Gastric sleeve surgery or vertical sleeve gastrectomy is a procedure where around 80% of the stomach is removed, leaving behind a much smaller portion similar in size and shape to a mere banana. The reduced stomach size will lead to a decreased amount of food intake and elicit hormonal changes that help weight loss.
The statistics speak for themselves: obesity is a global disease with alarming rates. According to the WHO, worldwide obesity has nearly tripled since 1975. Additionally, the World Obesity Federation predicts that by 2030, 1 billion people around the globe will be suffering from obesity. It’s also important to remember that obesity isn’t just about looking good either. Obesity is a life-threatening condition that brings with it a higher risk of developing cardiovascular diseases, type 2 diabetes, and cancer.
In the past, obesity has been assessed using the Body Mass Index (BMI). While not entirely accurate, it’s a quick and easy way to measure a person’s apparent fat levels using the relationship between their height and weight. It should be noted however that a person’s BMI should be used purely as an estimation as numerous patients with high or low BMIs can still be healthy, depending on their unique body compositions; some people with high BMIs may simply weigh more as a result of bulk muscle, and others may weigh less from being naturally leaner. Having a BMI of 25 or higher classifies you as overweight, while a BMI equal to or greater than 30 is considered obese.
A healthy diet to limit calorie intake combined with exercise is an excellent start to losing weight. In more extreme or circumstantial conditions where obesity imposes immediate health dangers however, surgery may be more suitable.
Bariatric surgery or weight loss surgery is part of a group of surgical options intended to modify your digestive system to assist in weight loss. These types of surgery achieve the same goal in a variety of ways, from inserting a band to squeeze the top of the stomach, removing a part of the stomach, or rerouting the food passages to bypass a part of the small intestine, decreasing food absorption. Bariatric surgical options include Adjusted Gastric Band (AGB), Vertical Sleeve Gastrectomy (VSG), Roux-en-Y Gastric Bypass (RYGB), Biliopancreatic Diversion (BPD), and Biliopancreatic Diversion with a Duodenal Switch (BPD-DS).
Gastrectomy (partial or complete stomach removal) can be performed as an open surgery or laparoscopically. Laparoscopic gastric surgery (LGS) is carried out through multiple small incisions used to insert small operating instruments. The laparoscopic approach is a more conservative technique with fewer postoperative complications compared to the open surgical one.
The basic solutions for weight loss include diet, exercise, and medication. Bariatric surgery is recommended only when:
The main goal for gastric sleeve and other bariatric surgery is to modify the digestive system by removing a part of the stomach and bypassing a part of the small intestine. Gastric sleeve surgery aims to decrease food intake and absorption. Additionally, Gastric sleeve surgery helps regulate hunger and increases the sensation of fullness as well, as a decrease in stomach issue equates to a diminished release of hunger-inducing hormones.
All in all, the procedure helps to treat obesity, and resolve medical conditions associated with it (diabetes, sleep apnea, high cholesterol, infertility, cancer, and hypertension). Otherwise, gastric sleeve surgery can also be used as a treatment for benign tumors, bleeding, peptic ulcers, and perforations in the stomach wall.
Gastric sleeve surgery:
The concept for gastric sleeve surgery is simple: a smaller stomach size leads to a quicker sensation of fullness, a decline in the release of the appetite-regulating hormone, and increased stomach motility which quickens the digestion procedure.
Other Bariatric Surgeries:
This method of bariatric surgery allows for adjustments over time. Instead of a permanent stitching or modification, a band is inserted and looped around a portion of the stomach to create a pouch. This band is adjusted through fluid injection through a port inserted below the skin. The pouch size controls the amount of food consumed before feeling full. It is a simple and reversible surgery but requires frequent visits for band size adjustment. This surgery shows a slow rate of weight loss and presents a risk of band slippage or erosion of the stomach wall with time. It has minimal incidents of vitamin and/or mineral deficiency compared to other bariatric surgeries.
This is a more complex surgery that includes both the stomach and the small intestine, also known as a gastric bypass. Usually, food travels from the esophagus to the stomach before entering the small intestine. In this case, surgery is performed to bypass most of the stomach entirely, instead routing food only to a small upper portion of the stomach that has been separated from the rest of the organ to connect directly to the small intestine. Ultimately the amount of food that can be consumed before feeling full is severely limited, helping greatly with weight loss and diabetes. It must be noted that RYBG results in a high risk for nutritional deficiency and bowel obstruction/ leakage. Tobacco and NSAIDs are well known contraindications to this surgery, resulting in ulcers. Post-surgical dumping syndrome (sickness, abdominal cramping, and diarrhea) is common after this surgery following sugar consumption.
While both procedures are similar and result in the removal of a considerable part of the stomach, each requires a different portion to be removed. In Biliopancreatic Diversion, the stomach is cut horizontally, and the lower part containing the valve regulating food passage from the stomach to the intestine is removed. In contrast, Biliopancreatic Diversion with a Duodenal Switch requires the creation of a vertical pouch similar to gastric bypass, conserving the valve. The remaining segment bypasses most of the small intestine to be linked near the duodenum. Both are highly effective in weight loss and resolving diabetes but have a higher risk of developing bowel complications and nutritional or vitamin deficiency.
Laparoscopic Gastric Sleeve surgery is a safe and minimally invasive weight loss option compared to other bariatric surgeries.
Some rare general surgical complications may occur as bleeding, infection, sensitivity to anesthesia, and leakage from the staple line.
Vitamin deficiencies may result from this type of surgery. This can be avoided by regularly taking the vitamin supplements prescribed by your doctor after the surgery.
Some patients may experience worsened gastric acid reflux due to the smaller stomach size, but this can be managed with medication.
There may be a risk for weight regain and widening of the stomach sleeve if you don’t follow a healthy diet plan combined with exercises.
Are gastric sleeve procedures safe?
Gastric sleeve surgery is a safe procedure with rare risks that can be avoided by choosing a skilled surgeon and strictly following the post-operative instructions. The risks of obesity and the accompanying health problems are by far more dangerous than the rare surgical risks.
Who should consider Gastric Sleeve Surgery?
The qualifying requirements for gastric sleeve surgery include:
What are the benefits of Gastric Sleeve Surgery?
Gastric Sleeve Surgery decreases the stomach size which will be reflected in the amount of consumed food, appetite, and easily feeling full. This will lead to great results in weight loss that help resolve associated medical conditions such as diabetes, hypertension, high cholesterol levels, and heart problems.
Will I ever gain weight again?
It is possible to regain some of the lost weight due to the expansion of the stomach sleeve. This can be avoided by following a healthy diet plan, exercising, eating small frequent meals, and having the motivational power to control your food consumption.
How long is the recovery time?
You may feel fatigued in the first few weeks of recovery following surgery due to the decreased food intake. It may take up to a month of recovery to feel normal again.
When can I eat regular food after surgery?
As mentioned before, you will be required to follow a strict diet plan after surgery to ensure safe stomach healing. You will begin with liquid food for 1-2 weeks, then puree food and soft food for 2-3 weeks. Finally, you will be able to consume regular food around 5 weeks after surgery. Never jump to regular food as this may elicit pain and vomiting.