannot handle foods you used to eat.  Most people experience some problems at first, especially with dry meats and breads.  However, these problems usually resolve with behavioral modifications and more time. Eventually all textures of foods are well tolerated.

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