Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach along the greater curvature. The result is a sleeve or tube like structure. The procedure permanently reduces the size of the stomach, although there could be some dilatation of the stomach later on in life. The procedure is generally performed laparoscopically and is irreversible.
ProcedurSleeve gastrectomy was originally performed as a modification to another bariatric procedure, the duodenal switch, and then later as the first part of a two-stage gastric bypass operation on extremely obese patients for whom the risk of performing gastric bypass surgery was deemed too large. The initial weight loss in these patients was so successful it began to be investigated as a stand-alone procedure.
Today sleeve gastrectomy is the fastest-growing weight loss surgery option in North America and Asia. In many cases, but not all, sleeve gastrectomy is as effective as gastric bypass surgery, including weight-independent benefits on glucose homeostasis. The precise mechanism that produces these benefits is not known.
Sleeve gastrectomy surgery.
The procedure involves a longitudinal resection of the stomach starting from the antrum at the point 5–6 cm from the pylorus and finishing at the fundus close to the cardia. The remaining gastric sleeve is calibrated with a bougie. Most surgeons prefer to use a bougie between 36-40 Fr with the procedure and the ideal approximate remaining size of the stomach after the procedure is about 150 mL.
Sleeve gastrectomy is gaining popularity in children and adolescents. Sleeve gastrectomy causes large weight loss in children and adolescents aged 5 to 21 years. Moreover, they compared weight loss with adults and found comparable weight loss. Recent reports from the group show that growth progresses unaffected after sleeve gastrectomy in children younger than 14 years of age.
Sleeve gastrectomy may cause complications; some of them are listed below:
- Sleeve leaking (occurs 1 in 200 patients)
- Blood clots (happens 1% of the time)
- Wound infections (occurs in about 10-15% of post-op patients)
- Strictures (occurs 3.5% of post-op patients)
- Aversion to food and nausea
- Damage to the vagus nerve which will cause constant nausea
- Gastroparesis, with a delay in moving food from the stomach to the small intestine
- Esophageal spasm/pain
- Gastroesophageal Reflux Disease (GERD)
Most patients find that after a reasonable recovery, that they are able to comfortably eat a wide variety of foods, including meats and fibrous vegetables. Unlike the adjustable gastric band and the gastric bypass, the sleeve gastrectomy is a permanent procedure – it cannot be reversed.