The Gastric Sleeve: An Effective Weight Loss Surgery On Its Own or The Previous Step to A Gastric Bypass?

Nowadays, obesity can be considered a worldwide epidemic and a major cause of preventable death. So, trying to stay on your ideal weight goes beyond vanity; it is a matter of health.

If you’ve tried to lose weight through diets and exercise for years without success, maybe you could consider a gastric sleeve.

After all, it is the most popular weight-loss surgery worldwide. But since there are other bariatric procedures available, you may be confused about which one is right for you.

You must be aware of the risk and benefits of the gastric sleeve, how is the procedure, and the long-term commitments you need to make not to regain any weight.

What Is the Sleeve Gastrectomy?

A gastric sleeve is a type of weight-loss surgery that involves removing a large part of your stomach (nearly 80%) to reduce its original size. The result is a sleeve (hence the name) or tube-shaped stomach similar to a banana.

Your stomach will end up being much smaller than it was before. It will only hold about 50-100mL of fluid (the equivalent of a ½ cup of tea).

This restrictive method dramatically reduces the total amount of food you can eat. With a smaller stomach, you will feel full faster and with less food!

A gastric sleeve also produces hormonal changes, including less production of the appetite-regulating hormone called ghrelin so that you will feel less hungry. But, this surgical procedure will not affect the absorption of nutrients and calories in the intestines.

The weight loss mechanisms of a gastric sleeve rely on a combination of restriction, hormonal factors, eating habits, and changes in gastric emptying. However, gastric restriction plays the most important role. But even though the surgery is irreversible, there could be some dilation of the stomach afterward if you don’t follow your nutritionist’s instructions.

Sleeve gastrectomy is not for everyone. You must meet strict criteria to qualify as a candidate for a bariatric procedure.

Your body mass index (BMI) should be 40 or higher. But you could also be a candidate if your BMI is 35-39,9 with the presence of obesity-related conditions, such as hypertension, diabetes, fatty liver disease, or sleep apnea.

In recent years, sleeve gastrectomy has been gaining popularity as a bariatric procedure for adolescents with morbid-obesity comorbidities. Indeed, restriction procedures hold a low risk of nutritional complications because they don’t affect the food’s normal passage through the small intestine. Also, they have a less psychological impact and complications in this population.

The sleeve gastrectomy can also be an excellent choice for patients with a BMI greater than 40 but that refuse surgery.

Moreover, your doctor may recommend gastric sleeve surgery first. Some patients are too heavy for having gastric bypass surgery, or the risks are too high, so that it may be a good alternative. If this is your case, you’ll need to wait nearly a year and a half after your gastric sleeve surgery before having the gastric bypass. By then, you should have lost a lot of weight.

Gastric sleeve Surgey MSB

What Are the Benefits of a Gastric Sleeve?

Sleeve gastrectomy, and all bariatric procedures, are performed to help you lose excess weight and improve obesity-related medical conditions, such as type 2 diabetes, high blood pressure, asthma, obstructive sleep apnea, dyslipidemia, and arthritis.

A gastric sleeve can provide great long-term results. In fact, you could have approximately 60-86% EWL (excess weight loss) within two and five years. However, the total amount of weight you lose will depend on your change in lifestyle habits.

In some patients, the final weight loss may not be as significant as with gastric bypass, but it is undoubtedly faster than after a gastric band. This may be enough for many patients.

Also, you will lose weight more slowly than with a gastric bypass. In theory, you should keep losing weight in the next 2 to 3 years.

The Disadvantages of Having a Sleeve Gastrectomy

Remember that it’s possible not to lose enough weight or regain it after a gastric sleeve, especially after seven or more years.

To help avoid regaining weight, you must make changes in your diet and exercise regularly. You must take care of your gastric sleeve! Even though it is an irreversible surgery procedure, you could lose it.

There are other disadvantages, such as nausea and vomiting if you eat too quickly or too much. Also, there is the risk of developing gastritis, heartburn, or stomach ulcers. So, you will need to take proton pump inhibitors daily to reduce your stomach acidity.

A gastric sleeve may also worsen severe acid reflux if you have one already.

Following the procedure, some patients could present with depression. For that reason, psychological support is of the utmost importance during your bariatric journey.

Another side effect is insomnia. After the procedure, many patients can only sleep after taking sleeping medications, such as melatonin.

Sleeve Gastrectomy Vs. Gastric Bypass: Which One Is Better?

In many cases, sleeve gastrectomy can be as effective as gastric bypass surgery, including improvements in glucose levels before significant weight loss has occurred.

Indeed, sleeve gastrectomy is simpler than gastric bypass and has similar initial effects on diabetes. Also, you won’t suffer from malabsorption, so you are less likely to take vitamins in the future.

In terms of total body weight loss, you could place the gastric sleeve between the gastric band and the gastric bypass. Also, there is the option of having an endoscopic sleeve gastroplasty, which is a less invasive procedure and an improvement from the traditional gastric sleeve.

Of course, a gastric bypass procedure reduces the size of the stomach to 30ml. Hence, there is more potential to lose weight with a gastric bypass. However, in the end, how much weight you lose will depend on your lifestyle changes and not the procedure itself.

When choosing a bariatric procedure, you must consider your initial BMI, suitability, expectations, budget, and commitment to the process. Also, you may not have to choose between one or the other. A gastric bypass and a sleeve gastrectomy could complement each other in a two surgeries approach.

