Gastric sleeve surgery, also called a sleeve gastrectomy, is a procedure designed to induce weight loss. Originally, it was considered the first half of the gastric bypass, to reduce weight in patients who were too at risk for the whole bypass surgery. The longer obese patients are anesthetized, the more at-risk they are of heart failure and similar problems.
Since full gastric bypass surgery can take up to 3 ½ hours, surgeons split the procedure into two. First they would take away part of the stomach, and let weight loss drop to a safer rate for bypass surgery. However, when patients started returning to the hospital with their weight already vastly improved, gastric sleeve surgery became a stand-alone surgical procedure for inducing weight loss.
What Is Gastric Sleeve Surgery?
Gastric sleeve surgery is relatively new, but it makes up 60% of all weight loss surgery procedures performed. It is also much safer than gastric bypass surgery, with less than 1% resulting in serious complications within 30 days, compared to 1.25% for gastric bypass. Gastric sleeve surgery also has a 0.08% chance of resulting in mortality within 30 days, compared to 0.14% for gastric bypass surgery.
For this procedure, the larger, lower rounded portion of the stomach, about 85%, is removed altogether. The 15% left, about the size and shape of a banana, is neatly stapled shut. There is no attaching and reattaching of the digestive system, like what happens in gastric bypass surgery. As a result, there is little or no interruption of nutrient absorption by the stomach and intestines. All that happens is that the size of the stomach is extremely reduced.
How is Gastric Sleeve Surgery Different from Other Weight Loss Surgeries?
The two most well-known forms of bariatric (obesity-related) surgery, besides gastric sleeve surgery, are gastric bypass surgery, and gastric banding. These both predate gastric sleeve surgery, but do have some potential complications that the newer gastric sleeve surgery seeks to correct.
Gastric bypass surgery is probably the better-known procedure of the two. It is also the most effective for weight loss, since patients lose 40% of their Body Mass Index (BMI), compared to 30% for gastric sleeve and 20% for gastric banding. For this procedure, the larger part of the stomach is stapled so that nothing can enter, leaving only a walnut-sized pocket that can hold approximately 1 ounce of food. Because it is no longer connected to the small intestines, part of the small intestine is diverted to the pocket, so that less calories are absorbed and less food is eaten in general.
The second, gastric banding, involves a silicone band being wrapped around the stomach, squeezing until an average of 1 inch of space is left for food to enter. The stomach will not be able to hold more than an ounce of food, and usually the patient will simply cut down on eating because he or she feels full already. Although there is no direct puncturing of the stomach, there are sometimes complications because the silicone band is a foreign object.
Gastric sleeve surgery is highly preferable to gastric bypass surgery, because nutrient absorption is not interrupted. It is the small intestines that absorb the most nutrients from food. In gastric bypass surgery, it is the jejenum that is attached to the remaining pocket of stomach. This skips the duodenum altogether, which is the part of the small intestine that absorbs iron. Such interruption may lead to cases of malnutrition post-surgery.
The same is not true for gastric banding. Indeed, for both gastric banding and gastric sleeve surgery, there is no interruption of nutrient absorption post-surgery. Gastric banding has the advantage of being adjustable and reversible, and may be better used for early prevention of worse obesity. However, gastric banding also has the highest need for reoperations, at 15.3% compared to 7.7% for gastric bypass and just 1.5% for gastric sleeve surgery.
How Does Gastric Sleeve Surgery Cause Weight Loss?
With the size of the stomach reduced by much more than half, there is inevitably less space to put food away in. After the surgery, patients will discover that they become full even faster. If they follow their stomachs’ warnings, and do not eat enough to stretch them (which would make the surgery useless), it should be easy for patients to adjust to that new feeling, and quickly.
Taking away that much stomach, scientists discovered, also takes away ghrelin. It is the ‘hunger-producing hormone,’ that tells people that it is time to eat, or reminds them that they are still full. With a significantly lessened amount of ghrelin in their stomachs, gastric sleeve surgery patients not only get full faster, they do not get hungry as often. For those who need the rapid weight loss, this makes the changed lifestyle much easier to adapt to.
Who Needs Gastric Sleeve Surgery?
Like all surgical procedures designed to induce weight loss, there is no real substitute for healthy eating and adequate exercise. However, in some cases, there is real and urgent need for reduction of weight loss, especially when a second disease is involved.
Some of these cases include sleep apnea (when the breathing is hindered or stopped completely through a collapsed airway), type 2 diabetes (when cells are not as effective in turning sugar into energy), and heart disease. These three types both worsen and are worsened by obesity. However, it is not all of these who are instantly in need of surgery.
The point at which the last resort, surgery, becomes the only one is when a patient is morbidly obese and has a life-threatening obesity-related disease. Simply put, if the patient is carrying over 100 pounds excess of the ideal body weight, and his Body Mass Index (BMI), or weight in proportion to height, is over 35-40 (25 is the upper limit of normal), he may be too at-risk of health-related diseases to take the time needed to reduce weight through diet and exercise.
