Sleeve Gastrectomy

The sleeve gastrectomy is a bariatric surgery procedure that aims at reducing weight. During a sleeve gastrectomy, the surgeons remove about 80% of your stomach to create a tube-shaped stomach. It limits your stomach size and restricts your food intake. Lesser calorie intake regulates your weight to a more healthy one.

Additionally, the surgery will initiate a lot of hormonal changes. These changes can ease health problems caused due to being overweight - diabetes or hypertension.

Alternate Name

Vertical sleeve gastrectomy

Body Location

A sleeve gastrectomy is performed on the stomach.

How is the Sleeve Gastrectomy Performed?

You will receive general anaesthesia before your surgery. General anaesthesia keeps you unconscious and numbed during surgery, so you do not feel anything. Sleeve gastrectomies can be performed with either large central incisions (traditional) or laparoscopy. Your surgeon will decide the approach depending on your specific conditions. Laparoscopic sleeve gastrectomies are more common in practice.

In a laparoscopic procedure, your surgeon will make small incisions at specific locations on your abdomen. They will then insert a camera and other instruments through these incisions to access your abdomen.

They will remove the larger, curved section of the stomach and will staple your stomach vertically to create a tube-like sleeve. Then the incision will be closed with a suture and bandage to promote healing.

Typically, a sleeve gastrectomy takes an hour or two. Following the surgery, you will stay in the recovery room, where the staff can observe you closely for any complications. Your surgeon may want you to stay in the hospital for a few days to manage your pain and any temporary effects. Once everything is stable, you can shift to the general ward for the rest of your hospital stay.

Why is it performed?

Sleeve gastrectomy reduces overweight and the risk of associated health conditions that can impact your quality of life. Common health problems associated with obesity that show significant improvement include:

• Diabetes
• Hypertension
• Risk of heart disease
• Hyperlipidaemia (High blood cholesterol levels)
• Obstructive sleep apnea
• Nonalcoholic fatty liver disease
• Arthritis
• Infertility

Preparations Required for the Surgery

Who can get the sleeve gastrectomy done

You qualify for a sleeve gastrectomy procedure only if you have tried conservative weight loss options, such as a healthy diet and regular exercise.

If your body mass index (BMI) exceeds 35, your doctor may prescribe sleeve gastrectomy as an option. You may also be a candidate for the surgery if you have obesity-related health conditions and your body mass index (BMI) ranges between 30 and 35. Some cases with a even lower BMI can also be a candidate for sleeve gastrectomy if you have severe health problems.

A sleeve gastrectomy involves the permanent removal of part of your stomach. Due to the irreversible nature of the procedure, you should be mindful of the permanent changes that will occur. You will have to lead a healthy lifestyle to ensure the surgery's efficacy. Ensure to get a proper follow-up to monitor your diet, lifestyle behaviour, and medical conditions.

Preparations before the surgery

After qualifying for the procedure, you will have to prepare for the surgery. The purpose is to ensure your surgery is successful. Before the surgery, you will receive counselling to mentally prepare you for all the changes you need to incorporate into your lifestyle and diet.

You will also have to restrict alcohol and tobacco use before the surgery. Your doctors will also recommend enrolling in an exercise program to get you physically ready for the surgery. The next step is restricting your diet. You may start the liquid diet about a couple of weeks before surgery. It helps reduce your abdominal fats, making the surgery safer.

The preparatory phase is the time to plan for your recovery care. You might want to arrange for some help around the house in advance. Your doctor will advise you to be nil-by-mouth 12 hours before your surgery. It means you should avoid eating or drinking anything before surgery. An empty stomach during surgery can prevent the severe consequences of having food or liquid left in your stomach.

Routine tests before the surgery

Underlying medical conditions can interfere with the success of any major surgery. Identifying them before the surgery can help in preventing any complications during and immediately after the surgery.

Before the surgery, your surgeon will advise you to perform certain tests that will establish your fitness level for the surgery. The tests include:

• Complete blood count
• Urine analysis
• A complete chemistry panel
• X-ray imaging of the chest
• ECG
• Cardiological evaluation including Echocardiogram
• Lung function tests
• Gastrointestinal evaluation
• Psychiatric evaluation
• Ultrasonography

Your surgeon will prescribe whether you need to do all these tests or only a few indicated ones. These tests are important as they can help identify potential complications and prepare to address them beforehand.

Procedure Type

Sleeve gastrectomy is an invasive surgical procedure.

Follow-up for Sleeve Gastrectomy

Your doctor will call you for multiple follow-ups for a few months after the weight loss surgery. You will also need blood tests and other examinations to ensure your body is healing and becoming healthy.

Ensure you are taking the following supplements

• Multivitamin supplements -
• Calcium supplements
• Vitamin B-12 supplements

As your body heals, there will be several after-effects. Typically in around six months after your weight loss surgery, you may experience:

• Fatigue
• Body aches
• Thinning of hair
• Dry, flaky skin
• Hair fall
• Fluctuations in mood

Risks of Sleeve Gastrectomy

Sleeve gastrectomies being a major surgery, do have potential complications. The short-term complications of sleeve gastrectomy are common in most abdominal surgeries. These include:

• Staple line leak though rare in Center of Excellences
• Dumping syndrome

Long-term risks and complications develop after the recovery. These complications are easily treatable in experienced centres.

Nutritional deficiencies are the most common complications of sleeve gastrectomies. The stomach is the primary organ for the absorption of vital nutrients such as vitamins.

Another chief complication is acid reflux. These problems may be present before the surgery and become worse. Due to the reduced stomach size, acid reflux can prove a recurrent complication.

Other long-term complications of sleeve gastrectomy include:

• Gastrointestinal obstruction
• Hernias
• Low blood sugar (hypoglycemia)
• Vomiting

Recovery for Sleeve Gastrectomy

You will be on a sugar-free liquid diet for the first seven days following your surgery. Pureed food is introduced after three weeks. You can slowly transition to regular food after a month following the surgery.

You will also be advised to start walking to help improve gut mobility and prevent complications post-surgery. Rehab for the lungs and limbs is advisable at the earliest following any abdominal surgery to reduce the risk factors and improve quality of life.