1) Will the weight loss last after gastric sleeve surgery?
The gastric sleeve surgery is a relatively new procedure and it is gaining rapid popularity worldwide. In the late 1980s and 1990s, surgeons started to do the sleeve gastrectomy as part of the duodenal switch operation. Over the years, surgeons noticed that gastric sleeve along caused significant weight loss itself. In the late 2000s and early 2010s, this procedure became more and more popular. Large datasets from many centers with more than 5 years of follow up after the surgery showed sustained weight loss.
2) What are the advantages of the gastric sleeve versus the gastric bypass surgery?
The main advantage of gastric sleeve surgery is that it doesn't need to create a new connection between the stomach and small bowel (anastomosis). The long term complication rate for gastric sleeve is lower than the gastric bypass surgery. There is almost no risk for internal hernia or marginal ulcer after gastric sleeve because there is no anastomosis. Those two complications can be seen after gastric bypass surgery. The chance of nutrient deficiency is also lower than gastric bypass surgery because there is no malabsorption.
3) Why wouldn't I be able to get the gastric sleeve?
For obese patients with esophageal dysmotility (cannot swallow easily) and gastroparesis (food stay in the stomach for too long time), the gastric bypass surgery is the preferred operation. Patients with severe Gastroesophageal Reflux Disease (GERD), especially those with Barrett's esophagus, also should have gastric bypass surgery. For patients with mild reflux, we don't think gastric sleeve is a contra-indication.
4) How can surgeons pull out a huge stomach from a small incision?
The stomach can be distended, or stretch, significantly after eating. Studies have shown that the human stomach can hold 2-4 liters (64-128 ounces) of food once distended. During the gastric sleeve operation, a tube is inserted from the mouth into the stomach and all the gas and liquids are removed to totally decompress the stomach. The removed part of the stomach (75-80% of total stomach) is totally decompressed and then can be pulled out from a very small incision. At UCLA, the largest incision we make for the gastric sleeve surgery is about 2-3 cm. Because we totally decompress the stomach during the procedure, we don't need to enlarge this incision in more than 95% of our cases. The small incisions significantly reduce the pain after surgery and the chance of getting a hernia later in life.
5) What is the trend of the gastric sleeve surgery in United States?
A study from the Cleveland Clinic showed that the sleeve gastrectomy has become more and more popular over the past a few year in United States. In 2010, it accounted for just 9.3 percent of procedures, while 58.4 percent were still the laparoscopic gastric bypass and 28.8 percent were gastric band (lap-band) procedures. By 2013, nearly half (49%) the procedures were sleeve gastrectomy, 43.8 percent were gastric bypass, and the number of gastric band procedures had plummeted to just 6 percent.
According to American Society for Metabolic and Bariatric Surgery (ASMBS), about 193,000 people had bariatric surgery in 2014. Sleeve gastrectomy was also found to be the most common procedure, accounting for 51.7 percent of weight-loss operations, followed by gastric bypass (26.8%), gastric band (9.5%), and biliopancreatic diversion with duodenal switch (0.4%).
6) How long will I be in the hospital after the gastric sleeve operation?
Most patients go home the day after surgery once they can drink enough to stay well hydrated. Because of the small incisions, the pain usually is well controlled with oral pain medications at home. Almost all the patients are expected to walk a few hours after gastric sleeve surgery and can start their clear liquid diet the morning after their surgery.
7) Will the gastric sleeve cause heart burn?
This is a very controversial topic. Some centers reported an increased incidence of Gastroesophageal Reflux Disease (GERD) after gastric sleeve surgery. However, other reports showed decreased incidence of GERD. Overall, the heart burn after gastric sleeve can usually be managed with antacid medications and lifestyle changes. Very rarely will surgeons have to convert the gastric sleeve to the Roux-en-Y gastric bypass surgery to treat the reflux (less than 1% in most reported series).
In our own experience, we feel that many of our patients reported decreased reflux after gastric sleeve surgery. From the reported literature, retained fundus (the upper part of stomach) is one of the reasons that patients develop reflux after gastric sleeve surgery. At UCLA, the surgeons pay meticulous attention to this part of the procedure to make sure that all the fundus of stomach is removed during the gastric sleeve surgery.
*Weight loss results can vary depending on the individual. There is no guarantee of specific results. Read full disclaimer >