We are pleased to offer the vertical sleeve gastrectomy at Healthy Steps Bariatric and Metabolic Center. The sleeve gastrectomy, also known as the gastric sleeve, is performed laparoscopically, much in the way that our roux en-Y gastric bypass and adjustable gastric band procedures are. Gastric sleeve offers a combination of restriction and hormonal mechanisms of action, filling the gap between the gastric bypass and gastric band.
The sleeve gastrectomy has historically been a component of the biliopancreatic diversion with duodenal switch. Many centers were performing this operation in stages for super-morbidly obese patients, too sick to tolerate the entire procedure at one time. These patients first underwent sleeve gastrectomy, which resulted in significant rapid weight loss and improvement in medical status. This allowed the patients to then undergo the “duodenal switch” portion. Some patients, however, did so well with just the sleeve gastrectomy that they never underwent the second stage.
How The Sleeve Gastrectomy Works:
To understand the procedure one must think of the stomach as having two parts. One part, the “fundus” or “body”, can stretch to the size of a football to accommodate storage of a meal while initial breakdown by stomach acid occurs. This part also secretes a hormone called “ghrelin” which tells the brain one is hungry. The other part of the stomach is called the “antrum.” This portion is involved in mixing and pumping the food to the duodenum. Sleeve gastrectomy involves removing most of the body of the stomach, but preserving the antrum. After the procedure, the patient can only hold a small amount of food at a time. Additionally, there is a loss of ghrelin resulting in less hunger.
Results of the Sleeve Gastrectomy:
The above findings prompted researchers to examine sleeve gastrectomy as a stand-alone operation. We now have several high-quality early studies that report weight loss somewhere between 50-70% excess weight loss at one to three years. Five-year data is emerging, showing durability of this result. In addition, medical co-morbidities such as diabetes, sleep apnea, and hypertension improve as weight is lost.
Advantages of the Sleeve Gastrectomy:
- As above, there is very good long term data now published on this operation as a stand-alone procedure showing excellent results.
- Since there is no bypass segment, there are no malabsorption complications.
- Since the stomach is otherwise intact, there is less ulcer risk, possibly making it an especially good operation for patients on non-steroidal, anti-inflammatory drugs “NSAIDs” needing to rapidly lose significant weight before hip or knee replacement surgery.
Risks and Considerations of Sleeve Gastrectomy:
- Vertical sleeve gastrectomy is not without risks, which can be exacerbated by a patient’s poor health. It is a major surgery and should be treated as such.
- Sleeve gastrectomy patients will have dietary volume restriction and should take supplements.
- This procedure is not adjustable or reversible.
Learning more about the procedure is important to a patient’s success. Speak to your primary physician and bariatric surgeon to learn more about the advantages and disadvantages of the gastric sleeve. You can also attend a free weight loss surgery seminar to learn more about our procedures and practice.