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What is the Sleeve Gastrectomy?

gastric sleeve

The Sleeve Gastrectomy (also referred to as the Gastric Sleeve, Vertical Sleeve Gastrectomy, or VSG) is the most commonly performed weight loss procedure worldwide. It is also our most common procedure at OClinic, having performed over 3000 gastric sleeves. It involves significantly reducing gastric size by removing approximately 80% of the stomach organ, performed under a general anaesthetic using advanced laparoscopic keyhole surgery. It is very important that the sleeve is constructed properly, so the final shape of the gastric sleeve is consistent and even, without twists or narrowings; otherwise swallowing difficulties and reflux may develop. The other concern is staple line leakage, which studies show is less likely if your sleeve is performed by an experienced surgeon.

Although the physical size of the stomach is reduced, the normal direction of the food stream through the stomach and the rest of the intestinal tract is not altered. This means that all nutrients including vitamins, minerals and protein will continue to be absorbed in the small intestine normally. It simply reduces the holding capacity from about 1.5 litres of food and liquid to approximately 200mls. This allows a person to feel comfortably satisfied and full with a meal size approximately equivalent to a cup of food, such as a typical entree.

Typically, Sleeve Gastrectomy patients will have between 4-6 small meals per day, which is actually the ideal way to eat. Dietitians recommend small frequent meals as a way of avoiding big swings in Insulin levels and achieving a more even intake of calories as part of a healthier eating pattern.

How does it work?

The Sleeve Gastrectomy appears to work in three distinct ways:

  • Portion Control: The major reduction in stomach capacity allows patients to become full and satisfied with a much smaller meal. This sense of fullness is carried back to the brain along the Vagus nerves.
  • Hunger Reduction: As the removed part of the stomach is rich in cells that make a hunger hormone called Ghrelin, the circulating levels of Ghrelin are reduced considerably. Additionally, there is enhanced release of other gut hormones including GLP-1 and PYY after the sleeve that suppress appetite. As a result, patients report feeling less hungry after the sleeve gastrectomy.
  • Improved Metabolism: A number of other beneficial changes have been shown to occur after the sleeve, including improvement in the bowel bacteria balance (the gut microbiome), gut hormones, and bile acid concentrations. These beneficial effects may explain why weight loss after bariatric surgery is more durable and longer lasting than from dieting alone.

Am I eligible?

The Sleeve Gastrectomy procedure may be suitable if:

  • You have a BMI of at least 35 CHECK YOUR BMI
  • You have not been able to control your weight despite several genuine attempts at diet and exercise
  • Your weight problem is not directly the result of an underlying endocrinological disorder (such as Cushings Syndrome) or medication (such as long term prednisone use)
  • You are at least 16 years of age (no upper age limit)
  • You are prepared to participate in long term medical follow-up

If you also have Type 2 diabetes, high blood pressure, sleep apnoea, or other obesity related medical disorders, or have a family history of these problems, weight loss surgery may be especially beneficial in improving your health and longevity.

The Sleeve Gastrectomy procedure may not be possible if you have had some types of surgery on your stomach organ in the past. Examples of surgery that may make it inappropriate or impossible to have a Sleeve include anti-reflux surgery, or removal of part of your stomach organ to treat cancer or an ulcer. Please check with us if you have a history of any procedures on your stomach organ.

What are the risks of Gastric Sleeve?

Because the stomach itself has to be divided, there are some additional risks over Gastric Banding in the early post-operative period. One problem is that gastric fluid may leak through the staple line if healing along the staple line is not perfect. This causes infection around the outside of the Gastric Sleeve, and can be quite serious. Recovery may take several weeks, and treatment usually involves the use of antibiotics, endoscopic, radiological or surgical interventions, drains, and gut rest.

If leakage occurs, additional procedures such as re-operation or endoscopy may be needed. The risk of this complication in our experience is very rare (0.3%), but it may be suspected if a patient develops fevers and acute upper abdominal/back pain in the early postoperative period. Early treatment is the key to managing this problem successfully, so it is important to be on the watch for these symptoms and return back to the hospital without delay if concerns exist.

If you live outside Sydney, our preference is that you stay in Sydney for at least one week from the date of your surgery before returning home. This allows us to be able to treat you more quickly in the event of a complication. We have arrangements with our hospitals for extended accommodation in nearby apartments at very reasonable rates for you after hospital discharge if you require this.

Other complications that can occur include internal injuries, bleeding, blood clots in the leg veins, intestines or lungs, infections in the abdomen, chest or wounds, and allergic reactions to anaesthesia or medication. These problems may occur following any surgical procedure, and precautions are taken in all patients to reduce these risks to the absolute minimum.

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