Laparoscopic Sleeve Gastrectomy

Written by Ali Zarrouk on 09 January 2014.

Sleeve Gastrectomy (also called Vertical Sleeve Gastrectomy) is a relatively new procedure. It has been gaining popularity since 2005 and is quickly becoming the most commonly performed weight-loss operation.

How is Sleeve Gastrectomy done?

The operation is done laparoscopically. The outer part of the stomach ( about 80% of the stomach) is permanently removed lengthwise along the long axis of the stomach. The stomach is thus converted from a large sac into a narrow banana-like tube. The stomach volume is reduced from nearly 2 Liters to 100-200 mL only. This results in feeling full and satisfied after a small meal.

How does Sleeve Gastrectomy work?

Sleeve gastrectomy works in several ways to help reduce weight.

Sleeve gastrecotmy is a restrictive operation. By reducing the size of the stomach, it produces satiety (feeling full) after a small meal.
Sleeve gastrectomy is also a metabolic operation. It recaliberates the neuro-hormonal pathways the body uses to regulate weight and appetite. There is a hormone called Ghrelin that is produced by the fundus of the stomach (part of the stomach that is removed during the sleeve operation). This hormone stimulates another hormone called Neuorpeptide Y (NPY). NPY stimulates the appetite and tells the body to store fat. With less Ghrelin being manufactured there is less production of NPY and thus less hungar feeling and fat storage.

Many view the sleeve gastrectomy as a hybrid operation combining the best features of gastric bypass and gastric banding.

What is the expected weight loss after Sleeve Gastrecotmy?

Weight loss is achieved in approximately 12 months and patients tend to lose around 60% of their excess weight during that time ¹*. (* Results may vary from person to person). The weight loss is very similar to that of a gastric bypass but occurs a bit faster. Since it is relatively a new procedure there are not many long term follow-up studies.

What to expect after sleeve gastrecomy?

Hospital stay is around 2-3 days. Patients often have nausea after the operation but this goes away within few days. In addition, patients often notice chest pain if they drink quickly. This gets better within few weeks as the body adjust to the fact that there is no more big stomach to push fluid and food into. Within few weeks patients are able to eat most food without difficulty.

Advantages of Sleeve Gastrectomy

Effective weight loss for most patients and improvement in many obesity-related health conditions
Normal food can still be eaten
No sensation of obstructed eating
Reduces hungar sensation by removing the source of ghrelin hormone ( a hungar hormone)
No or minimal dumping syndrome
No malabosorption of vitamins and minerals
Safer option for the super obese. Sleeve gastrectomy can be used as the only weight loss operation or as a first stage to gastric bypass or other obesity surgery.
Improvement or resolution of diabetes in 80-90%
Improvement or resolution of hypertension in 80%
Improvement or resolution of hypercholestrolaemia in 80%
Resolution of obstructed sleep apnea in 95%

Disadvantages of Sleeve Gastrectomy

Cutting and stapling of the stomach is required. This can lead to early complications like leaks and bleeding from the staple line. Leaks are rare (1-2%) but serious complications.
Non-reversible.
Long-term outcomes are not certain as it is a relatively new procedure.
Concerns about stomach tube dilatation long term.

Sleeve Gastrecotmy and Gastro-Oesophageal Reflux Disease (GORD)

Some patients complain of mild reflux after the sleeve gastrectomy and patients on reflux prior to the operation may notice that their symptoms to worsen after surgery. This tends to improve and hopefully resolve after few weeks as patients' weight drop. Patients with severe reflux before the procedure should consider other weight loss operation such as gastric by-pass.

Sleeve gastrectomy compared to gastric banding

Compared to gastric banding in sleeve gastrectomy the whole gastric tube fills when eating so patients feel naturally full rather than obstructed. Patients are able to tolerate food items not tolerated with gastric banding e.g. bread, meat and fruits. Thus sleeve gastrectomy allows patients to eat a healthy normal day to day diet. Other advantages include more rapid weight loss, there is no foreign body, no adjustments, and a greater end weight loss. The disadvantages are that it is irreversible, and has a higher upfront surgical risk.

Sleeve gastrectomy compared to gastric bypass

Compared to gastric bypass there is no alteration in gut continuity and thus no small bowel obstruction, no ulcers and no malabsorption and micronutrient problems. This is at the expense of a slightly lower overall weight loss and the lack of data about long term success of the sleeve gastrectomy.

Other Names for Sleeve Gastrecotmy found in literture and on the internet

Vertical Sleeve Gastrectomy (VSG)
Sleeve Procedure
Sleeve Operation
Greater Curve Gastrectomy
The Sleeve
Vertical Gastroplasty
Vertical Sleeve Gastroplasty
The Sleeve Gastrectomy
Stomach Sleeve Operation
Stomach Sleeve Resection
Gastro Sleeve
Vertical Gastrectomy
Stomach or Gastric Stapeling (inaccurate name referring to an older differnt operation)