A sleeve gastrectomy, also known as gastric sleeve surgery, is a weight loss operation in which a thin vertical sleeve of stomach is created using a stapling device via keyhole surgery.
How does a sleeve gastrectomy aid weight loss?
The human stomach is a distensible pouch-shaped organ that can hold up to two litres. During a sleeve gastrectomy, the stomach is changed from a pouch to a thin, vertical sleeve using a stapling device. The newly-created gastric sleeve will only hold between 50ml and 150ml, and is about the size and shape of a banana.
The removed portion of the stomach, called the antrum, is also the part of the stomach that secretes many of the metabolically active gut hormones responsible for the neuro-hormonal response to food. Removing this portion can alter the body’s biochemical response to food, changing appetite and food preferences.
Despite being smaller, the stomach ‘sleeve’ still functions in a relatively normal manner:
- Food passes through the digestive tract in the usual order
- Acid continues to be made to assist digestion
- Vitamins and nutrients continue to be absorbed into the body
A sleeve gastrectomy allows you to eat much less, while still enjoying your food and feeling satisfied, by:
- Portion control:
The sleeve has a restrictive effect that allows you to feel full and satisfied with smaller meals, preventing overeating.
- Hunger control:
You feel less hungry in between meals. A sleeve gastrectomy not only reduces the stomach capacity, it also alters appetite by changing the patient’s biochemical response to food.
- Healthier food choices:
It changes the way the gut handles sugary and fatty foods, causing reduced desire for these foods and making healthier food choices easier.
- Altered metabolism:
It changes the blood levels of metabolically active gut hormones and affects the complex biochemical pathways regulating appetite and metabolism. This leads to changes in blood sugar metabolism, independent of weight loss.
How much weight can I expect to lose after a sleeve gastrectomy?
Patients typically lose between 65 to 70 per cent of their excess body weight. By comparison, non-surgical weight loss options achieve an average weight loss of 5 to 10 per cent.
The graph above depicts surgical weight loss (which is normally measured in percentage of excess weight lost) compared to medical weight loss (which is normally measured in percentage of initial weight lost). To accurately compare them, percentage excess weight lost has been converted to percentage of initial weight lost. Therefore the typical surgical weight loss result of 60-80% excess weight lost has been converted into almost 35% initial weight lost.
The best results are achieved when a multidisciplinary team supports patients though both surgical and lifestyle options.
Our patients have lost up to 100 per cent of their excess weight with our program.
What are the potential benefits of a sleeve gastrectomy?
It is one of the most effective weight loss procedures, with patients losing more weight after a sleeve gastrectomy than after a gastric band, and equal weight loss to that of a gastric bypass, with less risk of complications.
Sleeve gastrectomy effectively resolves obesity-related health problems including rapid resolution of Type 2 Diabetes in 80 per cent of patients by the time they are discharged from hospital, long before significant weight loss occurs. The results are equivalent to those seen after gastric bypass, with less risk of complications.
A sleeve gastrectomy has less follow-up appointments than a gastric band, and fewer potential post-operative problems than a gastric bypass.
- It is expected to cause fewer nutritional deficiencies than gastric bypass and therefore requires less frequent monitoring.
- Unlike a gastric band, a sleeve gastrectomy does not require follow-up appointments for adjustments.
- Patients are less likely to regain weight after a sleeve gastrectomy than a gastric band.
Typically, once a patient has recovered from a sleeve gastrectomy, there is minimal risk of potential complications. It can almost be called a ‘set and forget’ procedure.
What are the potential disadvantages of a sleeve gastrectomy?
Fewer patients develop complications after a sleeve gastrectomy than after gastric band or gastric bypass surgery. However, if complications do occur, they can potentially be difficult to fix.
In just one per cent of cases, a staple line leak occurs. Early detection and management is crucial for a fast and smooth recovery. In some cases however, the recovery time can be lengthy. A leak will typically present in the first two weeks post surgery. After this time, there are few potential complications from sleeve gastrectomy.
Severe pre-existing reflux and heartburn may not be well controlled by this procedure. In some cases, a gastric bypass may control these severe symptoms more effectively.
In comparison to gastric band and bypass, sleeve gastrectomy is a relatively new procedure and therefore there is limited long-term data about weight loss maintenance. Published results up to 10 years after gastric sleeve surgery show that up to a third of people have some weight regain a few years after a weight loss operation. Weight regain after a sleeve gastrectomy is comparable with gastric bypass. Fortunately, after a gastric sleeve or bypass, the patient’s weight does not return to previous levels. This is not the case with patients who choose a gastric band, where if the restriction provided by a gastric band is removed, the patient typically regains the weight and sometimes more.
Am I eligible for a sleeve gastrectomy?
The general requirements are:
- Your BMI is over 40
- Your BMI is over 35 and you already have one of the medical conditions associated with obesity
- Your BMI is over 30 and you have difficult to control Type 2 Diabetes and a higher risk of heart disease
- You do not have an underlying medical disorder or medication causing your weight problem
- Do not have serious oesophageal or gastric problems
- Are over 16 years of age
Living in, or traveling, remote locations does not exclude you from gastric sleeve surgery as it may with other weight loss procedures.
Who gets the best results from a sleeve gastrectomy?
A sleeve gastrectomy is the weight loss procedure of choice in Australia. It provides predictable, effective weight loss with resolution of obesity-related health problems, plus has a low risk of complications. A sleeve gastrectomy can also be performed as a revisional procedure in cases where a gastric band has become problematic or ineffective. For these reasons, the sleeve gastrectomy has become the most common weight loss procedure performed in Australia.
How will I recover after a sleeve gastrectomy?
Patients recover quickly after a sleeve gastrectomy and experience minimal pain as a result of laparoscopic, or ‘keyhole’, surgery.
Most patients can move around a few hours after a sleeve gastrectomy procedure. They can drink liquids the following day and are generally home only spend two or three nights in hospital. Most people feel well enough to perform gentle day-to-day activities within a few days, however we recommend taking one to two weeks off work.