Sleeve Gastrectomy

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Sleeve Gastrectomy

Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 25% of original size by removing of the major curve of stomach. It can be performed with laparoscopic or robotic technique. The remaining stomach is like a sleeve or a banana. It is a restrictive procedure.

Technique

It is performed under general anesthesia. Five trocar technique is used. After identification of pylorus, greater omentum is divided by the aim of ultrasonic scalpel. Before dividing the stomach, anesthesiologist places a bougie to the stomach. Stomach is divided with a stapling device in guidance of the bougie. After controlling for bleeding and leakage, remaining stomach is stitched to the omentum. Divided stomach is taken out of the abdomen.

Advantages of Gastric Bypass Procedure?

• Normal gastrointestinal anatomy is preserved.
• Ghrelin (appetite hormone) is reduced and patient has less appetite.
• Operation time is short.
• Technique is simple.
• Hospital stay is short.
• No requirement for long life vitamin and mineral supplementations.
• No foreign body left in abdomen.
• Less chance of ulceration.
• No dumping syndrome.
• Accessible gastric lumen with endoscopy

Who is the candidate for Sleeve Gastrectomy?

• Age between 18-65 years
• Body mass index (BMI) of 40 or higher
• BMI of 35 or more and comorbidities like diabetes, hypertension, sleep apnea.
• BMI of 30 or more and serious comorbidity like diabetes and metabolic syndrome.
• Inability to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts.
• Enough physical condition to undergo general anesthesia

Who is not good candidate for Sleeve Gastrectomy?

People who are not candidates for Sleeve Gastrectomy include those who:
• Have other medical problems that make the surgery too risky
• Have unmanaged psychiatric issues
• Refuse to quit smoking
• Abuse drug or alcohol
• Are not ready for lifestyle changes
• Have untreated cancer
• Are pregnant or plan to become pregnant
• Have inflammatory bowel disease

Disadvantages of Gastric Bypass Procedure?

• The procedure is irreversible.
• Expected weight loss is lower compared to other bariatric procedures.

Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 25% of original size by removing of the major curve of stomach. It can be performed with laparoscopic or robotic technique. The remaining stomach is like a sleeve or a banana. It is a restrictive procedure.

Gastric bypass has historically been the most popular bariatric procedure. It is still widely accepted as the gold standard for bariatric procedure. This is preferred operation especially in patients with reflux. It causes food restriction and malabsorbtion. Unlike sleeve gastrectomy, stomach remains in abdomen. It is more effective compared with gastric banding and sleeve gastrectomy. But, it is a more complicated procedure and may cause malabsorbtion of some required nutrients such as calcium, iron, vitamin B12, vitamin D, vitamin B1, zinc.

It is simpler and takes lower time compared to Roux-n-Y gastric bypass. It is a popular procedure recently. It is an alternative procedure to the gastric bypass. Its complication rate is lower compared to bypass. It causes malabsorbtion and restriction of nutrients.

Someone in the world dies from complications associated with diabetes every 10 seconds. Diabetes is one of the top ten leading causes of deaths. Diabetics have health expenditures higher than non-diabetics. Approximately 90 percent of type 2 diabetes mellitus the most common form of diabetes, is attributable to excessive body fat. The prevalence of diabetes is 8.9 percent but more than 25 percent among individuals with severe obesity.

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