LAPAROSCOPIC SLEEVE GASTRECTOMY

ABOUT SLEEVE GASTRECTOMY SURGERY

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The sleeve gastrectomy is part of the biliopancreatic diversion with duodenal switch (BPDDS) weight loss operation. It is often used as a staging operation when it is not safe to do the entire operation at once. The sleeve was performed first to help the patient lose enough weight to make it safer to perform the rest of the DS operation at a later date. Many patients did not want the second part of the operation. They were happy with the weight loss from the sleeve operation alone.

Over the years, these patients were monitored and modifications to the sleeve gastrectomy surgery were made to improve its performance. In 2007 it was approved as an independent weight loss operation. Many insurance companies now cover the sleeve gastrectomy including United Healthcare, Aetna, Cigna, GEHA, Medicare, Medicaid, and Blue Cross Blue Shield.

SLEEVE GASTRECTOMY: REDUCING STOMACH SIZE

The laparoscopic sleeve gastrectomy is a restrictive operation, which means it works mostly by reducing the size of the stomach and thus your ability to eat large amounts of food at one time. The stomach size is reduced by about 80%. The part of the stomach that stretches most to accommodate more food is the part that is removed. The surgery does not alter the normal digestive process. Food absorption and digestion remain the same. About six months after surgery, the patient is able to eat about 4 ounces of food per meal, three to four times per day. The weight loss is projected to be 70% of the excess body weight, which is comparable to that of the Roux-en-Y gastric bypass. The weight loss is expected to occur over one to one and half years. Half of the expected weight loss is lost in the first six months after surgery.

The sleeve gastrectomy surgery is gaining popularity among weight loss surgeries. Its simplicity is likely its most attractive feature. It carries more risk than a Lap-Band operation, but less risk than a bypass operation. The risk mostly occurs because of the very long staple (cut) line. Staple lines can leak, infect, and bleed. Many doctors like this operation because it gives them an alternative to the bypass operation. The sleeve behaves a lot like the bypass operation in weight loss, diabetes control, and beneficial side effects. These help patients lose more weight than would have been expected from restriction alone.

The small stomach pouch is created by using stapling devices. Stapling devices cut and sew the stomach wall at the same time. A bougie is inserted into the stomach to ensure the sleeve is not too small or too large each time. The bougie is a long, smooth-tipped, flexible rubber, solid filled tube. The stapling device hugs the bougie while cutting the stomach. As a result, a perfect sleeve is created each time and approximately 80% of the stomach is removed. The lumen (diameter) of the new stomach is about the size of a thick yellow highlighter marker.

The operation restricts food intake very effectively, particularly during the first year, the time of maximum weight loss. Ultimately, a sleeve gastrectomy patient will be able to eat about half a cup of food per meal three times a day while experiencing prolonged satisfaction and fullness from that small amount of food. Portions, hunger, and cravings are controlled particularly well if the patient is compliant with the rules. This is a profound experience for many, being released from a prison of hunger. The average expected weight loss with the sleeve gastrectomy in the first year is comparable to that seen with the Roux-en-Y gastric bypass - about 70%. Many of our patients with proper education and good compliance to the rules can achieve even better weight loss.

Proceeding with weight loss surgery is a very personal and often difficult decision. Educating yourself about weight loss surgery is a very important first step. Although the information presented may be very helpful, patients have repeatedly told us that attending the weight loss surgery seminar was a vital first step. If you are ready to meet with the surgeon, schedule a first visit appointment by calling the office at 913-322-7401 or request a new patient appointment via our website.

For those of you who may be traveling large distances to visit us, please inform our staff you are traveling so they can prepare you better and help you minimize the number of trips that may be required to get you ready for your weight loss operation.

AM I A SLEEVE GASTRECTOMY CANDIDATE?

Supplied by BMI Calculator USA

To be a candidate for any type of weight loss surgery, the individual must be severely (BMI > 35) or morbidly (BMI > 40) obese. Morbid obesity is usually defined as being about 100 pounds over your ideal body weight. A better way of defining morbid obesity is by using the Body Mass Index (BMI).BMI is a calculated number that takes weight and height into consideration. A person weighing 300 pounds who is 5ft tall will have a higher BMI than a person weighing 300 pounds but is 6ft tall.

To determine if you qualify for sleeve gastrectomy, you can start by entering your weight and height into a BMI calculator.

Insurance companies often will have additional criteria to qualify for weight loss surgery. Our office can help you determine what those are. Below you will find the basic criteria most insurance companies use to determine if patients qualify for weight loss surgery:

A Body Mass Index (BMI) equal to or greater than 40, regardless if medical problems or co-morbidities are present or not.

A Body Mass Index (BMI) equal to or greater than 35 and experiencing severe negative health effects or co-morbidities, such as high blood pressure, diabetes, and/or sleep apnea.

HOW DOES THE SLEEVE GASTRECTOMY WORK?

