Laparoscopic Gastric Sleeve / Sleeve Gastrectomy
What is sleeve gastrectomy?
Sleeve gastrectomy is a type of weight-loss surgery where the size of your stomach is reduced by removing the lateral 2/3rds of the stomach (approx. 75-85%) with a stapling device, shaping the remaining stomach into a tube or ‘sleeve’ so that you can only eat small meals.
The operation is done as a laparoscopic (keyhole) surgery procedure while you are asleep under a general anaesthetic. It usually takes one to two hours.
On average, patients tend to lose 50-60 % of their excess body weight with this procedure.
About the operation:
The laparoscopic sleeve gastrectomy is a relatively new operation that can be performed either as a standalone procedure, or as part of a staged operation for very large patients (BMI>60). In these patients, the second operation (a roux-en-Y gastric bypass) is then done several months later when the patient has lost a significant amount of weight and the risks associated with having further surgery is much less.
The operation involves dividing the stomach along its vertical length from top to bottom with a stapling device in order to create a slender pouch – ‘banana-shaped’ stomach along the inside curve. The pyloric valve (which regulates the emptying of the stomach into the small intestine) remains intact at the bottom of the stomach. The excess stomach is removed. The operation leads to limiting the amount of food ingested at any given time (restrictive operation), without altering the normal absorption of the vitamins and minerals.
What are the alternatives?
Other alternative surgical options are laparoscopic gastric banding or laparoscopic gastric bypass surgery.
Surgery is usually recommended only if non-surgical treatments, such as diet, exercise and medicines haven’t worked.
What are the advantages of having sleeve gastrectomy?
During the laparoscopic sleeve gastrectomy the nerves of the stomach and pylorus are not altered, preserving the function of the stomach.
The rest of the gastrointestinal tract anatomy is not altered, so the food ingested follows the normal course. This results in less chance of developing lack of vitamins and minerals and dumping syndrome.
The procedure decreases significantly the hunger by removing the part of the stomach that produces the main stimulating hormones.
Fewer clinic follow-ups than the laparoscopic gastric band, since there is no need for band size adjustments.
What are the risks?
Sleeve gastrectomy is generally a safe operation.
However, in order for you to make an informed decision and give consent for the operation, you need to be aware of the possible side-effects and the risk of complications of this procedure.
These are the unwanted, but mostly temporary effects of a successful treatment.
You are likely to have some bruising, pain and swelling of the skin around the healing wounds.
You may feel or be sick after eating, especially if you try to eat too much.
In the long term, your restricted diet may cause some shortage of nutrients like iron, calcium and vitamins, so you may need to take multivitamin/mineral tablets indefinitely.
This is when problems occur during or after the operation.
Most people will not experience any serious complications from this surgery.
As with any operation, there are risks associated with having a general anaesthetic. The possible complications include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT) or in the lungs (pulmonary emboli, PE). The risks increase for people who already have other medical conditions, such as heart disease or high blood pressure.
Some of the complications you may get after sleeve gastrectomy operation are listed here:
Infection - antibiotics are usually given during surgery to prevent infection.
Damage to other organs in your abdomen - you may need further surgery to repair any damage.
Staple line leak - the staple line along the stomach could leak in the first few days to a week and you may need further surgery to repair this.
Sleeve stricture or ulceration – the gastric ‘sleeve’ could narrow or form ulcers after surgery and you may need endoscopy with or without dilatation or further surgery to fix it.
Heartburn / reflux – there is a risk of worsening of your pre-existing symptoms or you may develop new symptoms of heartburn / reflux after surgery. These can be easily controlled with medication in the majority. However, some patients may need further surgery to control it.
Gallstones - there is a risk you may develop gallstones if you lose weight quickly. These can be painful and you may need surgery to remove them.
Failure to lose weight - it's possible you may fail to lose sufficient weight or regain weight you have lost after bypass surgery.
There is a chance your surgeon may need to convert your keyhole procedure to open surgery. This means making a bigger cut on your abdomen. This is only done if it's impossible to complete the operation safely using the keyhole technique.
The exact risks are specific to you and will differ for every person. Overall, there is a 5% risk of adverse effects (as listed above) and a 1 in 500 (0.2%) risk of death caused by having this operation.
How long does it take to get better from surgery?
You will normally need to stay in hospital for about two to three days after the operation. Full recovery from a sleeve gastrectomy can take two to three weeks.
Is the sleeve gastrectomy operation reversible?
The sleeve gastrectomy operation is considered to be a permanent weight-loss procedure.
This factsheet is for people who are planning to have sleeve gastrectomy, or who would like information about it. Although every effort is made to inform you on sleeve gastrectomy, there will be specific information that will not be discussed here. Also, your care will be adapted to meet your individual needs and may differ from what is described here.
Association for the Study of Obesity (ASO) 020 8503 2042 www.aso.org.uk
British Obesity Surgery Patients Association (BOSPA) 0845 602 0446 www.bospa.org