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Understanding the Sleeve Gastrectomy Procedure

Doctors in surgery

What is Sleeve Gastrectomy or a Gastric Sleeve?

In the USA, gastric sleeve procedures are the most popular bariatric surgeries and makeup 42 percent of all surgeries of this type. A sleeve gastrectomy or gastric sleeve is a laparoscopic surgical procedure that removes 75 to 80 percent of the stomach. The remaining 20 to 25 percent of the stomach will be left as a tubular pouch. A relatively new procedure, which has evolved from other procedures, such as anti-reflux surgery. The procedure has grown in popularity rapidly because it provides optimal weight loss results with a low complication rate.

How Does Sleeve Gastrectomy Stack Up Against Other Weight Loss Options?

Gastric sleeves are known as an effective and safer alternative to gastric bypass and banding or LAP-BAND procedures. It is designed to help obese patients lose weight rapidly and safely, and can be used as a single procedure or as the first stage of a gastric bypass. However, it is the number one competitor of gastric bypass surgery.

The difference between the two is that in a sleeve gastrectomy the surgeon simply removes a portion of the stomach to create a sleeve instead of stapling a pouch to the intestine in order to bypass the stomach. The gastric sleeve procedure is not only safe; it is also highly effective for weight loss. The way that it works for weight loss is as follows:

  • The new tubular stomach will hold much less than a normal stomach, which will help reduce the amount of food that can be eaten in one sitting. This food will also move faster in the new stomach.
  • The procedure affects the gut hormones, which will help the patient feel fuller longer and less hungry throughout the day, thus effectively suppressing the appetite. It will also work to control blood sugar levels.
  • To help facilitate weight loss, the patient must follow the sleeve gastrectomy diet. The diet basically includes three meals per day, no snacking in between these meals, eating small amounts, eating protein rich foods first, chewing food slowly and thoroughly, avoiding foods that are high in fat and sugar, and taking no less than 20 minutes to finish a meal.

What Are the Benefits of a Sleeve Gastrectomy?

In the sleeve gastrectomy vs. gastric bypass or LAP-BAND debate, there are many arguments for why the sleeve gastrectomy is the best option. The benefits of this surgery are great, including:

  • It preserves stomach function because the pylorus or outlet valve and the nerves of the stomach are not changed.
  • There is an average loss of 50 percent or more of excess body weight, and weight loss management of more than 50 percent as well.
  • Lower complication rates than other bariatric procedures with a hospital stay of one to two days and less chance of wound infection.
  • Less office visits than the gastric bypass and LAP-BAND procedures, as there is less need for close monitoring and no need for band size adjustments.
  • Reversal of other obesity-related illnesses, such as high blood pressure, type 2 diabetes, sleep apnea, and fatty liver disease.
  • There is less of a risk of developing several deficiencies including nutrient, mineral, and vitamin deficiencies, as the food in the gastric sleeve diet follows normal digestive health regulations.

Who is a Candidate for Sleeve Gastrectomy?

The gastric sleeve is ideal for individuals who are morbidly obese and need to lose a significant amount of weight but are unable to do on their own. It's classified as a weight loss option for those who have one or several of the conditions below:

  • Are at least 100 pounds overweight with a BMI of 40 or more and without any other conditions or complications
  • Are at least 75 pounds overweight with conditions such as type 2 diabetes, heart disease, or sleep apnea
  • Have a complex weight loss surgical history
  • Have a non-effective foreign body implanted, such as an LAP-BAND
  • Are at great medical risk for gastric bypass surgery or who will not benefit much from the LAP-BAND procedure
  • For those who want to change their lifestyle and will maintain weight loss through diet and exercise after the procedure is performed
  • Have a BMI of 35 or more and serious health conditions that might improve through extreme weight loss

What is the Procedure Like?

A sleeve gastrectomy is a surgical procedure that lasts for 60 to 90 minutes and involves the use of general anesthesia. The laparoscopic procedure is performed using a tiny camera known as a laparoscope that is placed in the stomach. This laparoscope allows the surgeon to see into the patient's stomach to perform the procedure. The procedure is performed as follows:

  • Two to five small incisions or cuts are made in the stomach
  • The surgeon's instruments and the scope are inserted through these incisions
  • The laparoscope or camera is connected to a video monitor, which allows the surgeon to see the stomach clearly in order to perform the surgery
  • Then at least 75 percent of the stomach is removed
  • The remaining 25 percent is stapled back together using surgical staples, which will create a banana-shaped tubular stomach
  • The laparoscope and other tools are then removed and the incisions stitched closed