For that reason, you must put yourself in experienced hands and talk with your surgeon to make the right decision.

Before The Procedure

Before having a sleeve gastrectomy, you must pass a complete physical exam. Also, you will have blood exams, an ultrasound of your gallbladder, and other tests to ensure you are fit for surgery.

You may also need other evaluations to control and check other medical problems you may have, such as high blood pressure, type 2 diabetes, and heart or lung disease. The main goal is to get you to surgery in the best physical state possible.

Additionally, your doctor will put you on a calorie-controlled diet, low in fats and carbohydrates, to help you lose weight and reduce the size of your liver. This is important before surgery to make enough room for your surgeons to access the stomach.

Nutritional counseling is of the utmost importance, too, especially considering the dietary changes you will have to make. And a visit to the psychologist is also essential to make sure you are emotionally ready for this surgery.

Other general recommendations include stopping taking anti-inflammatory medications (ibuprofen-like) and blood thinners to reduce bleeding. Also, you should stop smoking several weeks before surgery to improve the healing process and diminish complications.

How Is the Sleeve Gastrectomy Performed?

Some gastric sleeves are performed using the traditional approach with large (open) incisions in the abdomen. But in most cases, sleeve gastrectomy is typically performed laparoscopically (aka keyhole surgery).

With laparoscopic surgery, your surgeon will insert tiny instruments, including a camera, through multiple small cuts in your upper abdomen. Don’t worry. You will receive general anaesthetic before your surgery begins and will be asleep through the whole process.

A harmless gas called carbon dioxide is pumped into your abdomen to expand it. This makes room for the surgeon to perform the procedure. Then, the surgeon creates a banana-shaped tube by stapling the stomach vertically. Most of the stomach is removed. Finally, the camera and surgical tools are removed, and the incisions are stitched closed. Surgery usually takes between 60 and 90 minutes.

How Is the Recovery After a Gastric Sleeve?

Depending on your recovery, you will stay in the hospital for one or two nights. After surgery, some pain and discomfort are normal, but you will receive appropriate painkillers.

The first week after surgery, you will be allowed to drink clear liquids, preferably sugar-free. Then, you will progress to pureed foods, and protein shakes for three to four weeks after surgery.

After the first month, you’ll switch to soft solid foods very slowly. Also, meal portions should be small to avoid stretching the sutures and the remaining stomach. After 2 or 3 months, you can try regular meals, following your nutritionist’s advice.

You should be able to return to work within one to three weeks of surgery and resume most activities between four to six weeks.

You will be required to take a multivitamin daily and have a vitamin B-12 injection once a month for life. Even though gastric sleeve surgery will not change how well the stomach can absorb food, it can impair the absorption of vitamin B12 and iron.

From the surgery on, you’ll have frequent medical check-ups to monitor your health status in the first months and then annual consultations.

Are There Any Complications After Gastric Sleeve Surgery?

After having surgery, you may experience nausea, vomiting, or constipation. Also, infection, bleeding, and blood clots may present.

The risk of blood clots can lead to complications such as DVT (deep vein thrombosis) and pulmonary embolisms. Hence, you will receive anti-clotting medication and will have to wear compression stockings.

There is also the risk of leaking from the staple line. This will require immediate surgery to fix it. And scarring inside your abdomen could lead to a blockage in your intestines in the future.

Life After Having a Gastric Sleeve

After having a gastric sleeve, you must change how you eat and start exercising. It truly is a journey to getting healthier.

Tips you must follow are:

  • Chew thoroughly before swallowing.
  • Don’t drink while you eat because it could cause your new stomach to overfill.
  • Avoid high-calorie sodas and snacking.
  • Eat small portions spread out during the day.
  • Take vitamin and mineral supplements every day.
  • Avoid getting pregnant for the first 18 months so your weight can stabilize.

After sleeve gastric surgery, it all comes down to eating healthy foods, controlling portion sizes, and exercising!

Dr. Eduard Targarona Specialist in Bariatric Surgery

Doctor Eduard Mª Targarona Soler

Specialist in Bariatric Surgery and Obesity Surgery.

Current President of the Spanish Association of Surgeons (AEC).

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    Other articles that may interest you – External links – Bibliography

    Laparoscopic sleeve gastrectomy: More than a restrictive bariatric surgery procedure? Benaiges D, Más-Lorenzo A, Goday A, Ramon JM, Chillarón JJ, Pedro-Botet J, Flores-Le Roux JA.World J Gastroenterol. 2015 Nov

    Quantification of gastric sleeve stenosis using endoscopic parameters and image analysis. Yu JX, Dolan RD, Bhalla S, Mazer L, Watts L, Schulman AR.Gastrointest Endosc. 2021 Jun;

    Mechanisms of Esophageal and Gastric Transit Following Sleeve Gastrectomy. Johari Y, Wickremasinghe A, Kiswandono P, Yue H, Ooi G, Laurie C, Hebbard G, Beech P, Yap K, Brown W, Burton P.Obes Surg. 2021 Feb

    Sleeve gastrectomy for treatment of delayed gastric emptying-indications, technique, and results. Lee AM, Fuchs KH, Varga G, Breithaupt W, Neki K, Broderick R, Horgan S.Langenbecks Arch Surg. 2020 Feb

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