Gastric Sleeve Surgery- Types, Indications, and Procedure

What Is Gastric Sleeve Surgery?

The gastric sleeve, also known as sleeve gastrectomy, is a bariatric surgery procedure designed to promote weight loss by reducing the stomach size. The term “gastrectomy” refers to removing part or all of the stomach. During the gastric sleeve operation, approximately 80 percent of the stomach is removed, leaving a tubular "sleeve" about the size and shape of a banana.

Which Medical Conditions Can Be Treated With Gastric Sleeve Surgery?

Gastric sleeve surgery is a surgical intervention aimed at treating obesity and its associated medical conditions. It is typically available to individuals who have serious health issues related to their obesity or are at high risk for such conditions.

This surgery can enhance or even resolve several diseases, including:

• Type 2 diabetes and insulin resistance.

• Hypertensive heart disease and hypertension.

• Arterial disease and high cholesterol.

• Nonalcoholic fatty liver disease and steatohepatitis.

• Obstructive sleep apnea and obesity hypoventilation syndrome.

• Joint pain and osteoarthritis.

How Frequently Is Gastric Sleeve Surgery Performed?

Gastric sleeve surgery is the most commonly performed weight loss surgery in both the U.S. and globally. In the U.S., sleeve gastrectomies account for over half of all bariatric surgeries annually. Approximately 150,000 gastric sleeve procedures are conducted annually in the U.S., with around 380,000 performed worldwide. However, only 1percent of individuals who could benefit from and qualify for the surgery undergo the procedure.

Is Gastric Sleeve Surgery Considered Safe?

The risks associated with gastric sleeve surgery are significantly lower compared to the risks of obesity and its related health conditions. Additionally, the procedure has fewer complications than other common surgeries, such as gallbladder removal and hip replacement. Most gastric sleeve surgeries use minimally invasive techniques, resulting in less incision pain and quicker recovery time.

What Are the Benefits of This Procedure?

The gastric sleeve is simpler, quicker, and safer than other bariatric surgeries. It is often suitable for individuals with health conditions that might not be ideal for more extensive procedures. Since the surgery does not involve rearranging the intestines, it also poses a lower risk of long-term nutritional complications. Although the average weight loss with gastric sleeve surgery may be somewhat less than that achieved with more complex weight loss surgeries, it still provides substantial weight loss and health benefits. Initially designed as the first phase of a two-step procedure known as the duodenal switch, the gastric sleeve is now commonly performed as a standalone operation after many patients found they did not need to undergo the second stage.

What Are the Risk Factors Related to Gastric Sleeve Surgery?

• Bleeding, blood clots, and infection are the basic possible side effects that can occur after the surgery.

• There might be breathing complications due to general anesthesia.

• Over some time, there might be some difficulty in absorbing some nutrients.

• Formation of strictures (narrowing of the wall) in the stomach sleeve.

• Sometimes, there can be moderate to severe reflux after the surgery. In cases with a history of acid reflux, gastric sleeve surgery can worsen the situation. Gastric bypass surgery may be needed to stop the reflux and heartburn.

What Is the Process Leading up to Gastric Sleeve Surgery?

Once individuals pass their health screening and are approved for gastric sleeve surgery, they must follow a two-week liquid diet. The surgeon will provide specific instructions to help individuals with this. The goal of this diet is to reduce the fat in the abdomen and liver, which helps make the surgery safer. Additionally, individuals must abstain from eating or drinking for 12 hours before the procedure. This ensures the stomach is empty during the surgery, as any remaining food or liquid could lead to unpleasant or potentially dangerous complications.

How Is Gastric Sleeve Surgery Performed?

• The anesthesiologist administers the patient's general anesthesia for the surgery. This causes the patient to sleep during the entire surgery.

• The technique used is laparoscopy. The doctor makes several incisions in the upper abdomen, inserts a laparoscope, and inserts small surgical instruments inside through the incisions.

• The anesthesiologist then passes a sizing tube from the mouth into the stomach.

• The surgeon then uses a laparoscopic stapler to divide the stomach, leaving a vertically narrowed sleeve. The part of the stomach that was removed is taken out through the incision.

• After this, leaks are tested in the sleeve using a dye or upper abdomen endoscopy.

• At last, the laparoscope is removed, and all the incisions are sutured back.

What Happens Post-Gastric Sleeve Surgery?

• The patient is generally discharged one day after the surgery.

• The patient is instructed to follow a liquid diet for the first two weeks after the surgery.

• It is advised to gradually move from liquid food to pureed food, then soft food, and finally to regular food.

• The quantity of meal should be very small and chewed properly and slowly. Sudden shifts to regular food can give rise to pain and vomiting.

• Even after the healing, eating habits need to be small quantity meals only, as the stomach size has reduced.

• Patients who underwent gastric sleeve surgery may suffer from vitamin and mineral deficiency due to impaired nutritional absorption. Thus, vitamin and mineral supplements should be prescribed to them.

• Regular blood tests are advised every few months after the surgery. This helps check for high blood glucose, anemia, or low calcium or vitamin D levels.

• There is a chance of gaining some weight back after losing it due to surgery. So, it is important to follow a healthy diet and regular exercise.

• The sleeve may dilate over time, which can lead to excess eating and weight gain. Therefore, it is important to control food intake and maintain a diet.

Will Individuals Need to Adhere to a Specific Diet Following Gastric Sleeve Surgery?

In the immediate aftermath of gastric sleeve surgery, individuals will need to adhere to strict dietary guidelines to ensure proper stomach healing. After a few months, they can gradually return to a more regular diet, but it is important to choose their foods carefully. Since individuals will not be able to eat as much as they did before, their food intake must remain nutritious to meet their energy needs. Additionally, individuals will start taking vitamins shortly after the surgery and must continue taking them for life.

Conclusion:

Gastric sleeve surgery is done to lose weight. It is also known as bariatric surgery. Gastric sleeve surgery is suggested in people with a basal metabolic index of more than 40 who could not lose weight with other alternating methods. Obese patients with high blood pressure, diabetes, or sleep apnea also suggest gastric sleeve surgery. Maintaining a proper diet and following all the instructions during and after the surgery is essential for a successful prognosis.