Sleeve Gastrectomy is a surgical weight-loss procedure in which a large portion of the stomach along the greater curvature is removed. Stomach size is removed to about 15-20% of the original and the result is a “sleeve” or tube-like structure.
Sleeve gastrectomy is a relatively new procedure as it has been performed for the past 8-10 years. However, it has gained increasing popularity among surgeons worldwide because of its very low complication rate and excellent weight-loss results.
According to the American Society of Metabolic and Bariatric Surgery, more than 50% of all bariatric procedures performed in the US in 2014 were sleeve gastrectomies, which makes it the most popular weight-loss surgery.
How does sleeve gastrectomy work?
The efficacy and success of sleeve are attributed to two main factors:
- Sleeve gastrectomy is a primarily restrictive procedure. It dramatically reduces the size of the stomach and as a result, the amount of food that can be eaten at one time is also decreased. This means, that after eating a small amount of food, you will feel full very quickly.
- The procedure also causes a decrease in appetite by means of a hormonal mechanism. Ghrelin, a potent neuroendocrine factor, is considered by several recent studies as the “hunger hormone”. It is produced by cells that are found mainly in the fundus of the stomach. When the stomach is empty, ghrelin levels in the blood are high, thus signaling the brain (hunger and satiety center) that we are hungry. In sleeve gastrectomy, the fundus is removed resulting in a decrease of ghrelin levels in the blood. This explains the fact that after sleeve gastrectomy, patients commonly experience a long-lasting feeling of loss of appetite.
What are the advantages of sleeve over other weight-loss procedures?
The advantages of sleeve gastrectomy include:
- Excellent immediate and long-term results with average excess weight loss of 75-80% in the first year after the operation. Rate of weight loss decreases and reaches a plateau during the next 2-3 years. Results are similar to RYGB.
- Stomach function is preserved and the digestive pathways are not changed or bypassed as in RYGB.
- Risk of malnutrition and vitamin/mineral deficiencies is very low compared to RYGB.
- There is no need for continuous patient monitoring and lots of office visits for adjustments as in gastric banding.
- After sleeve, people usually stay in hospital for 1-2 days and return to everyday activities within 2-3 weeks.
- Complication rate is extremely low compared to both gastric banding and RYGB. Overall complication rate is estimated to 3-5%, including bleeding, sleeve narrowing/stricture and staple-line leakage.
- Except for the first 2 months after the operation, there are no lifetime dietary restrictions as in gastric banding. Patients may eat anything they enjoy, only in a small amount.
- There are no foreign bodies inserted, as in gastric banding. Therefore, there is nothing to slip, erode or cause infection in the body.
- It can be performed laparoscopically in superobese patients (BMI ≥55) who are at high risk for complications with respect to bariatric surgery as a first-step procedure. Later on, your surgeon may assist with further weight loss, if required, by doing RYGB.
Are there any disadvantages of sleeve?
A potential disadvantage of this procedure is that it is irreversible. Moreover, as it is a relatively new procedure, there is very little data concerning weight loss maintenance 15-20 years after the operation. In addition, sleeve is not recommended in sweet-eaters and patients with symptoms of GERD.