The gastric sleeve began as the second part of a two-part procedure known as a duodenal switch. The gastric sleeve was performed on extremely obese patients because it was seen as a safer primary-stage procedure before modifying the small intestine with the DS. However, as time went on, it became clear that the gastric sleeve had excellent results as a standalone procedure. This led to the gastric sleeve being considered, and ultimately approved, as a major bariatric option in and of itself.
Gastric sleeve surgery is currently the most popular bariatric surgical procedure in the United States. There is a very good reason for this popularity – its simplicity. It is both a straightforward procedure, but also a very effective one.
The gastric sleeve is purely restrictive, meaning that it simply reduces the size of the stomach, limiting the number of calories that can be consumed at any given meal, unlike the gastric bypass which includes a malabsorptive component (bypassing the intestine).
But the gastric sleeve also provides a hormonal weight loss benefit. Due to the way the gastric sleeve is performed, ghrelin, a hunger hormone secreted from the fundus of the stomach, is significantly reduced, and most patients experience a reduction in hunger.
How it works
The sleeve is performed under general anesthesia and usually in a hospital setting. Four-to-five small incisions are made in the abdomen. This is known as laparoscopic, or minimally invasive, surgery and replaces traditional open surgery that required a single, long incision to access the abdominal cavity. The abdomen is inflated with carbon dioxide gas to allow Dr. Higa enough space to perform the surgery. Then, specially-made medical devices are passed through trocars, which are used to protect the skin around the incision and act as passageways into the abdomen. If robotic surgery is employed, the robot is docked next to the patient and appropriate devices are attached to its arms.
Dr. Higa passes a device known as a French bougie through the throat and into the stomach. This allows him to accurately determine how much stomach should be cut away during the procedure. Using an advanced stapling device with multiple rows of staples, Dr. Higa will slowly separate the stomach in two. What remains is about a quarter of the size of the original stomach retaining the general shape of a sleeve or banana. The upper and lower parts of the GI tract are left untouched.
Benefits and expectations of the gastric sleeve
- More generally, the technique used to perform the gastric sleeve – laparoscopy – leads to far fewer complications after surgery when compared to a large open incision. The risk of blood loss, infection, pain, nerve involvement and incisional hernia are all significantly reduced.
- Patients will lose a significant amount of excess weight as long as they follow their postoperative bariatric lifestyle requirements, including improved diet and exercise. Patients can expect to lose between 60 and 80% of their excess body weight
- Even more important than the weight loss itself is the disease resolution that is associated with the gastric sleeve. Patients often see an improvement or complete resolution of type two diabetes, high cholesterol, high blood pressure, sleep apnea and more within weeks of having the procedure, and these results are long-lasting.
- Gastric sleeve patients will have a more liberal and less restrictive diet then gastric bypass patients. The likelihood of dumping syndrome is virtually eliminated.
- As mentioned above, the primary production center of hunger hormones, the fundus, is removed during the procedure and a significant number of patients will feel less hungry after surgery.
Risks and Considerations
- As with any surgical procedure, there are risks inherent to surgery. These may include a reaction to anesthesia, infection of the wound sites, pain, blood loss, and very rarely, death.
- Interestingly, some patients experience new or worsened Gastroesophageal Reflux Disease or GERD after a gastric sleeve. If a hiatal hernia is present and remains uncorrected, this risk increases dramatically. Typically, however, Dr. Higa repairs a hiatal hernia at the same time as performing the sleeve.
- Rarely, the staple line used to divide the stomach can leak, causing an infection in the abdomen and requiring a surgical procedure to correct. Dr. Higa minimizes this possibility with certain safeguards.
- Patient will require a daily multivitamin and may find themselves deficient in certain vitamins and nutrients. However, the risk of this is much lower than in gastric bypass patients.
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The bottom line: the gastric sleeve is a straightforward and effective procedure that not only offers excellent potential for weight loss, but also has fantastic disease improvement and resolution results. Patients should know, however, that the gastric sleeve is not a magic bullet and, just like any procedure, requires a great deal of dedication from the patient to achieve the best results. To learn more about the gastric sleeve, we encourage you to watch our online seminar or to visit Dr. Higa for a consultation.