Weight loss surgery – Sleeve gastrectomy

It works in two ways, firstly, the stomach is much smaller and therefore the patient feels full quickly after a small amount of food.  This is quite profound initially and gradually improves with time so that eventually patients can eat small amounts of most things.

The second mechanism of action is that it lowers the production of Grehlin, a hormone that makes the patient feel hungry.  This is produced by special cells in the fundus (top part) of the stomach which is removed by the surgery.  So, as well as feeling full quickly after eating, the patient also feels less hungry all the time.  This affect may wear off with time.  It is therefore essentially a restrictive operation.

The operation is usually performed with keyhole (laparoscopic surgery) and takes approximately one hour to perform.  Most patients are in hospital for two nights, but occasionally three is necessary depending on oral intake.

The major operative risks of sleeve gastrectomy is leakage (1-2%) or bleeding (<1%) from the staple line.  To reduce the risk of these occurring, the surgeons at VBSC over sew the staple line with continuous stitch and the whole staple line is prayed with tissue glue.  At the end of the procedure, the staple line is tested for leakage and this is also confirmed the next day with an x-ray.

Advantages:

The perceived advantages of sleeve gastrectomy, particularly over gastric banding are:

1.  The ability to eat a broader range of food.  Most patients can eat most foods after sleeve gastrectomy (small amounts, but most things).  The gastro-intestinal quality of life is therefore perceived to be better.
2. There is a lower rate of revisional surgery after sleeve gastrectomy (2.5%) than lapband (30%).  The reasons for band revision have already been outlined in the relevant document, but for sleeves revision may be necessary long-term because of intractable reflux, gastric stricture (narrowing) or weight regain (as for any weight loss operation).
3. Better overall weight loss achieved.  We have been performing sleeves for over 12 years and most patients have maintained adequate weight loss over that period. 

Disadvantages:

The disadvantage of a sleeve in comparison to a lapband is its slightly higher operative risk due to the possibility of leaks

In comparison to a Bypass operation, weight loss and operative risk are similar for Sleeves, but there are fewer long-term complications with Sleeves than Bypass and Revision Surgery, when necessary is earlier to perform.  The disadvantage of Sleeves in comparison to Bypass is the incidence of reflux after Sleeve Gastrectomy which can occasionally lead to conversion to Bypass.  As state previously, overall revision rate for sleeves is only 2.5%, so this is rarely necessary in our experience.

This document needs to be read in conjunction with the Royal Australasian College of Surgeons booklet on obesity surgery, and particular note needs to be made of post-operative symptoms you might experience after discharge about which you should contact your surgeon or go to the nearest Emergency Department. Please note your surgeons after hours Emergency number.