Laparoscopic sleeve gastrectomy

The sleeve has many other names:

Tube gastrectomy
Stomach stapling
Vertical sleeve gastrectomy
Vertical gastroplasty

They are all the same procedure

The Sleeve Gastrectomy involves removing around 80% of your stomach volume with a stapling device. It is usually done with keyhole surgery and offers success in weight loss through restriction. It basically leaves a stomach shaped like a tube or sleeve instead of a sack.

The residual stomach capacity is about 200mls or less. This has become the most common bariatric procedure done in Australia and is proving to offer a reliable amount of weight loss, when patients are able to follow the recommended diet afterwards.

It is very important to get the size and shape of sleeve consistent and even, without twists or narrowing. If this isn’t done right, leaks can be more common and patients can have problems with food passing through.

After this procedure, our patients feel satisfied after eating smaller meals, taking away many of the cravings or hunger signals that contribute to snacking and spontaneous food choices. Expected weight loss and metabolic control (treatment for diabetes etc) is not as great as the bypass, but still very good (around 65% excess weight).

Residual stomach capacity: 30-50mls
Estimated weight loss: 60-80% EWL over 2 years.

Advantages

  • Usually straight forward surgery

    often a better operation for those who are extremely obese (which may be as a staged approach
    Also often chosen by less obese patients

  • The amount of weight reduction is in the region of 60%-70% of excess weight lost over the first 1-2 years

  • It is a good option for people living in remote areas because it is a “set and forget” operation which requires less post op follow up
  • Malabsorption to nutrients is minimal as is dumping syndrome

  • Less impact on bowel habit; better for those with irritable bowel and other conditions associated with diarrhoea

Disadvantages

  • Restriction decreases over time that can account for weight regain

  • High pressure within the sleeve can cause reflux that can bring other problems and require more surgery

  • The unfortunate few who suffer a leak can take a long time to recover

How does it work

Everyone seems to talk about the sleeve being successful because it stops people from being able to eat a lot. This is true… but not the whole truth. Its actually a bit more complex than that:

  • Portion control; You will feel satisfied after a much smaller meal.
  • Less hunger: The removed part of stomach was making a lot of hormones that drive hunger. The main one is Ghrelin, and so there is much less of this “hunger hormone” produced after a sleeve. There are also some gut hormones that are made more after a sleeve that suppress appetite. People feel less hungry after a sleeve.
  • Better gut health: We find that many other factors of the gut are more balanced after a sleeve. These include the bacteria in the gut, the hormones and the concentration of bile acids

There are many neurohormonal and microbial aspects of the stomach and gut that are not completely understood. In the same way as food choices and portion size are but one aspect of cause for obesity, Restriction is an important part of the success from this operation but there are other factors as well.

What is the procedure like?

Most patients are in hospital for two nights (counting the night after surgery). We get you sipping water on the first day and very often this can be a challenge because there is spasm through the stomach. Because of this we support you with a drip that can usually stop after 24 hours.

On the second day you usually feel much better and so can be offered more nourishing fluids to drink. We will check your bloods and double check everything is ok before getting your paperwork done and getting you home. Occasionally people need to stay an extra night, and that’s ok too.

When you get home, you need to stick to a liquid diet for two weeks. Some people are asked to continue a blood thinner injection for two weeks (we will explain more about this if it is necessary). Your surgeon will contact you after you’ve been home for a couple of days to make sure everything is ok and will arrange to see you in clinic at about two weeks following surgery.

  • You must sip fluids constantly to avoid dehydration
  • You can’t eat and drink at the same time
  • Now you will take 4 6 small meals each day

Our expert staff will guide you through all of this, so it will be very clear by the time you need to know.

Complications are uncommon

  • Leak from staple line (and possible fistula) 1%
  • Bleeding 0.5%
  • Clots (to liver or lung) 1%
  • Infections 5%
  • Hernias 2%
  • Splenectomy 0.5%