Sleeve Gastrectomy

What Is a Gastric Sleeve?

The gastric sleeve, also called sleeve gastrectomy, is a surgical method for weight reduction. 50% of patients undergoing adiposity surgery receive a gastric sleeve- with an upward trend. During this procedure, a large of the stomach (approx. 90%) is removed, and only a tubular residual stomach remains. This means that the patient can only eat small amounts of food, which usually results in massive weight loss.

The option of so-called "step concepts" is possible for patients suffering extreme forms of obesity (BMI over 50 kg/m²) or massive secondary diseases. This means the overweight patients receive a gastric sleeve in the first surgery to initially lose some weight. Then, a duodenal switch surgery can be carried out as a second step (also see: biliopancreatic diversion with duodenal switch), which results in more effective weight loss. The mortality risk can be reduced from 6% to 1% with this procedure when it is divided into two interventions.

Requirements for a Sleeve Gastrectomy?

The requirement for sleeve gastrectomy is that the structured, conservative therapy for weight reduction has been completely exhausted. Conservative therapy means nutrition, exercise and behavioral modification, and possibly psychological therapy.

The indication for surgical therapy is usually based on the patient’s BMI (body mass index). A surgical procedure should be discussed if conservative therapy fails, and the BMI exceeds 40 kg/m² or 35 kg/m² involving secondary diseases (e.g., diabetes,high blood pressure).

There is no standard procedure that is suitable for every patient. Therefore, it has to be checked individually for each patient which method (gastric banding, gastric bypass, gastric balloon) is the best one. The choice of procedure is influenced by the patient's BMI, age, gender, and secondary diseases.

What Causes Weight Reduction After Sleeve Gastrectomy?

Since the filling volume of the stomach is drastically reduced with this procedure, the patients feeling of satiety sets in quickly, and smaller amounts of food are consumed.

At the same time, the part of the stomach that produces the hormone "ghrelin" is removed during the surgery. This hormone triggers the feeling of hunger in the brain. As a result, patients feel less hungry in the beginning and suffer less frequent cravings for food.

Sleeve gastrectomy is carried out using the "keyhole technique." This results in fewer long-term complications due to large scars and less pain; the patients are fit again more quickly after the surgery.

Advantages of Sleeve Gastrectomy?

The stomach-filling volume is significantly reduced with the sleeve gastrectomy method so that only small amounts of food can be absorbed. After three years, an average of 66% of the overweight was lost, and 66% of diabetes caused by the overweight has receded.

The normal digestive tract remains intact during this procedure, which is why a lack of vitamins and minerals is very rare. However, as the gastric sleeve usually causes massive weight loss in a very short time, taking that vitamins and minerals is still recommended in consultation with the doctor.

The patients have a reduced feeling of hunger and less food craving due to the loss of the hormone ghrelin. Since the pylorus is preserved after sleeve gastrectomy, the patients do not develop a "dumping syndrome" after gastric bypass surgery, which leads to intolerance of foods with high sugar or fat content. Undergoing gastroscopy is still possible after sleeve gastrectomy.

Disadvantages of Sleeve-Gastrectomy?

When consuming high-calorie foods or liquids, weight reduction is not possible. Therefore, strict adherence to the recommended diet is essential for adequate weight loss. Good dietary advice, also concomitant after the procedure, is strongly recommended for the patients.

The sleeve gastrectomy method is a non-reversible surgery in which the stomach is permanently removed. Complications such as leakage or fistula formation are possible due to the stitches on the gastric sleeve. A sleeve gastrectomy is not suitable for overweight patients with severe pyrosis.

Chances of Success and Long-Term Experience with Sleeve Gastrectomy

Initially, sleeve gastrectomy was developed as a combined procedure before biliopancreatic diversion. Today, it is more and more used as an independent method, especially in high-risk patients. Since the sleeve gastrectomy method is a relatively new surgical procedure, there are unfortunately no meaningful long-term data available to date, and the final rating of this procedure is not possible, yet.

After the surgery, patients lose an average of 60-70% of their excess weight and mostly experience an improvement in the diseases caused by their overweight (such as diabetes, high blood pressure). The recovery of a good quality of life is possible through this surgery. Each of these patients requires lifelong follow-up treatment by a doctor or nutritionist experienced in obesity therapy to prevent possible deficiency symptoms.

Which Doctors and Clinics Are Specialists in Sleeve Gastrectomy?

Anyone thinking about a weight loss surgery wants the best medical care. Therefore, the patient is wondering where to find the best clinic for a sleeve gastrectomy.

As this question cannot be answered objectively, and a reliable doctor would never claim to be the best one, we can only rely on the doctor’s experience. The more obesity surgeries a doctor carries out, the more experienced he becomes in his specialty.

Specialists in sleeve gastrectomy are abdominal surgeons who have specialized in the field of obesity surgery. They are the right contact person for carrying out sleeve gastrectomy due to their experience and many years of medical practice as abdominal surgeons with a focus on bariatric surgery.

Sources

• Informationsbroschüre für Patienten über Adipositaschirurgie, Johnson&Johnson MEDICAL GmbH, Ethicon Endo-Surgery
• Adipositaschirurgie Indikation, Operationsverfahren und Erfolgsaussichten; Thomas P. Hüttl
• S3-Leitlinie Chirurgie der Adipositas, 2010