Sleeve Gastrectomy - A Weight Loss Procedure

Introduction:

Sleeve gastrectomy, also known as vertical sleeve gastrectomy, is a weight loss procedure done surgically. In the modern era, it has become one of the most widely performed bariatric surgeries. It was first performed through open surgery in 1990. It was in 1999 that the first laparoscopic sleeve gastrectomy was performed. When compared to other surgeries, this weight loss surgical procedure is technically easier with relatively less morbidity. It has become the most common surgery for weight loss in the United States.

What Is Sleeve Gastrectomy?

Sleeve gastrectomy is a bariatric surgery performed mainly to induce weight loss. By removing a significant portion of the stomach, the size is reduced by 80 %. The new stomach is smaller in size and is about the size of a banana. It limits the quantity of food that can be eaten by making the person feel full after eating small amounts of food.

Why Is Sleeve Gastrectomy Done?

Sleeve gastrectomy is majorly performed to help in weight reduction and reduce the risk of the following life-threatening weight-related health conditions:

• High blood pressure.

• Type 2 diabetes.

• Obstructive sleep apnea.

• High cholesterol (hyperlipidemia).

• Stroke.

• Heart disease.

• Joint pain and osteoarthritis.

• Cancer.

• Infertility.

What Are the Risks Associated with Sleeve Gastrectomy?

Sleeve gastrectomy poses health risks, both in the short-term and long term. But it is seldom that complications of this procedure turn fatal. Risks associated with the procedure include the following:

• Infection.

• Adverse reaction to anesthesia.

• Excessive bleeding (hemorrhage).

• Blood clots.

• Breathing or respiratory problems.

• Leakage of the fluid from the stomach through the cut edge.

Long-term complications of the procedure include:

• Hernia occurs when an internal organ protrudes through a weakened area in the muscle or tissue.

• Gastrointestinal obstruction (it is a condition where the normal passage of digested material through the bowel is obstructed).

• Hypoglycemia (low blood sugar levels).

• Gastroesophageal reflux (the stomach acid repeatedly enters the esophagus).

• Scar tissue.

• Gastritis (inflammation of the stomach lining).

• Gallstones (these are hard deposits within the fluid of the gallbladder. Rapid weight loss makes gallstones more likely).

• Vomiting, nausea, and difficulty eating (after surgery, scar tissue can make the stomach narrow, which can slow or block food from moving through the stomach causing nausea, vomiting, and difficulty eating).

• Malnutrition and nutritional deficiencies (it is difficult to get enough nutrients when the person is eating very less).

What Are the General Requirements to Qualify for Sleeve Gastrectomy?

The following are the requirements for sleeve gastrectomy:

• It is suitable for the ones who have undergone the surgery previously but did not succeed in losing weight.

• The person must be mentally and physically prepared for the sleeve gastrectomy and recovery procedure.

• Sleeve gastrectomy is recommended for individuals with a body mass index (BMI) of 40 or higher, indicating extreme obesity.

• Individuals with a body mass index ranging from 35 to 39, which indicates obesity, and who have severe weight-related health conditions such as high blood pressure, type 2 diabetes, or severe apnea, may be considered for this procedure.

In Which Conditions Is Sleeve Gastrectomy Contraindicated?

It is absolutely contraindicated in the following:

• Inability to tolerate general anesthesia.

• Severe psychiatric illness.

• Uncontrollable coagulopathy (impaired ability of the blood to coagulate or form clots).

Sleeve gastrectomy is relatively contraindicated in the following:

• Severe gastroesophageal reflux disease (stomach acid flows back into the esophagus repeatedly).

• Barrett esophagus (this condition involves the replacement of the tissue lining the esophagus with tissue resembling the lining of the intestine).

How Is Sleeve Gastrectomy Performed?

Before Procedure:

If a person has passed health screening and qualifies for the bariatric sleeve gastrectomy, the next step is a two-week liquid diet. The doctor gives specific guidelines to follow this. The purpose of this diet is to lose some of the fat in the abdomen and the liver to have a safe surgery. The person will be instructed to refrain from eating or drinking anything for a period of 12 hours prior to the surgery. This is done to make sure the stomach is empty during the surgical procedure. The presence of food or liquid in the stomach during the surgery can cause unpleasant or dangerous side effects.

During the Procedure:

• Generally, sleeve gastrectomy is done by laparoscopic or robotic surgery. This means instead of having an open surgery or surgery that involves large cuts, the doctor will perform the surgery through small incisions. They help in easier and faster recovery, but some people are better served with open surgery, depending on the conditions.

• During the procedure, the surgeon will give general anesthesia to the patient. In the abdomen, a small incision will be given and a port will be inserted. The carbon dioxide gas through the port will be pumped out to expand the abdomen. Then a small lighted video camera (laparoscope) is placed through the port that projects the inside of the abdomen onto a screen. Through one to three more incisions, the surgeon will insert the additional ports and complete the procedure using long and narrow tools. They will measure the gastric sleeve and then divide and separate the remaining stomach using a surgical stapler. The surgeon will remove the remaining stomach and close the incisions.

• Compared to other surgeries, this surgery is short and simple. It takes around 60 to 90 minutes. The surgeon wants the patient to stay in the hospital after the surgery for one or two days as it can help manage the pain and any other temporary side effects of the surgery.

After the Procedure:

• A person after the sleeve gastrectomy is expected to have frequent check-ups with the concerned doctor in the following weeks and months. The doctor will monitor the weight loss progress, related health conditions, and any side effects of the surgery. The doctor will suggest necessary lifestyle guidelines to maintain health and weight loss.

• In the short term, the person is expected to follow strict dietary guidelines so that the stomach heals properly. After a few months, they can begin to have a more normal diet but still have to choose their food wisely. Since the person will be able to eat a decreased quantity of food, he should make sure that he eats nutritious food that is enough to sustain energy needs. The person should begin taking vitamins shortly after the surgery and should continue them permanently.

Conclusion:

Sleeve gastrectomy is a procedure performed surgically for weight loss and reduces the risk of associated health conditions. This surgical procedure is generally performed laparoscopically. The average weight loss through this procedure is expected to be 25 % to 30 % in the first two years. Sleeve gastrectomy does pose some complications, but they usually are not fatal.