The Gastric Sleeve Surgery (or Vertical Sleeve Gastrectomy) is a bariatric procedure that removes 75-80% of the stomach. It is now the most commonly performed bariatric procedure in United States and worldwide.
Gastric Sleeve Surgery brings profound changes to life!
Overall improved quality of life
Excess weight loss of about 60-70% within one year of surgery
Remission or improvement of obesity related health conditions such as diabetes mellitus type II, hypertension, sleep apnea, fatty liver disease, joint pain, and hyperlipidemia
Desire to eat decreases
Reduction in hunger sensation
How Gastric Sleeve surgery is performed
1. Small incisions are made in the abdominal wall for the insertion of small trocars
2. The stomach is inspected and the blood vessels to the lateral side of stomach are divided
3. A Bougie tube is inserted into the stomach and serves as a sizer for the new stomach
4. The stapler is used to divide the stomach into two parts
5. Continuous firing of the stapler is used to divide the stomach
6. The stomach is completely divided into two parts
7. The new banana shaped stomach has about 20-25% of original stomach volume
There is a reduction in stomach volume, causing people to feel full much quicker after the surgery
Hormonal changes such as reduced secretion of hunger hormones cause people to feel less hungry
Increased stomach motility, which allows food to pass stomach and intestine quicker after surgery
History and Trend of the Gastric Sleeve
Initially, the Gastric Sleeve was the restrictive part of the biliopancreatic diversion duodenal switch operation. Then, the gastric sleeve became the first stage operation for very obese patients who underwent duodenal switch operation to reduce the perioperative risks. Some patients lost enough weight after the gastric sleeve surgery and did not undergo the planned second stage duodenal switch operation. These findings prompted bariatric surgeons to consider the gastric sleeve surgery as a standalone bariatric procedure. The first laparoscopic Gastric Sleeve was performed in 2000.
Over the past decade, the number of gastric sleeve surgeries continue to increase nearly every year. Now, more than half of all bariatric surgeries performed in US are gastric sleeve procedures.
Large clinical trials and studies have proven gastric sleeve surgery lead to resolution or improvement of many obesity related health problems such as:
Type 2 diabetes: Most studies indicated that 60-80% of patients with type 2 diabetes could achieve disease remission or improvement after gastric sleeve surgery
Hypertension
Fatty liver disease
High cholesterol
Sleep apnea
Decreased cancer risk
PCOS
Asthma
Migraine
Join pain
Depression and other psychosocial problems
Infertility
Low testosterone: Gastric sleeve can naturally lead to increased testosterone level
For patients with BMI of 30-34.9, insurance will not cover bariatric surgery procedures. However, we have self-pay options for those individuals who have struggled with obesity for a long time, especially those with obesity related health problems.
Discharge from hospital typically occurs after 1-2 nights
All patients are encouraged to walk as early as 3-4 hours after surgery
In general, the pain is easily manageable after surgery. Most patients take less than the recommended pain medication
Most patients go back to work and/or school after 2-4 weeks. Fatigue is common the first 2 weeks due to low calorie intake from liquid diet. However, the majority of patients do not feel hungry during this stage of the diet. The energy level improves quickly after the introduction of the soft diet, which is approximately 2 weeks after surgery. On occasion, we allow patients to work from home 2-3 days per week after surgery.
Patients can begin exercising 4 weeks after surgery
Over the past decade, with the improvement of surgical techniques and surgeons’ experience, the gastric sleeve has become an overall safe bariatric surgical procedure. However, complications can still occur during and after surgery. Below are the main complications and risks of the gastric sleeve surgery:
Leakage from the staple line – this is a rate but serious complication of the gastric sleeve surgery. The reported leak rate is between 0.7-3 percent. At UCLA, we pay paramount attention to our surgical techniques to minimize all the complications. At this point, we have never had a leak from the gastric sleeve surgery at UCLA.
Stricture/stenosis - In the past, we had one stricture among our first 20 gastric sleeve procedures. We have not had any strictures within the past 5 years.
Bleeding
Blood Clot
Heart Burn – This is a very controversial topic in bariatric surgery and the data from different centers is inconsistent. In our experience, most patients with heartburn before surgery see improvement of symptoms after surgery due to weight loss. Some patients may develop new heartburn, which is treatable with over-the-counter anti-acid medications, in most cases.
Nutrient or vitamin deficiency
Weight Regain – After 1-2 years, slight weight regain is common among all bariatric procedures and about 10-20% of patients can have significant weight regain after gastric sleeve surgery. After 5 years of follow up, many centers collected data to show that the majority of patients can maintain their weight loss after the Gastric Sleeve Surgery.
Excess skin, in some cases, insurance will cover excess skin removal
Day 1: Clear liquid diet. Some surgeons allow patients to drink water a few hours after surgery
Day 2-14: Full liquid diet including protein shakes, yogurt, broth, milk, and juice
Weeks 3-5: Soft food diet
Patients can begin introducing regular food 5 weeks after surgery. They are encouraged to eat a small amount of food each time and have meals that are more frequent.
All patients must take multi-vitamin and B complex after surgery
Comparison of Gastric Sleeve to other Types of Bariatric Procedures
Laparoscopic gastric banding (Lap-band) was once very popular. However, due to its high rate of long term complications and inferior weight loss, the number of Lap-band surgeries went down every year in the US and worldwide. Most of the US large academic Bariatric Surgery Centers rarely perform the Lap-band procedure at this time.
Laparoscopic Roux-en-Y Gastric Bypass Surgery is the gold standard of bariatric surgery. However, Gastric Sleeve has replaced the Gastric Bypass Surgery as the most popular bariatric surgery in recent years due to its technical simplicity and fewer long-term complication rates.
Advantage of Gastric Sleeve versus Gastric Bypass Surgery
Technically, the Gastric Sleeve is a much simpler surgery. The operating time for gastric sleeve is usually 40-70 minutes, while gastric bypass surgery takes approximately 2-3 hours to complete.
There is a much lower chance for nutrient or vitamin deficiency with the Gastric Sleeve procedure. In addition, there is no mal-absorption for Gastric Sleeve patients.
Some long-term complications could occur with the Gastric Bypass patients including bowel obstruction, marginal ulcer, and internal hernias. The chance of Gastric Sleeve patients developing these complications is exceedingly rare.
Gastric Sleeve Surgery Success Stories
Kallista's Story - Weight Loss Surgery: Gastric Sleeve*