The sleeve gastrectomy maintains the principles of restriction with several metabolic effects. The small and very narrow new stomach restricts food intake and helps maintain satiety. The size and narrowness of the stomach limit how much food you can comfortably eat at any one time. The longer the pouch is full, the longer you experience satiety and no hunger. The restriction in food intake is similar to that experienced by a bypass patient, ultimately about 4 ounces of food 3 to 4 times per day. This is a profound experience for many, being released from a prison of hunger. The success in keeping the weight off strongly relies on patient education and compliance with the rules.

Sleeve gastrectomy surgery alone without permanent lifestyle and eating habit changes will not ensure long-term success. Proper education and compliance with the rules are key to any patient's success. The operation and its metabolic effects to a significant degree will force many patients to change their eating habits but we do not want patients to rely on that solely. The sleeve is only a tool. A tool to significantly help patients with the necessary work to reach their health and weight loss goals. Attend the weight loss surgery seminar for more information about weight loss surgery.

WHAT CAN YOU EXPECT FROM THE SLEEVE GASTRECTOMY?

The medical and emotional benefits of the sleeve gastrectomy procedure begin almost immediately after surgery, and the cosmetic benefits follow their wake. Over time, the benefits of sleeve gastrectomy surgery may include:

  • Significant sustained weight loss

  • Portion control

  • Blood sugar levels that become completely normal or dramatically improved

  • Lower or normal blood pressure

  • Lower or normal cholesterol levels

  • Relief from sleep apnea, acid reflux, and urinary stress incontinence

  • Decreased joint pain and improved mobility

  • Increased energy and ability to exercise

  • Improved mood and self-esteem

  • Arrested progression of heart disease

  • Improvement of many lung conditions

  • Exercise endurance

  • Reduced need for medication

The co-morbidities of clinically severe obesity begin to resolve before complete weight loss occurs. These include better control or cure of diabetes; lowered or normalized blood pressure and cholesterol; relief from sleep apnea, severe acid reflux, and urinary stress incontinence; eased lower back, knee and hip pain. Patients also report enhanced mobility and increased stamina and endurance. Many conditions, such as evolving heart and pulmonary disease, have been arrested or its progression significantly slowed.

With the sleeve gastrectomy, patients lose around 70% of their excess weight within one to one and a half years. Half of that weight is lost in the first 6 months.

Example:

Patient X weight is 300 lbs, patient X ideal weight is 100 lbs, therefore patient X has 200 lbs of excess weight. If patient X chooses the sleeve gastrectomy that patient will lose a total of 140 lbs (70% x 200 lbs = 140lbs), 70 lbs of which the patient will lose in the first 6 months. Research is still in progress determining the sustained efficacy of weight loss with the sleeve gastrectomy after fifteen years.

RISKS OF THE SLEEVE GASTRECTOMY

As with all surgery, there are risks. Patients considering surgery must weigh the risks and benefits of surgery against the severity of their obesity. The decision to proceed is based on the premise that the treatment should be less harmful than the disease being treated. Complications can occur as with any type of surgery.

Below is a list of some general and specific complications that are unique to the sleeve gastrectomy procedure:

  • Leakage from a staple line causing infection

  • Spleen injury - requiring removal

  • Esophageal injury

  • Sleeve narrowing/stricture

  • Blood clots in legs

  • Pulmonary embolism (blood clot in the lung)

  • Inability to eat, or difficulty eating, certain foods

  • Development of gallstones or gallbladder disease

  • Inflammation of sleeve lining, sleeve ulcer

  • Weight gain (failure to lose satisfactory weight)

  • Instrumentation failure may or may not result in additional surgery

  • Pregnancy is not recommended during the first one and a half years of active weight loss

  • Other potential complications not included can also happen

  • Anemia, vitamin/mineral deficiency, protein malnutrition, temporary hair loss

Women are already at risk for osteoporosis particularly after menopause and should be aware of the potential for heightened bone calcium loss. All of the deficiencies mentioned above, however, can be easily prevented and managed through proper diet and vitamin supplements.

A chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 supplements.

Advantages 

  1. Restricts the amount of food the stomach can hold 

  2. Induces rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass. Weight loss of >50% for 3-5+ year data, and weight loss comparable to that of the bypass with maintenance of >50% 

  3. Requires no foreign objects (AGB), and no bypass or re-routing of the food stream (RYGB) 

  4. Involves a relatively short hospital stay of approximately 2 days 

  5. Causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve satiety 

Disadvantages 

  1. Is a non-reversible procedure 

  2. Has the potential for long-term vitamin deficiencies 

  3. Has a higher early complication rate than the AGB 

DECIDING ON THE SLEEVE GASTRECTOMY

The decision about which operation is best for you is a complicated one. The decision to proceed is based on the premise that the treatment should be less harmful than the disease being treated. Please read the obesity section of our website to learn about the disease, and the benefits weight loss surgery can offer to morbidly obese patients. Although the information presented throughout our website may be helpful, you will be able to learn substantially more about the benefits and risks of the sleeve gastrectomy operation during your visit with the bariatric surgeon.