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Ask the Experts
The Gastric Sleeve has become the world’s most popular weight-loss surgery procedure and is carried out regularly delivering remarkable, life-improving results for patients.
Unlike a Gastric Bypass where food enters a small pouch and then passes straight into the small bowel, the route that food takes following a Sleeve Gastrectomy is the same as it took before surgery.
As the stomach is smaller, it is able to hold less and stretches more quickly to give a feeling of fullness and satisfaction. So patients who have had this procedure want to eat less and therefore lose weight.
What is a Gastric Sleeve?
The Gastric Sleeve (Laparoscopic Sleeve Gastrectomy) is the world’s fastest growing weight loss procedure.
The Gastric Sleeve is a simple concept. The surgeon accesses the abdomen laparoscopically (keyhole surgery) and cuts the stomach along its length and removes about 80%. After Sleeve surgery, the food you eat will still enter and exit the stomach in the same place as it did before (unlike the Gastric Bypass) but you’ll have a much smaller stomach.
The Sleeve helps you lose weight in two ways. It reduces the capacity of your stomach and it also changes the balance of hormones and proteins in the stomach. The change in gut hormones, including changes to GLP1, change and suppress appetite. For this reason Sleeve patients are expected to lose weight quickly.
It’s important to note that your weight loss isn’t directly related to the size of your remaining stomach. The change to gut hormones will facilitate weight loss whether you have a relatively ‘tight’ or ‘loose’ Sleeve.
Sleeve Gastrectomy is carried out laparoscopically (keyhole surgery) under general anaesthesia. Your surgeon will make about five small incisions in your belly. Through one of the incisions, he/she will insert a thin telescope connected to a tiny high-definition video camera. The camera will be connected to a TV screen in theatre which your surgeon will be looking at during the surgery. Through the other cuts, long thin instruments are introduced which your surgeon will use to perform the operation.
During this stomach-reduction surgery, your surgeon will divide and seal any blood vessels supplying the part of the stomach that will be removed.
He will then use a special surgical stapling device to surgically staple and seal your stomach using a calibration guide tube to measure the size of the stomach tube left behind. The surgeon then removes the bulk of your stomach (about 80%) permanently, leaving behind a thin banana-shaped stomach tube or ‘sleeve’, hence the name Sleeve Gastrectomy. No intestines are removed or bypassed during this procedure. The operation takes usually about one hour.
If you have tried to lose weight by eating healthier and exercising but these measures were not effective, then you might qualify to have a bariatric procedure to help you with your weight loss. In general, weight loss surgery could be an option for you if:
- Your body mass index (BMI) is 40 or higher or if your BMI is above 35 and you also suffer from obesity-related medical conditions which may improve with the surgery (e.g., diabetes, high blood pressure or sleep apnoea).
- Your BMI is greater than 30 (greater than BMI 27.5 if you are of Asian origin) and you have type 2 diabetes.
- You are committed to a healthy life after surgery by maintaining lifestyle and diet changes in the long term.
Sleeve Gastrectomy is an effective weight-loss surgery which reduces your weight and improves/resolves many of the obesity-related medical conditions you might have. It will also improve your ability to perform routine daily activities and can help improve your quality of life.
You surgeon might recommend Sleeve Gastrectomy to you if:
- Your BMI is less than 65 and you have a diet that doesn’t contain a large number of sugary foods. Gastric Sleeve in this situation could be done as primary surgery.
- Your BMI is > 65. Gastric sleeve, in this case, could be used as a first surgery to help you lose enough weight so you can then safely have a more extensive type of weight-loss surgery later on (usually about 12 months after the gastric sleeve operation).
- You are older or have other risk factors for surgery like heart, lung or liver problems. Sleeve Gastrectomy may be in this situation a safer choice for you than other longer and more complicated weight-loss surgeries.
Rarely, the decision to perform Sleeve Gastrectomy (instead of Gastric Bypass) is made during the operation. Reasons for making this decision include an excessively large liver or extensive scar tissue and bowel adhesions that would make the Gastric Bypass procedure too long or unsafe. If we think it’s likely that this might be necessary for you, we will explain this plan to you beforehand and ensure that you are happy to proceed on that basis.
Each clinic and surgeon have their own recommendations and requirements for the pre-surgery period. However, there are some general instructions common to all the bariatric patients.
- Quitting smoking; Smoking greatly increases the possibility of blood clots, pneumonia, infections. It also increases the risk of post-operative complications and slow healing.
- Following a Gastric Sleeve pre-op diet; Usually, 2-3 weeks before the surgery, patients start a high protein and low calories liver reducing diet which would reduce the fat accumulated around the liver.
- Organizing family life; Care after children, pets, making sure you have a person that would assist you for the first days after the operation.
- Quitting some medications; E.g. Aspirin based ones are forbidden, so patients need to discuss with the surgeon any meds they take.
Patients also ask what to take to the hospital for their Gastric Sleeve surgery? Each clinic has its own recommendations of course, but you should remember about all the preoperative paperwork and instructions, ID card or passport, a cell phone, toiletries and pyjamas.
The surgery gives a patient a perfect tool for losing weight, however, it is the aftercare and Gastric Sleeve recovery that play a key role in losing weight.
If everything heals properly, patients spend only 1-3 days in a hospital after surgery. Before leaving the hospital, the surgeon prescribes gastric tablets and pain medications and gives instructions for special post-op diet and exercises. It is important to start moving (even a slow walk is good) just after waking up in the hospital. Any activity will influence the recovery in a positive way and will speed it up.
Regarding the short-time recovery once back home, patients are recommended to take 3-4 weeks off. Of course, if the job is purely physical, this time should be longer. During this time, patients get used to the new lifestyle, follow a special diet, engage in light physical activity, take the prescribed meds and simply cope with all the changes in life.