The Sleeve Gastrectomy or aka Gastric Sleeve, is a relatively new procedure for weight loss. It involves the permanent removal of 80% of the stomach, performed under a General Anaesthetic using advanced keyhole (laparoscopic) surgery. Sounds a bit icky hey?
The sleeve procedure has emerged as an effective and safe form of weightloss surgery that compares very well against other established procedures such as the Gastric Band and the Gastric Bypass.
Although surgical staplers are used during the procedure, it is a very different operation to the old 'stomach stapling' procedure which was popular in the 1980's and 90's. In that procedure, the stomach was simply partitioned by staples, but no part of the stomach was actually removed. Over time, this partition was prone to opening up, restoring the stomach back to its original dimensions and leading to weight regain. The Sleeve Gastrectomy is a fundamentally different procedure in several ways; perhaps the most important difference is that the part of the stomach on the other side of the staple line is physically removed, eliminating the possibility of the 2 areas joining back up later. Another difference is that the Sleeve Gastrectomy is performed using keyhole (laparoscopic) surgery rather than by a major incision, so recovery is much faster and post-operative pain is minimal. Further advantages are that wound infections and hernias are virtually eliminated.
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 normally. It simply reduces the holding capacity from about 1.5 litres of food and liquid to approximately 250mls. This allows a person to feel comfortably satisfied and full with a meal size approximately equivalent to a cup of food. 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 healhier eating pattern. Despite being smaller, the stomach sleeve still functions normally- food and nutrients continue to enter and leave in the same way, acid continues to be made to assist in digestion, and essential vitamins and minerals such as B12, calcium, folate and iron can be absorbed normally.
The sleeve gastrectomy appears to work in 3 distinct ways. Firstly, the major reduction in stomach capacity allows patients to become full and satisfied with a much smaller meal, providing portion control. Secondly, levels of the hunger hormone Ghrelin are reduced by 50%, as the removed part of the stomach is rich in cells that make that hormone. Patients consistently report feeling less hungry between their meals as a result of this. Thirdly, there appears to be a change in way that fatty foods are handled by the digestive track- patients frequently report losing their taste for greasy foods, which seem to make them feel more bloated, unsettled, or queesy. Dietitians like this aspect of the Sleeve- it helps patients adopt healthier eating habits.
Another advantage is that there are generally fewer dietary restrictions as the entrance to the stomach is not narrow like a gastric band. Generally all types of food, including breads and steak, can usually be comfortably eaten, and eating quality maximises once the sleeve has settled in (Generally around 3-6 months after surgery).
Althought the average weightloss overall is similar between the band and the sleeve, weight is usually lost more quickly after the sleeve gastrectomy (typically the goal weight is reached within 9-12 months with a sleeve gastrectomy instead of 12-18 months with a gastric band). Also, the amount of weight lost seems to be more consistent and reliable, with the majority of patients achieving at least 50% loss of their excess weight. This is because the sleeve gastrectomy is more powerful, as it restricts the quantity of both liquid and solid calories, where as the band can easily be 'cheated' with liquid calories. Whilst the gastric band is very good at reducing hunger and allowing small meals to be satisfying, it relies more heavily on patients improving their dietary habits and lifestyle in order to achieve best results.
Info taken from OClinic http://oclinic.com.au/sleevegastrectomy.html