Preparing for Gastric Sleeve Surgery
Gastric sleeve surgery is just one step in the total lifestyle change that is weight loss, and this needs to begin even before the surgery itself. The earliest change that needs to be made is in the area of smoking, if the patient smokes. At least 30 days before the surgery date, patients need to completely quit smoking.
Smokers find themselves with a 53% more chance of serious heart and lung problems after surgery. They also have a 17% more chance of dying after surgery. Smoking makes it harder for the breathed-in anesthesia to have a natural effect, makes it 77% more likely that the patient will have a heart attack after surgery, and slows the healing process by cutting down on the oxygen in the body. Smokers need to preemptively find another habit or anxiety-reducing activity to calm their nerves before surgery.
Second, those planning to have gastric sleeve surgery should follow the surgeon’s prescribed pre-operation diet for at least 2 weeks before the operation date. It depends on what the surgeon suggests, but most of the time, the diet will be composed of mostly protein-rich foods and many, many liquids.
There are 2 reasons for this. First, the key to success in the surgery is to lower the risk of complications as much as is humanly possible. Changing the diet 2 weeks before surgery to a protein-rich, liquid-high system shrinks the liver, which lessens overall surgical complications. It also begins to lessen the overall fatty tissue, which makes surgery easier and less dangerous for both surgeon and patient.
Second, dieting 2 weeks before the surgery accustoms the patient to eating less, regularly, and with a lot of liquids. After gastric sleeve surgery, if the patient continues to eat anything and in as much quantities as he can consume, the remaining stomach will still eventually stretch to accommodate, and the gastric sleeve surgery will have been for nothing. The patient should also stop taking any extra medication, prescribed or non-prescribed, that the surgeon advises him to stop taking, a week before surgery.
Right before operation day, the patient should already be avoiding extra risky drinks such as alcohol (technically, abstaining from alcohol is part of the 2-week diet). The day before surgery, the patient should not eat anything solid after 8:00 pm. After midnight, he should completely stop eating and drinking between then and his surgery time.
Making the Gastric Sleeve Surgery Work
Normally, patients can return home within 2 days of the surgery, although they should take 2 to 3 weeks before attempting to go to work, and 4 to 6 weeks if they want to be in top form when they return. If they follow the prescribed diet, the weight loss will continue for 2 to 3 years after surgery. An average of 60% of the excess body weight is lost; at best, over 80% of the excess body weight is lost.
With a small stomach, even with the small intestines intact it is harder for the body to extract all the needed nutrients from whatever food is taken in. Since the patient will become full all the faster, the diet should be nutrient-rich so that whatever is eaten in hunger will be enough for sustenance. The week directly following surgery, only clear liquids can be taken in. This includes mineral water, decaffeinated tea, broth, and other similar drinks. The liquids will be comfortable to the stomach, and help the patient adjust to its size.
By week 2 the patient will still be on liquids, but he can have protein shakes. By week 3 soups enter the menu, as do scrambled eggs and cottage cheese. Week 4 moves to soft foods that are easy to digest, such as mashed potatoes, cereal, fish, and boiled chicken. By week 5 the diet is back to ‘normal’ foods–but in very small amounts by necessity. Only 3 meals should be taken a day, the diet should be protein-rich with lots of fruits and vegetables, and small, healthy snacks are permitted only when absolutely necessary.
Right after the surgery, the patient should begin to walk every day. In fact, prior to the surgery, getting into the habit of a daily walk would help the overall systems of the body. After the surgery, walking daily will help the healing. It should help reduce any pain, ease breathing problems, lessen muscle spasms, and allow free blood flow in the legs. Since the risk of any surgery is blood clotting in the legs, this is particularly important.
Possible Risks and Complications of Gastric Sleeve Surgery
Surgery, no matter how much the risk can be lessened, will always have its share of possible complications. First, since the patient will be anesthetized, there is an automatic risk of the patient having an allergic reaction to the medicine. There may also be breathing problems, especially if the patient was already suffering from sleep apnea. Since the patient cannot be woken up by the brain to recover air, the surgeon should be aware of the condition.
For surgery itself, even for laparoscopic surgery, there are still various risks. Laparoscopic surgery is when a series of small cuts to the abdomen is made instead of one large incision. There will still be the possibility of blood loss, getting a stroke or a heart attack while in surgery, and infections in internal organs or around the incisions. For gastric sleeve surgery in particular, the long line of staples closing the stomach may leak or become infected. There is also risk of gastritis, or inflamed stomach lining. If the patient does not hold to the prescribed diet, there is also risk of post-op malnutrition.
Gastric Sleeve Surgery: Best Option, Last Resort
With the lowest risk of need for reoperation and much better chances for survival and health than gastric bypass surgery, gastric sleeve surgery is emerging as a frontrunner in the field of bariatric surgery. With the correct pre- and post-surgery diet and lifestyle change, those who require this surgery for rapid weight loss may be assured that this is probably their best option with the highest possibility for weight loss success.