What does a sleeve gastrectomy consist of?
- It is a restrictive procedure; by reducing the stomach capacity, the patient feels full after a small intake of food.
- It is advisable for people with a body mass index of 60 or more, since the risks of intra and post surgical complications for them is very high. In these cases, sleeve gastrectomy is performed before a gastric bypass. This is done so that the patient will weigh a lot less at the time of the bypass, reducing the risks of complications.
- It helps the patients reduce their weight considerably in 40% of the cases. If these patients also change their eating habits, they may not need a second surgery to complete the treatment.
- If it is necessary to resort to a second surgery, such as a bypass or a gastric band, the patient will have to wait 18 months.
- It may also be used as a first option of a restrictive procedure in patients of a BMI of between 45 and 60, if the medical assessment of the case determines so.
How is sleeve gastrectomy performed?
It is done by means of laparoscopic techniques. These techniques involve the use of special instruments that are introduced through very small incisions that allow the area treated to be seen on a closed circuit monitor.
The incisions that the surgeons make nowadays are of no more than 0.4 inches (1 cm); the surgical trauma they produce is much lower and the post surgical pain much more tolerable. Through these incisions, the surgeon can reach the stomach and, using a special stapler, he makes a vertical suture to divide the stomach in two. One of the sections is shaped like a tube that goes from the esophagus to the intestine. The other one is separated and removed. The staples used are very strong.
The Results
Bariatric surgery procedures have -generally- good results. Apart from losing weight, most of the patients recover physical and psychological health.
Expected Weight Loss
This combined approach has tremendously decreased the risk of weight loss surgery for specific groups of patients, even when the risk of the two surgeries is added. Most patients can expect to lose 30 to 50% of their excess body weight over a 6 - 12 month period with the sleeve gastrectomy alone. The timing of the second procedure will vary according to the degree of weight loss, typically 6 - 18 months.
What Are the Advantages of the "Sleeve?"
The sleeve gastrectomy has a number of advantages over other bariatric procedures:
* It does not require disconnecting or reconnecting the intestines
* It is a technically simpler operation than the gastric bypass or the duodenal switch
* It may be a safer operation for patients with a body mass index (BMI) more than 60. To figure out your BMI, click here
* It may be used as the first stage of a 2-stage operation. (See below)
What is a 2-Stage Operation?
Certain patients may have a body shape that makes their surgery more technically difficult. For example, patients with a BMI over 60 -- particularly those who carry their weight in their belly area -- may be at increased risk for bariatric surgery. If you fall into this category, you may benefit from a 2-Stage bariatric surgery.
In the staged approach, a multi-step operation like the gastric bypass or the duodenal switch is broken down into 2 simpler and safer operations. In the first stage, a sleeve gastrectomy is performed. This allows to lose 80 to 100 pounds or more, which will make the second part of the operation substantially safer.
The second stage operation is usually performed 8 to 12 months after the first. The "sleeve" stomach is converted into a formal gastric bypass or duodenal switch. This will permit additional weight loss and will provide a much more permanent result than sleeve gastrectomy alone.
Both stages of the surgery can be performed laparoscopically, giving the advantage of shorter recovery, shorter incisions, fewer incision-related problems and less pain.
Are There Any Disadvantages?
The sleeve may be an excellent option for you if your BMI is over 60, or if you have medical problems that would put you at excessive risk for a gastric bypass or duodenal switch (BPD-DS). However, the sleeve is usually considered to be a temporary treatment for obesity, until the second stage of the surgery is performed. Some people perceive the need for 2 separate operations as a disadvantage, despite the health benefits.
Before surgery: Tips
Before thinking about undergoing bariatric surgery, such as a sleeve gastrectomy, it is important for you to bear the following things in mind:
- You must be at least 18 years old.
- Your obesity must not be due to other diseases that could be treated with other procedures.
- Your body mass index (BMI) should be over 40, or at least over 35 if you suffer from a disease related to morbid obesity.
- You must have lived at least 5 years with that BMI and failed in your attempts to lose weight by non-surgical treatments.
- Take your time to think about the important changes in your diet after a reduction of your stomach capacity. Get psychologically prepared to follow these new habits for the rest of your life.
- Bear in mind that you will not be able to drink large quantities of alcohol. If you are used to drinking a lot of alcohol, you may not be a good candidate for this surgery.
After surgery: Tips
Hospitalization
3 or 4 days (1 day in intensive care unit and 2 or 3 days in the recovery room)
Bandages
You will have small adhesive strips on each of the incisions of 0.4 inches (1 cm). You will also have two drainage tubes connected to airtight plastic bottles, one of which will be removed on the third day after the surgery and the other on the seventh day.
Amount of pain
Mild to moderate.
Scars
Seven scars of only 0.4 inches (1 cm) will be distributed on your abdomen in the shape of a diamond; its lower vertex will be on the navel and the upper one at the base of the breastbone.
Removal of the stitches
7 to 10 days after the surgery.
Recovery
At first, you will feel discomfort on the abdominal area, but very oon the pain will become milder.
Risks and complications of vertical gastroplasty
Every surgical procedure, regardless of its triviality, has some risks and we should always think of them as a possibility. Gastric bypass is a major surgical procedure and it is certainly not against this rule. The average percentage of immediate post surgical complications is about 2%.
The main complications are:
* Acid reflux
* The sutures (staples) may open or there may be leakage through them.
* Hemorrhages where the incisions and/or sutures have been made.
* Intestinal obstruction.
* Blood clots may form on the legs or other parts of the body and migrate to the lungs, increasing the risk of pulmonary embolism.
* Breathing problems.
* As time goes by, the remaining portion of the stomach may stretch and partially recover its original capacity.
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