Gastric Sleeve Surgery (Sleeve Gastrectomy)
What is a gastric sleeve?
Gastric sleeve surgery, also known as sleeve gastrectomy, is weight loss surgery that has dramatically increased in popularity over recent years.
Gastric sleeve is a restrictive procedure where the capacity of your stomach is dramatically reduced by about 75% in order to aid substantial long-term weight loss. As a result, your overall health usually improves too.
It can be performed as a single procedure for weight loss or it can be the first step before other weight loss surgical procedures, such as gastric bypass.
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.
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 procedure.
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 surgery.
How does a gastric sleeve work?
A gastric sleeve works by permanently removing a large portion of your stomach leaving a new, smaller stomach about the size of a banana. As the capacity of your stomach is vastly reduced, it can only hold a small portion of food. You will feel full after eating much less food and be less hungry between meals. Your weight loss is normally fairly rapid, due to a reduced intake of food.
The sleeve gastrectomy or gastric sleeve is an operation where a long thin tube is created from the inside of the stomach the remaining stomach is remove dafter this procedure the patient remains on liquids for a period of time but thereafter once they start eating.
The small stomach rapidly fills the patient feels contented with a much smaller meal and goes on hopefully to lose a meaningful amount away.
A sleeve gastrectomy also removes the part of your stomach that produces the hunger stimulating hormone ghrelin. This means that your appetite is reduced.
Weight loss starts as soon as you have had the operation. After 18 months the sleeve stretches so it is important to maintain sensible portion sizes and not wait for the sleeve to stop you eating. If you eat the recommended foods (not soft or liquids), you will not feel hungry. You would need to take vitamins for life including quarterly B12 injections.
Benefits of a gastric sleeve
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. By weighing less, patients should also find it much easier to move around and carry out normal everyday activities.
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. 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 occur.
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).
How much does a gastric sleeve cost?
Gastric sleeve surgery typically costs between £7,000 and £11,000 throughout the UK. Ramsay Health Care UK has a guide price from £8,195. This competitive gastric sleeve cost includes: 24 months aftercare that comprises appointments with specialist bariatric nurses, specialist dieticians and medical reviews. Payment plans are available to fund your treatment.
Is a gastric sleeve right for me?
So, who is suitable for a gastric sleeve? You may be eligible for gastric sleeve surgery if:
- You have a BMI (body mass index) score is of 40 or more
- You have a BMI o 35 or more and you have other medical conditions such as type 2 diabetes or high blood pressure that may be improved by losing weight.
- You are fit enough to have a general anaesthetic and surgery.
- You are committed to losing weight and maintaining your weight loss through lifestyle and gastric sleeve diet changes.
You have tried to lose weight by eating healthily, exercising and taking relevant medicines, for at least six months and this hasn’t worked.
A gastric sleeve should be recognised as a permanent procedure as it cannot be reversed.
Your bariatric nurse/surgeon will discuss with you if you are eligible for this type of weight loss surgery.
How to prepare 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.
What happens during a gastric sleeve procedure?
When preparing for any weight loss surgery you have to be able to make lifelong commitment to major changes in your diet and lifestyle. Try and start on healthy lifestyle in the weeks leading up to your operation. This is to get you used to change in lifestyle and may result in greater weight loss after surgery.
Before gastric sleeve surgery you’ll be given a general anaesthetic. The procedure is performed laparoscopically, using keyhole surgery, this has advantages over open surgery including a shorter hospital stay, a faster recovery time, reduced pain and bleeding following the procedure and less scarring.
Your weight loss surgeon will make two to five small cuts in your stomach and insert a long, thin telescope with a light and camera lens at one end, called a laparoscope through these cuts and other surgical instruments to carefully remove a large part of your stomach. They will then join together the remaining portions of your stomach using surgical staples to create a long sleeve shaped tube that will form your new stomach.
Your surgeon will then remove the laparoscope and operating tools and stich the incisions closed.
The procedure should take between 60 and 90 minutes.
Aftercare and recovery
After gastric sleeve surgery you’ll stay in hospital for approximately two nights.
Your stomach might be swollen and sore for several days therefore you are likely to need pain relief. You can take over-the-counter painkillers such as paracetamol or ibuprofen.
You’ll only be able to drink clear fluids the first day after surgery. You will then remain on a liquid diet for several weeks, progressing to soft, moist foods, and eventually after four to six weeks you’ll add solid foods.
Your weight loss surgeon or a dietitian will discuss your strict gastric sleeve diet and it's important that you follow it. You will need small portions as your stomach will fill quickly.
You should rest after surgery and avoid straining your wound. We recommend that you have someone around to help you with everyday activities in the early days.
Most people can return to their normal activities within two to four weeks following gastric sleeve surgery. You should discuss when to return to work and begin exercise with your weight loss surgeon.
Gastric sleeve surgery patients on average lose between 50 and 70% of excess body weight in two years. Initially weight loss might be rapid, to ensure the weight loss continues to come off and you reach your weight loss goals, you'll need to start regular exercise. Weighing less should make it much easier for you to move around, do your everyday activities and take up new past-times. Don't overdo things to start with, gradually increase the amount of exercise you do.
Aftercare is included within your treatment price and you will have access to a range of specialists and information to help you with your aftercare and support.
Complications and side effects
You may experience some gastric sleeve side effects such as pain, bruising and swelling around your wounds, and vomiting or feeling sick after eating more than your new small stomach can hold. You should try to chew your food well, eat smaller portions and stick to your gastric sleeve diet plan.
Possible complications of any operation include: bleeding or a blood clot, pain and wound infection. Complications associated with gastric sleeve surgery include:
- Stomach scarring that creates bowel blockage.
- Inflamed stomach lining (gastritis), stomach ulcers or heartburn.
- Injury to the adjacent organs.
- Staple line leakage and serious infection.
- Vomiting from eating more than your stomach pouch can hold
Your weight loss surgeon will discuss possible complications and side effects in detail with you before you decide to have gastric sleeve surgery.
Is gastric sleeve reversible?
A gastric sleeve procedure is permanent, non reversible surgery. A gastric sleeve works by permanently removing a large proportion of your stomach leaving a new, smaller stomach. Whilst a gastric sleeve is non reversible, it can be converted to another procedure if necessary. It can be performed as the first step before other weight loss surgical procedures, such as a gastric bypass.