Gastric Sleeve Surgery

What is gastric sleeve surgery?

Gastric sleeve surgery is one of the most popular obesity treatment procedures worldwide. A type of bariatric surgery that restricts the volume of the stomach to 15-20% of its original size, the gastric sleeve is very effective at causing weight loss. Studies have shown that people can lose on average 20-35% of their total body weight (that’s 1/3 of a person!). We have been performing this operation since 2004.

How gastric sleeve surgery causes weight loss

The gastric sleeve itself does not make you lose weight. Instead, it is a tool to help restrict the amount of food you eat by affecting your hunger, stomach capacity and the rate at which you consume food. With a smaller stomach size patients have a feeling of satisfaction (satiation) or a sense that they have eaten enough (feeling ‘full’), after eating a much smaller quantity of food than usual.

Not only changing the way you consume food and the amount you can eat but removing part of the stomach alters the hormones released after eating; this prolongs appetite suppression between meals. If a patient uses their operation to eat healthy meals (i.e. low-energy) three times a day, they will use more energy than they consume and lose weight.

Effectiveness of gastric sleeve surgery in causing weight loss

Studies have shown that after two years, people with a sleeve gastrectomy experience 20-35% total body weight loss. It is impossible to predict precisely how much weight each person will lose as this depends on many factors, including chance, age, starting weight, medical illness, ability to exercise and resilience. In the end, most people get to a stage where they feel that further weight loss comes at the expense of too much effort and settle at a weight that more or less suits them.

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Am I a candidate for gastric sleeve surgery?

As with all weight loss surgeries, gastric sleeve surgery should only be performed on people with a BMI greater than 40, or those with a BMI over 35 with other medical co-morbidities such as diabetes or high blood pressure.

Occasionally patients with BMI under 35 may also undertake this operation; however, the balance between risk and benefit is harder to gauge. Patients who are lighter than this run the risk of losing weight but at the expense of complications that can make them worse off. Other weight loss therapies should have been tried beforehand but have been unsuccessful.

Patients with eating disorders such as binge eating or a nocturnal eating disorder, and patients who habitually graze or emotionally eat, need to seek treatments for these disorders as well, otherwise, the surgery will fail after being initially successful.

Gastric sleeve surgery is non-reversible, unlike the gastric band and gastric bypass, so should only be undertaken by well-motivated people with acceptable operating risks, who are committed to improving their health through substantial weight loss.

Candidates should be well informed about the effect the gastric sleeve will have on their lifestyle, by accepting advice on eating and exercise practices. Although the operation is permanent, the impact it has on eating and weight loss may not last, even if the side effects of surgery do (such as reflux).

Advantages of gastric sleeve surgery

  • Generally, the gastric sleeve requires a short hospital stay of 2–3 days, and patients find it OK to return to work by about two weeks.
  • The gastric sleeve allows certain important structures in the stomach such as the pyloric sphincter, to remain, thus the ‘dumping syndrome’ of the gastric bypass occurs less often.
  • As the gastric sleeve does not affect the small intestine, nutritional deficiencies are less likely; patients with diseases affecting the small intestine, such as Crohn’s disease, can be candidates for this procedure.
  • A patient is less likely to experience vomiting or bowel blockage because the stomach emptying into the small intestine remains the same.
  • As a large portion of the stomach is removed, they are less likely to have a stomach ulcer.
  • While the operative risks are similar to those of the gastric bypass procedure, there are lower risks of complications months or years after surgery

Drawbacks of gastric sleeve surgery

  • As with every surgery, this operation poses risks to the patient. However, the operation is invariably performed laparoscopically which means less chance of infection and much quicker recovery times. But of course, this can vary from case to case.
  • Patients can often suffer from issues with reflux following surgery; this usually will subside after a month or two, but each case is different. About 10% of patients will need ongoing treatment for reflux, and 2-3% will need surgical therapy for reflux or similar symptoms.
  • One of the main concerns is that this operation is non-reversible and doesn’t necessarily mean that you will have long-term weight loss without considerable diet and lifestyle changes. The majority of the excess weight should be lost within the first year as it’s rare for patients to lose much weight after this time. Weight can easily be regained if a patient’s diet and exercise regime aren’t correct. The stomach can stretch to a larger size following surgery.

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