Sleeve gastrectomy, also referred to as vertical sleeve, gastric sleeve or tube gastrectomy, is a surgical procedure performed for the treatment of obesity. The procedure is a restrictive bariatric surgery to treat extremely obese patients with a high BMI of 40 and above. It encourages weight loss by restricting the stomach size so it holds only a limited amount of food. This helps patients to eat less without hampering the normal digestive process.

Sometimes sleeve gastrectomy is carried out as a first stage of a 2-stage operation in extremely obese patients with a BMI of 60 or more. This is done to achieve a considerable amount of weight loss so it is safer for the patient to undergo a second bariatric surgery if needed.

Indications

As per IFSO-APC Consensus statements 2011.

• Bariatric surgery should be considered for the treatment of obesity for acceptable Asian candidates with BMI ≥ 35 with or without co-morbidities.
• Bariatric/GI metabolic surgery should be considered for the treatment of T2DM or metabolic syndrome for patients who are inadequately controlled by lifestyle alternations and medical treatment for acceptable Asian candidates with BMI ≥ 30
• The surgical approach may be considered as a non-primary alternative to treat inadequately controlled T2DM, or metabolic syndrome, for suitable Asian candidates with BMI ≥ 27.5.

Surgery:

The procedure is performed under general anaesthesia. The surgeon makes 2 to 5small incisions on your abdomen. A laparoscope, a thin instrument with a light and camera attached, is inserted through one incision, allowing your surgeon to clearly view the internal organs on a monitor.

Additional surgical instruments are inserted through the other incisions. Your surgeon will remove nearly 75-80% of the stomach. A thin sleeve shaped like a banana is created by stapling the remaining part of the stomach. At the end of the procedure, the incisions are closed with sutures. The entire procedure takes about 60 to 90 minutes to complete.

Advantages:

• Reduced stomach size makes you feel full sooner.
• Normal functions of the stomach are retained.
• Simpler than other bariatric surgeries.
• Can be performed laparoscopically
• Shorter hospitalization stay
• Less operative time
• Minimal post-operative pain and discomfort.
• Shorter recovery time

Disadvantages:

• Irreversible
• Need for second surgery in highly obese patients
• Exposure to surgical risks twice in the case of 2-stage procedures

Post-operative care:

Your doctor will prescribe pain relieving medications to keep you comfortable following the procedure.

• You will be advised to take medication to reduce the amount of acid produced by your stomach.
• Avoid strenuous exercises and lifting heavy weights until approved by your surgeon
• For the first month after the procedure, eat only small amounts of soft foods
• Sip water throughout the day to prevent dehydration.
• Eat a highly nutritious diet, rich in proteins with a low fat content.
• Your dietitian will tailor a new diet regimen for you to follow.

Risks and Complications

As with any surgery there are potential risks and complications involved. The risks include blood loss, infections, problems associated with anaesthesia, and deep vein thrombosis (blood clot in the leg).

The major complication following sleeve gastrectomy surgery is occasional leakage or breakdown of the gastric contents from the staple line that secures the divided stomach.