What is Sleeve Gastrectomy?
A sleeve or vertical gastrectomy is a procedure in which the majority of the stomach is removed, leaving behind a stomach tube. Although, the intestines are not bypassed some vitamin and protein supplements may be required after the operation due to some malabsorption of food and nutrients.
Sleeve gastrectomy is considered by some surgeons as a good option for overweight adolescents because:
- Short-term results suggest that sleeve gastrectomy is more effective than banding and nearly as good as gastric bypass and other surgeries.
- Because the intestine is NOT bypassed, the likelihood of having nutritional deficiencies and the life-long need for nutritional supplements is reduced. For the adolescent who is still growing, may get pregnant and has his/her whole life ahead of him/her, this is an attractive option.
- Sleeve gastrectomy doesn't "burn any bridges". If the procedure is NOT effective on its own at achieving adequate weight loss and treating other medical problems related to excess weight (e.g. diabetes, hypertension, liver disease), a second-stage operation can be added without significantly increasing the risk of the operation. In fact, the sleeve gastrectomy is the first part of the duodenal switch operation and it is often done in high-risk patients as a staged operation prior to gastric bypass. Many patients don't end up needing the second-stage operation because they achieve enough weight loss and improve their overall health with sleeve gastrectomy alone.
How does the sleeve gastrectomy work?
- It reduces the capacity of the stomach.
- It decreases production of a hormone (ghrelin) involved in stimulating appetite and likely has other hormonal effects.
- It improves emptying of the stomach. Patients describe having less hunger between meals and feel full sooner during meals.
- Sleeve gastrectomy also appears to significantly improve diabetes and other health problems, with the exception, perhaps, of dyslipidemias.
- Because the operation requires fewer connections between bowels, there is an overall lower risk of complications during one's lifetime.
- The long-term nutritional consequences are not well known for sleeve gastrectomy, but they are likely to be less than that with other weight-loss procedures because there is no significant malabsorption. Close follow-up is advised.
What are disadvantages of sleeve gastrectomy?
- The main disadvantage of sleeve gastrectomy is possible leaking. It is estimated to occur in less than 1 of every 100 patients undergoing the procedure and can be problematic. Some leaks can be treated with drains or simple surgical repair, but some will require stenting or more aggressive surgical therapy, including removal and bypass of the stomach. Narrowing of the stomach tube can also occur and this usually responds to dilator therapy with endoscopy. On occasion, reoperation is required. If a serious complication is noted at the time of surgery, sleeve gastrectomy becomes unsafe and a gastric bypass or other surgery is required.
- Patients with a BMI of greater than 50 or 60 may not achieve enough weight loss to "cure" their diabetes and other health problems. They may require an additional "malabsorptive" procedure to improve their overall health.
- There are no long-term (greater than 5 year) data available on the sleeve gastrectomy.
- Because a portion of the stomach is removed, it cannot be replaced; thus, the procedure is considered "non-reversible."
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