A gastric sleeve surgery (sleeve gastrectomy) is a restrictive procedure to help you with weight loss. It restricts the amount of food you can eat by reducing the size of your stomach.
In sleeve gastrectomy surgery your surgeon will remove a large portion of your stomach leaving a new, smaller stomach about the size of a banana. Your new stomach size limits the amount of food you can eat. You’ll only be able to eat a small meal and you will keep a feeling of fullness for longer. Food will be absorbed in the normal way as your intestines aren’t by-passed, as in a gastric by-pass.
1. What is a gastric sleeve surgery?
In gastric sleeve surgery your surgeon creates a small stomach "sleeve” using a stapling device and the rest of your stomach is permanently removed. Your stomach’s size will be reduced by approx 75%.
It can be a single procedure for weight loss or it can be the first step before other weight loss surgical procedures, such as gastric bypass.
2. What is involved in a sleeve gastrectomy procedure?
Prior to your gastric sleeve surgery you will be given a general anaesthetic that will put you to sleep.
A sleeve gastrectomy is normally done using a tiny camera called a laparoscope that is placed in your stomach and allows your surgeon to see inside your stomach.
Your surgeon will make two to five small cuts in your abdomen and pass the laparoscope and other instruments needed to perform the surgery through these openings. They will remove a large portion of your stomach and the remaining portions of your stomach are joined together using surgical staples. This creates a long vertical tube or banana-shaped stomach.
The procedure should take between 60 and 90 minutes.
3. The history of the gastric sleeve surgery
Gastric sleeve surgery was first introduced in 1988 as the restrictive part of a bariatric surgery to treat morbid and super morbid obesity called biliopancreatic diversion with duodenal switch (BPD-DS). In these high risk patients sleeve gastrectomy was proposed as the first step of the procedure followed by a second procedure with the gastric bypass or BPD-DS.
Sleeve gastrectomy, the first step in the two-step procedure, showed excellent weight-loss results and led to the proposal of the sleeve gastrectomy as a stand-alone procedure. As a result, since 2003, gastric sleeve surgery has been offered as a stand-alone bariatric procedure¹.
In 2012, the American Society for Metabolic and Bariatric Surgery (ASMBS) updated its position statement on sleeve gastrectomy as a bariatric procedure, recognising it as both a primary procedure and as the first stage in a two-step surgery².
4. Is a gastric sleeve surgery the right option for me?
If you prefer the idea of a weight loss surgery that will help you lose weight by restricting the amount of food you eat but doesn’t interfere with the absorption of your food and doesn’t involve having a foreign body inside your body then a sleeve gastrectomy might be the best option for you.
You will need to bear in mind that the weight will usually come off more slowly than with other procedures such as gastric bypass, and to lose weight you will need to be committed to following an exercise and eating plan. A gastric sleeve surgery should be recognised as a permanent procedure as it cannot be reversed.
It may be that your BMI dictates that you cannot have another surgical procedure initially and in this instance your surgeon might therefore recommend the sleeve gastrectomy to lose excess weight to enable you to then opt for a second weight loss surgical procedure at a later date.
It is best to talk with your bariatric nurse/surgeon about the weight loss surgery options and the most suitable one for you.
5. Am I eligible for a gastric sleeve surgery?
You will usually have weight loss surgery such as a sleeve gastrectomy if you cannot lose a large amount of weight and maintain the weight loss long term by dieting and lifestyle changes alone; or if you have serious health problems caused by obesity.
This procedure may be recommended if you have a body mass index (BMI) of 40 or more as this indicates you are at least 100 pounds over your recommended weight. It may also be advised for you if you have a BMI of 35 or more and also a serious medical condition that might improve with weight loss. Some of these conditions are sleep apnoea, type 2 diabetes, and heart disease. A gastric sleeve surgery may also be used to treat extremely morbidly obese people (with a BMI of 60 or above).
Your bariatric nurse/surgeon will discuss with you if you are eligible for this type of weight loss surgery.
6. The benefits of the gastric sleeve surgery
A gastric sleeve surgery will dramatically reduce your calorie intake. You can eat normally but you will want much smaller portions during a meal. It can lead to dramatic weight loss in a relatively short period. In clinical studies patients lost an average of 66% of their excess weight³.
By weighing less, patients should also find it much easier to move around and carry out normal everyday activities.
