The laparoscopic gastric sleeve can be performed safely with only a two night stay in hospital and rapid return to work.
Laparoscopic (“keyhole”) surgery and surgical staplers are used to remove part of the stomach. The sleeve gastrectomy doesn’t involve the insertion of any foreign bodies but rather is a refashioning by removal of a portion of the stomach using surgical staplers. This leaves the patient with a new stomach shaped as a narrow tube or “sleeve” that has a reduced capacity of 100 ml (half a cup). This is a 90% reduction in the volume of the stomach. This procedure has been performed in Australia since the mid 2000s and is conducted under general anaesthetic.
The size of the remaining stomach is gauged by a tube (measuring approximately 12.5 mm in diameter) which is passed through the stomach during the surgery. The cut edge of the stomach is then carefully sealed with a stapling device. Some surgeons place a stitch along the staple line or may reinforce it with buttressing material and synthetic glue.
How does it work?
The sleeve gastrectomy works mainly through restriction. Improved portion control and restriction is achieved through the 90% reduction in the volume of the stomach. The sleeve gastrectomy also results in less production of the appetite- regulating hormone, Ghelin. This may lessen your desire to eat.
What is achieved from the operation?
The initial weight loss after a sleeve gastrectomy is very impressive and it is quite common for patients to lose up to 70% of their excess weight in the first 2 years. The remnant stomach does stretch and patients find that after a time they are able to eat slightly more that what is experienced in the first 6 months after the surgery. This does tend to result in some weight regain from the lowest weight achieved. We find however that the majority of our patients are able to maintain 60 to 65% of excess weight loss out to at least 10 to 12 years.
Any operation to help with weight loss is only as effective as the lifestyle changes that go with it. Good food choices as well as regular exercise are still necessary. Remember that success with weight control is characterised by 3 small meals per day of lean source protein, low starch carbohydrate, adequate fruits and vegetables and aiming for keeping caloric intake below 1500 calories per day. The sleeve gastrectomy with reduced hunger and early satiety gives people a powerful tool to help with long term weight loss. It is unlike being on a diet.
What is life like with the sleeve gastrectomy?
Because the stomach is now only 10 to 15% of its original size, the patient feels full after a much smaller meal. Despite this a wide range of foods can still be eaten. It does not feel like you are on a diet. Some studies suggest that because the outer curve of the stomach is removed a hormone called ghrelin is produced in much smaller amounts and this may also assist in appetite reduction. However, this will not reduce the desire to eat when it is driven by emotions such as boredom, loneliness or social expectations.
As the stomach is mainly a storage facility and most of the nutrients are absorbed in the small intestine, nutrition should not generally be affected by a sleeve gastrectomy. So, because all the food that is eaten is absorbed normally, it is still important to choose healthy foods and avoid calorie dense foods.