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Gastric Sleeve

Gastric Sleeve

What is a gastric Sleeve?

As can be seen from the image opposite, the operation requires complete removal of around 80% of the body of the stomach. This is done using a special instrument which cuts and staples at the same time.  What remains of the stomach has the appearance of a sleeve – or perhaps more accurately a banana.  This is done under a general anaesthetic using keyhole surgery and takes around 1-1.5 hours to complete. A key advantage is that, unlike gastric bypass, with a sleeve gastrectomy the food you eat enters and leaves the stomach in the same way it did before surgery.

Health Benefits of the Sleeve
  • Reduced risk of heart attack and stroke (due to lower blood pressure and cholesterol levels)
  • Type 2 diabetes – complete resolution or major improvement in the majority of Type 2 diabetics
  • Sleep apnoea – resolution or marked improvement in snoring, daytime sleepiness and fatigue
  • Back and joint pain – most sleeve patients experience dramatic reductions in back and joint pain and markedly improved mobility
  • Stress incontinence – is common in female patients who can expect significant improvement or complete resolution of symptoms
  • Infertility and PCOS – most patients with polycystic ovarian syndrome (PCOS) experience correction of underlying hormonal problems and restored fertility
  • Fatty liver – 80% of patients will have complete resolution of obesity-associated fatty liver disease
  • Psychological wellbeing – reduced depressive symptoms and anxiety, improved social interaction and overall quality of life.
How much weight will I lose?
Short term
  • Initial weight loss with a sleeve is high – in some studies as high as 75% of excess weight.  This is one of the reasons why the sleeve has become so popular; it appears to offer dramatic weight loss relatively easily and, unlike the gastric band, it seems to require minimal follow-up. However, the longer-term results are not quite so optimistic.
Longer term
  • Despite the dramatic early weight loss, longer-term results with the sleeve show a pattern of weight regain over time.
  • For example, in one study, excess weight loss at 1-year was 71% but fell to 53% at 10-years.  In another published trial, excess weight loss at 1, 3,5 and 8-years, was 72, 86, 63 and 52%.
  • Why does this weight regain occur?  It’s probably a combination of stretching of the gastric remnant (the 20% of stomach that remains after surgery), poor dietary habits and a return of the appetite due to increasing ghrelin levels.
Risks of the sleeve

The sleeve gastrectomy is the riskiest of the available surgical weight loss procedures.
The three main risks (two post-surgical and the third a later complication) are as follows:

  • Bleeding – is the most common complication and occurs in roughly 1 in 200 (0.5%) sleeve patients. It may require blood transfusion and a re-operation, but it can often be managed without further surgery.
  • Leakage – is the most feared complication following a sleeve operation and is due to stomach contents leaking through the long staple line. It usually occurs within the first few days following surgery, in roughly 1 in a 100 (1%) of patients.  It can be difficult to manage and may require an extended stay in hospital
  • Reflux – if you have a history of reflux (heartburn), then you will not be offered a sleeve gastrectomy. This is because your reflux will inevitably become much worse and you are less likely to be successful with your weight lossMoreover, a significant proportion of patients (around 9%) who did not have reflux prior to the procedure, will develop this as a direct result of the surgery.  This is not a trivial issue, because chronic reflux can cause potentially serious problems in the lower gullet (oesophagus).  Reflux is a problem particularly related to the
Am I eligible for the sleeve?
  • Age > 20 but under 65 years
  • BMI of 40kg/m² or greater (check your BMI here).
  • No history of reflux (heartburn)
  • No previous surgical weight loss procedures
  • A full understanding of the risks and benefits of the sleeve