What is the sleeve gastrectomy ?

The laparoscopic sleeve gastrectomy procedure is one of newer procedures used to treat obesity. It became an approved bariatric procedure by the American Society of Metabolic and Bariatric Surgery in 2009, and therefore doesn’t have the long-term follow-up of the gastric bypass or lap band procedure. But the short-term (1 year) and medium-term (3 year) follow-up has been very promising, closely mirroring the weight loss seen with the gastric bypass procedure. Most studies show 60-70% excess weight loss with this procedure at one year.

The procedure is primarily a restrictive procedure. It involves removing approximately 80-85% of the stomach, leaving just a “sleeve” of stomach remaining. This will significantly limit the amount of food that can be eaten at a time and will therefore decrease the amount of calories that can be consumed. There is no “re-rerouting” of the intestine, and therefore no malabsorption. Vitamins and minerals are all absorbed normally, so the risk of deficiencies is decreased. Since patients do take in significantly less food, we recommend they take an adult multivitamin daily. We also recommend sublingual (under the tongue) Vitamin B12, as the stomach that is removed does make a protein called intrinsic factor needed for absorption of this vitamin.

The sleeve gastrectomy historically was a two-stage procedure done for severely morbidly obese patients who were considered too high risk for a gastric bypass procedure. The patients would undergo a sleeve gastrectomy, lose a hundred pounds or so, and then undergo a conversion to a gastric bypass surgery in a 2nd operation. Many patients did not want to undergo the 2nd procedure, so we followed them – and they kept off their weight! So we now offer the procedure to all of our bariatric patients as a primary operation, with no plan to undergo a 2nd operation. While there is no long-term follow-up yet, studies have followed patients for 3 years and 5 years after surgery and they have kept off their weight.

Another of the potential benefits of surgery is that the portion of the stomach that is removed is responsible for the production of ghrelin. Ghrelin is a hormone thought to be one of the factors leading to hunger. Studies show that ghrelin levels in patients undergoing a sleeve gastrectomy are significantly lower and their hunger is less after this procedure than with other surgeries. Hunger is caused by many factors, but there is hope this will lead to better long-term compliance and sustained weight loss.

The procedure usually involves an overnight stay in the hospital. The surgery usually takes less than an hour. Most people are back to work 1-2 weeks after surgery. Weight loss is fast, and the average weight loss is approximately 60-70% of the excess weight at one year.

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After The Surgery

Immediately you will notice a difference in the amount and type of food you can eat. You will receive nutritional counseling to help show you the dos and don’ts.