Sleeve Gastrectomy
Because every patient's circumstances are different, OClinic offers a number of weightloss procedures to help you overcome obesity. All of our procedures include a comprehensive and ongoing aftercare program to help you achieve maximal results. The Sleeve Gastrectomy (also known as the Gastric Sleeve, or Tube Gastrectomy) is a relatively new procedure for weight loss. It involves the permanent removal of approximately 80% of the stomach, which is performed using surgical staplers. Like gastric banding, it is also performed laparoscopically, which keeps post-operative pain to a minimum and allows for a quick return to work and daily life.
As the size of the stomach is significantly reduced, patients feel full quickly and are satisfied by smaller meals. The sleeve gastrectomy has another important benefit- the part of the stomach that makes the hunger hormone Ghrelin is removed, which explains why patients commonly also notice a significant drop in their background hunger levels.
Because the stomach has to be divided, there are some additional risks over gastric banding. The main concern is that gastric fluid may leak through the staple line if there is not completely perfect healing, leading to peritonitis. (a condition similar to a perforated gastric ulcer or a ruptured appendix). Although this complication is not common (1-4%), it can be quite serious, and usually requires urgent treatment including re-operation to prevent further deterioration. Because of the potential seriousness of this risk, the minimum body mass index (BMI) required for the sleeve gastrectomy is higher than for gastric banding- Patients must have a minimum BMI of 40, or at least 35 if other medical conditions such as diabetes, sleep apnoea, polycystic ovary syndrome, high blood pressure are also present.
Also, because the procedure is still relatively new, long term data beyond 5 years is not yet available. Whilst the majority of patients with a sleeve gastrectomy do very well in the short and medium term, some obesity surgeons are concerned that the stomach sleeve may eventually stretch up in size which could lead to some weight being regained in the long term. Also, some patients may experience heartburn or reflux after the sleeve gastrectomy. In most cases this is generally mild, and can be well controlled by medication if necessary, and usually only affects patients who already had some heartburn beforehand. (In patients with significant pre-existing heartburn or a hiatus hernia, the gastric band might be a more suitable option as the gastric band itself seems to provide good reflux control)
The key advantages of sleeve gastrectomy however is that adjustments are not required, and the long term problems associated with the gastric band such as slippage, erosion or port issues are avoided completely. Follow-up appointments after the sleeve gastrectomy do not need to be as frequent- 3 monthly check ups in the first year, then annually thereafter is sufficient. Another advantage is that there are fewer dietary restrictions, and almost all food types (including bread and steak) can still be consumed as normal because there is no narrowing at the entrance to the stomach.
Althought the average weightloss overall is similar between the band and the sleeve, weight is usually lost more quickly after the sleeve gastrectomy. Also, the amount of weight lost seems to be more consistent and reliable, with fewer patients failing. This is because whilst the gastric band is very good at reducing hunger and allowing small meals to be satisfying, it relies more heavily on patients improving their dietary habits and lifestyle in order to achieve best results. Patients can still 'cheat' the band by having a lot of liquid/soft calories such as milkshakes or chocolates, which usually leads to poorer results. On the other hand, the sleeve gastrectomy is quite powerful, and really forces you to eat less because the new stomach is so small and will only allow a small amount of either food or drink to be consumed.
Like gastric banding, the sleeve gastrectomy is equally effective at improving the medical conditions that are associated with obesity, including type 2 diabetes, high blood pressure, sleep apnoea, polycystic ovaries, and high cholesterol. Patients also experience major improvement in their quality of life with more energy, self confidence, and greater physical agility.
Because of its excellent safety profile, proven track record, and reversability, the Gastric band remains our preferred procedure for most patients. The adjustability of the gastric band is also one of its advantages, as it means the level of restriction can be lessened if your circumstances change, such as falling pregnant. However the sleeve gastrectomy is a worthy alternative, and may be more suitable in some situations.
Sleeve Gastrectomy animation video.
(click here if the video does not play)
Want to see the real thing?!
(caution- contains real medical footage. viewer discretion advised)
Here is a real laparoscopic sleeve gastrectomy being performed on a male patient with a Body Mass Index of 49 who suffers from diabetes and high blood pressure. It was performed by Dr Craig Taylor at the Sydney Adventist Hospital in March 2010.
Just like the gastric band, the procedure is performed by keyhole (laparoscopic) surgery, involving 5 small incisions on the abdominal wall. This means that post-operative pain is significantly lessened, and recovery is more rapid.
The first step in the procedure involves separating the fat that is attached to the side of the stomach- this fat contains numerous blood vessels, which are sealed and divided by a specialised instrument called the Ligasure which allows this tissue to be divided without any blood loss.
The next step involves placing a temporary sizing tube inside the stomach via the mouth which will be used to calibrate the final size of the stomach sleeve. Here we have used a 32 french bougie tube. The staples are lined up along this tube and create the new smaller stomach. You might be suprised at how much smaller the new stomach is- it will now only hold about a cup full of food. This is why a very small meal will now feel filling and satisfying after surgery. Also notice the part of the stomach on the right hand side which is being removed- this removed part contains the cells that make the hunger hormone Ghrelin, which explains why patients feel much less hungry after surgery. As a result, the average patient will lose around 70% of their excess weight.
There are no vitamin or malnutrition risks, as everything that is eaten still passes through the gastrointestinal track in the normal way to be absorbed. Nothing is bypassed, and the small intestine is not altered in any way. The stomach capacity is simply reduced.
The main risk of this procedure is a leak from the staple line whilst it heals- this risk is between 1-4%. If a leak occurs, the patient will develop a fever and a rapid pulse rate. It is treated by controlling the leak with drains and using intravenous antibiotics. You may have noticed the staple line has been buttressed here by paper-like white strips called Seamguard which will dissolve within a few weeks- these strenghten the staple line and distribute the forces more evenly which helps reduce the risk of staple line complications.
This procedure took approximately 60 minutes, and the patient spent 3 nights recovering in hospital. He was back to work within 2 weeks and no complications occured.
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Sleeve Gastrectomy Fast Facts
| description | laparoscopic stomach stapling procedure which makes the stomach capacity smaller and removes Ghrelin hunger-hormone secreting cells |
| advantages | avoids prosthetic materials, no adjustments, slippage, erosion and port problems avoided, less intensive follow-up needed, less dietary restrictions |
| disadvantages | permanent and irreversible, effect cannot be adjusted, additional risks due to the staple line, long term performance still not known, heartburn in some patients |
| weight loss | 60-70% of the excess weight a person is carrying is lost within 12 months (faster than the gastric band but approximately same overall amount) |
| best suited to | patients with a BMI over 40, or over 35 with medical conditions that are caused by their weight. May be particularly suited to patients who live far away and would have difficulty returning for frequent adjustments. |
| best avoided in | high risk patients with extensive medical problems where the additional risk could be too dangerous, or patients who wish to have a potentially reversible procedure. |
| cost | $4950 with health insurance. click here for further details |
Click here to read about laparoscopic gastric banding
click here to read about costs
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