Sleeve gastrectomy is one of the types of surgical weight loss procedures performed in the United States to help obese or morbidly obese patients who struggle to lose weight with non-surgical medically supervised weight loss programs. Bariatric surgery, which includes gastric bypass, adjustable gastric banding, biliopancreatic diversion with duodenal switch as well as sleeve gastrectomy, is often the last resort for patients with a Body Mass Index higher than 40, or a BMI of 35 and an associated disease, such as high blood pressure, heart disease, diabetes, metabolic disease or sleep apnea.
During a sleeve gastrectomy procedure, surgeons remove approximately 80 percent of the stomach, stapling the remaining part as a tubular pouch that resembles a banana or a sleeve. Due to improvements and advancements in the procedures, it is now possible for surgeons to perform weight loss surgery using minimally invasive techniques. Despite the fact that it can be performed either as open surgery or laparoscopically, the latter holds less risks and it is much more common.
Prior to the Sleeve Gastrectomy Surgery
Undergoing a sleeve gastrectomy or any other type of bariatric surgery is a life changing decision, and prior to even choose these options, both physicians and patients need to evaluate if weight loss surgery is the best decision. An accredited medical care team evaluates patients’ overall health, need for a bariatric surgery and eligibility criteria. While patients are also informed about the implications of it, including risks, possible positive and negative outcomes, commitment needed before and after the gastric bypass, and eventually other non-surgical medically supervised weight loss programs.
In addition to the physical evaluation, a psychological evaluation is also critically important in the process to assess if obesity is not associated with other problems like stress or binge eating, which can be treated with other methods. Treatment involving sleeve gastrectomy does not start or end with the surgery, which is why it is important for patients to start making alterations in their lives even before sleeve gastrectomy surgery. The medical care team will provide specific guidelines on behavioral alterations during the preparation for the surgery, which can take months or even more than a year.
The behavioral alterations required before the surgery are related to improving results after the surgery, while some insurance companies also require the patient to lose weight before the surgery to grant financial support. The costs of the entire process also need to be considered, and seeking insurance or payment plans can be prolonged and demanding. During the journey, the medical team will define a plan and diet taking into consideration patients’ characteristics, age, weight, and the existence of any co-morbidity. In addition to adopting healthier habits, which increases the possibilities of losing more excessive weight after the sleeve gastrectomy and helps patients in the transition that needs to happen after the surgery, patients also need to stop smoking sooner or later to improve overall health and decrease the risk of chest infections such as pneumonia, that can slow down the healing process.
Sleeve Gastrectomy Surgical Procedure
The preparation for the sleeve gastrectomy culminates on the day of the surgery. The night before, patients are asked to not eat or drink since the stomach needs to be empty to minimize surgical risks. For the procedure, patients are asleep under general anesthesia and the surgeons will start by make small incisions in the abdomen to insert the surgical instruments and a small camera called laparoscope. By doing so, surgeons increase visibility, while the laparoscopic method involves less pain, scarring and recovery time.
The stomach is vertically divided into two parts, creating a small pouch shaped like a banana or a sleeve. After stapling the stomach, the surgeon removes the excess, reducing its size and capacity to enhance weight loss. The laparoscopic sleeve gastrectomy is a restrictive operation, since it limits the food intake, but it does not alter the normal function of the digestive system. Despite the fact that it is a safe and less invasive procedure, there is also the risk of complications, including bleeding, infection, injuries to the other organs, or the surgery may need to convert the procedure to an open procedure, as well as leak from the staple line, which is a problem that tend to occur in less than one percent of the cases.
On the other hand, a laparoscopic sleeve gastrectomy does not affect the normal function of the stomach, nerves or other aspects of the digestive system. Since the food ingested continues to follow its normal route, the development of dumping syndrome is less likely, and there is also a lower risk of ulcers and patients do not need to visit the hospital as often, compared to other methods. The procedure restricts the amount of food the stomach can hold and causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve satiety, which results in rapid and significant weight loss — higher than 50% excessive weight loss in the long-term. In order to ensure the success of sleeve gastrectomy, adopting a healthy diet and partaking in exercise as well as following a physician’s directions is critically important.
Following the Sleeve Gastrectomy Surgery
When patients wake up from the anesthesia, they are not likely to feel any pain right away due to the medication, and the hospital stay usually lasts a day or two. It may be helpful to ask a friend or family member to be at the hospital or at home and provide comfort and support, since after being discharged from the hospital, patients may start experiencing some pain. Right after the surgery, patients won’t eat anything and will gradually transition from liquids to solid food during the following months and according to the doctor’s recommendations. Regarding activity, patients are asked to start moving shortly after waking up, but need to reduce their activities and are advised not to lift anything heavy during the first times.
This entire process aims to let the stomach heal and patients usually return to work and their normal routine four to six weeks after the surgery. It is normal to notice alterations in the digestive process and bowel movements. Patients may also experience mental and emotional instability, which can be addressed with the help of individual counseling and bariatric support groups sessions. In the case of open surgery the recovery will take longer than in the case of laparoscopic sleeve gastrectomy.
Compared to other types of bariatric surgery, the results regarding weight loss are similar to the gastric bypass, superior to gastric band, but inferior to biliopancreatic division with duodenal switch. In addition, it requires no foreign objects — contrary to the gastric band — and no bypass or re-routing of the food stream, unlike the two other procedures. However, similar to gastric bypass and biliopancreatic division, it is a non-reversible procedure, and potential for long-term vitamin deficiencies.
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