As this surgery preserves the pylorus, the valve that regulates emptying of the stomach, it allows food to stay in the stomach for a while, making you feel full while the food trickles out.
There is no rearrangement of the bowel with a gastric sleeve surgery therefore dumping, which may occur to gastric bypass patients when their undigested stomach contents are “dumped” into their small intestine too quickly, should not a problem. Also a sleeve gastrectomy doesn’t affect the absorption of food, so nutritional deficiencies are less likely to occur⁴.
The part of your stomach that contains cells with an appetite prompting hormone, called ghrelin, has been removed during surgery, therefore, your hunger should be reduced in this procedure more than other weight loss surgical procedures such as gastric banding.
Losing weight after a gastric sleeve surgery can also improve many medical conditions you may have. Conditions that may improve are asthma, type 2 diabetes, arthritis, high blood pressure, obstructive sleep apnoea, high cholesterol, and gastroesophageal disease (GERD).
7. What are the risks of the gastric sleeve surgery?
As with any weight loss surgical procedure there are potential risks involved and it is important that you are informed of these before surgery. Most patients do not have complications after a gastric sleeve surgery however complications can occur and depend on your health status.
Specific potential complications of a gastric sleeve surgery:
• Leakage of digestive contents from the staple line that can lead to serious infection.
• Injury to adjacent organs such as your stomach and intestines during surgery.
• Gastritis (inflamed stomach lining), heartburn, or stomach ulcers⁵.
• Scarring inside your stomach that could lead to a blockage in your bowel in the future.
• Vomiting from eating more than your stomach pouch can hold.
8. Getting prepared for your sleeve gastrectomy
• When preparing for any weight loss surgery you have to be able to make a lifelong commitment to major changes in your diet and lifestyle.
• Always tell your bariatric nurse/surgeon what drugs, vitamins, herbs and other supplements you are taking. You may be asked to stop taking them before your surgery.
• Try to start on a healthy lifestyle in the weeks leading up to your operation. This is to get you used to a change in lifestyle and may result in a greater weight loss after surgery.
• Ensure that you have a ready supply of drinks, thin soups and purees for when you come out of hospital.
• Make sure that you have all the medications you will need after surgery in a liquid form if necessary.
9. After gastric sleeve surgery
You will probably be discharged and able to go home 2-3 days after your surgery. You should be able to drink clear liquids on the day after surgery, and will then be on liquid diet only for a period of time after surgery. Your Bariatric nurse/ dietician will recommend a strict regime for you. Eventually, meals should be small to avoid stretching your remaining stomach. Your small stomach pouch will fill quickly and you should feel full after eating a very small amount of food.
When you go home, you will probably be given painkillers. For the first few days after surgery you will have to rest. You will have to avoid putting any strain on your operation wound which means even the smallest task will be too much. Ensure that you have someone who can help you at home to help do things for you.
Here you can find our guide prices for gastric sleeve surgery
Read more weight loss surgery blog posts to find answers to the most common questions including: pros and cons of gastric balloon and gastric sleeve, how to choose a weight loss surgeon, exercise after weight loss surgery etc.
Big “thank you” to Mr Sanjay Agrawal MD, Consultant Surgeon specialising in Bariatric (Obesity / Weight-Loss), Laparoscopic (Key-hole) and upper Gastrointestinal Surgery at Rivers Hospital in Sawbridgeworth for reviewing this article.
Mr Agrawal is certified as ‘Bariatric Surgeon of ExcellenceTM, BSOETM’ by Surgical Review Corporation. He is the ONLY Weight-Loss/Obesity Surgeon in the UK to achieve this designation. Earning the BSOE certification signifies Mr Agrawal’s commitment to the highest standard of treatment to bariatric surgery patients.
Read more about Mr Agrawal’s qualifications, background and clinical interests.
About Ramsay Health Care Sleeve Gastrectomy Surgery
Ramsay Health Care is a leading provider of weight loss surgery in the UK. At Ramsay Health Care weight loss procedures are performed by highly qualified and experienced bariatric surgeons who have undergone intensive specialist training in their speciality. Ramsay Health Care offers sleeve gastrectomy surgery as a weight loss surgery option.
Please contact us if you would like to discuss sleeve gastrectomy in more detail.
Ramsay Health Care UK | 25/09/2014