Gastric Sleeve

Sleeve Gastrectomy (Click to dowload pre-operative diet instuctions)

In this procedure the stomach is stapled lengthwise to form a thin tube, and the rest of the stomach is removed. One of the main advantages of this procedure over gastric bypass, in which food enters the stomach and a small bag goes directly to the small intestine, is that the digestive process is exactly the same as before surgery.

Because the size of the stomach is smaller and therefore holds less food, patients feel full and satisfied with less food and consequently lose weight.

As the sleeve gastrectomy can be performed laparoscopically, for patients with morbid obesity requiring a gastric bypass, sleeve gastrectomy may be the first step. In this way, patients lose weight before gastric bypass and therefore the risks of this last surgery are much lower.

In general, patients who have been subjected to a sleeve gastrectomy lose so much weight that do not require any additional surgery. With the sleeve gastrectomy patients can lose up to 70% of their weight.

The sleeve gastrectomy has the same risks as any other method for reducing weight. The most common complication is leakage of fluid from the staple line.

The sleeve gastrectomy offers an excellent alternative to both the bypass and the lap band. Probably its greatest advantage is that it involves bypassing the intestinal tract and prevents or reduces complications such as obstruction and deficits of vitamins, protein and calcium.

This surgery is also known as vertical gastrectomy, gastric sleeve, sleeve, partial gastrectomy, subtotal gastrectomy, gastric reduction and has demonstrated several advantages:

• It removes the portion of the stomach that produces ghrelin (hunger hormone)
• The stomach is reduced in volume but it works normally
• Does not observe dumping so often (as in the bypass)
• There is no intestinal bypass and with it, reduced risk of nutritional deficiency
• Technically safer for obesity with a BMI greater than 50
• Most patients are dismissed on the 2nd-3rd day


Sleeve gastrectomy general procedure

You will receive general anesthesia before surgery, which will make you unconscious and unable to feel pain.
The surgery is usually done using a tiny camera placed in the abdomen. This type of surgery is called laparoscopy. The camera is called laparoscope and allows the surgeon to see inside the abdomen.

In this surgery:
• The surgeon will make 2 to 5 small incisions (cuts) in the abdomen and pass the laparoscope through one of these openings. This will be connected to a video monitor in the operating room. The surgeon will look at the monitor to see inside the abdomen and thin surgical instruments will be inserted through other openings.

• The surgeon will remove the majority (approximately 80 to 85%) of the stomach and join the remaining portions using staples. This will create a long vertical tube or banana-shaped stomach.

• Surgery does not involve cutting or changing the sphincter muscles that allow the food to enter or leave the stomach.

• The surgery may take only 30 to 60 minutes if the surgeon has performed many of these procedures.

When you eat after having surgery, the small pouch fills quickly. You will feel satisfied after eating only a very small amount of food.

The weight loss surgery can increase your risk of gallstones. Your doctor may recommend that you have a cholecystectomy (surgery to remove the gallbladder) before surgery.


Why is the procedure done?
The sleeve gastrectomy is not a "quick fix" for obesity. This will change your lifestyle dramatically, because you must diet and exercise after surgery. You may experience complications following surgery and insufficient weight reduction if it doesn't.
People who undergo this surgery must be mentally stable and not be dependant on alcohol or psychoactive drugs.

This procedure may be recommended if you have:
• A body mass index (BMI) of 40 or more. Someone with a BMI of 40 or 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 could improve with weight loss. Some of these conditions are sleep apnea, type 2 diabetes and heart disease.

The sleeve gastrectomy has been performed more frequently in patients who are too heavy to safely undergo other types of surgery to lose weight. Finally, some patients may need a second surgery to lose weight.
This procedure is irreversible.

Risks

The risks of vertical sleeve gastrectomy are:
• Injury to stomach, intestines or other organs during surgery.
• Leakage from the line where the stomach has been stapled.
• Scarring within the abdomen, which could lead to obstruction (blockage) bowel in the future.
• Gastritis (inflammation of the lining of the stomach), heartburn or stomach ulcers.
• Poor nutrition, although much less than with gastric bypass surgery.
• Vomiting from eating more than the stomach pouch can hold.


Before the procedure

The surgeon will be asked to review and consult with other doctors before undergoing surgery. Some of these are:
• A complete physical examination
• Blood tests, ultrasound of the gallbladder and other tests to verify that you are healthy enough to undergo surgery
• Visit your doctor to make sure other health problems you may have, such as diabetes, hypertension and heart or lung problems, are under control
• Nutritional counseling
• Classes to help you understand what happens during surgery, then what to expect and what risks or problems may occur after
• Consult a mental health professional to make sure you are emotionally ready for major surgery. You should be able to make important changes in your lifestyle after surgery.
If you are a smoker, stop smoking several weeks before surgery and not start smoking again after surgery. Smoking slows recovery and increases the risk of problems. Tell your doctor or nurse if you need help to quit smoking.

Let your doctor or nurse know:
• If you are or might be pregnant.
• What drugs, vitamins, herbs and other supplements you are taking, including those bought without a prescription.

During the week before surgery:
• You may be asked to stop taking aspirin, ibuprofen, vitamin E, warfarin, and any other drugs that hinder the clotting of blood.
• Ask your doctor what drugs you should take even the day of surgery.
On the day of surgery:
• Do not eat or drink anything after midnight the night before surgery.
• Take the drugs your doctor will take with a small sip of water.
• The doctor or nurse will tell you when to arrive at hospital.

After the procedure
You will probably be able to go home two days after surgery. You must be able to drink clear liquids the day after the operation and then eat porridge or pureed food when you go home.
When you go home, you probably will receive pain medicine, fluids and medicines called proton-bomb inhibitors.

The doctor, nurse or dietitian will recommend a diet. Meals should be small to avoid overburdening the remnant stomach.


FAQs about Sleeve Gastrectomy

How big will my stomach be after surgery?
Surgery usually removes 75-80% of the stomach using a probe calibration during surgery. The normal capacity is 2 cups of food.

Is it safe to remove part of the stomach?
The removal of the stomach is done as part of duodenal change since the mid 1980's. The risks are similar to any surgery, including gastric bleeding and infections among others, but the risks are low in experienced hands.

Do I need to take vitamins?
Vitamin deficiencies are rare in this surgery because there is no intestinal bypass, but being a restrictive procedure, supplements are recommended in the first year.

Will I regain weight?
All patients who undergo obesity surgery have a very low risk of weight regain. However, those patients who maintain good eating habits and regular physical activity are the ones who keep their weight compared with those who do not.

How will my diet be after surgery?
The diet will progress during the first year. Usually begins with 2-4 weeks of liquid and slurry protein regime. It then progresses to gradually thicker foods, and after two months you can eat seafood, eggs, cheese and any other regular food. The initial recommended diet is usually low-calorie (500 per day), high protein (70 g per day), low-fat (30 g per day) and low carbohydrate (40 g per day). The calorie intake increases during the first year and by 12 months many patients have reached their ideal weight and consume between 900 and 1500 calories per day. The daily calorie intake depends on the level of activity, age and gender.

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