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Gastric sleeve

Gastric sleeve surgery, also known as sleeve gastrectomy, involves changing the shape of the stomach by cutting part of it away. The surgery required is more extensive than having a gastric band fitted, but the procedure is also done laparoscopically, using small incisions to allow instruments and a light and camera inside the body. It is usually an option for people with more weight to lose – with a BMI of over 35-40. Weight loss is rapid afterwards but lifestyle changes and a new approach to eating are essential.

gastric-sleeveWhat does gastric sleeve surgery involve?

During the operation, Mr Alhamdani will remove around three quarters of your stomach, making the division from top to bottom. The larger part of the stomach is removed, leaving the part that is attached to the two openings, the top one from the oesophagus and the lower one leading into the small intestine.

What is left is a gastric sleeve, which has a much smaller volume, making it difficult for you to eat large meals.

Unlike a gastric bypass, a gastric sleeve allows your normal digestion – there is no re-routing of food directly into the intestine.

How does gastric sleeve surgery aid weight loss?

Like a gastric band, having a sleeve gastrectomy restricts your stomach volume. The tissue removed contains the source of hormones that stimulate appetite, so when that is gone, you will also feel less hungry.

During the weeks after surgery you will be given a diet plan to follow and your weight loss will be accelerated if you can combine your new way of eating with some exercise. Small meals are best, with healthy food choices to give you the nutrients you need.

What to expect

Gastric sleeve surgery is major abdominal surgery and is always done with you completely asleep under a general anaesthetic. Mr Alhamdani will explain the procedure in detail, including the potential complications before booking your surgery. All surgery carries some risks, and these are higher if you are obese. However, if your health is compromised by your excess weight, you have a lot to gain by being able to return to a healthier weight.

You can expect to stay in hospital for two nights, but the laparoscopic techniques used mean that your recovery will much faster than if you had traditional open surgery. You will feel sore afterwards, but getting up and moving around will help, and you will be given painkillers to ease your discomfort.

As part of our multi-disciplinary team approach you will see a specialist bariatric dietician (Mrs Lucy Jones) or a specialist nurse practitioner (Mrs Toni Jenkins) during your stay in hospital who will talk to you about your diet, how to lose weight after surgery, and what supplements and multivitamins you require after your sleeve gastrectomy.

Once home, you need to rest but also remain mobile and you can normally return to work after two to three weeks, but a little longer if your job involves heavy activity.

Weight loss after gastric sleeve surgery

Your appetite will be decreased and you will feel full after eating a small amount, which will make it easier for you to stick to a sensible diet plan. It is not unusual to lose 60% of your body weight in the first year after surgery, but you should see a noticeable difference within weeks.

As you lose weight, you could find that your blood pressure reduces (if it was high before) and people often find that they can control early stage type 2 diabetes just with their diet alone, without needing to take tablets or insulin.

Mr Alhamdani recommends that all patients having gastric sleeve surgery take vitamin and mineral supplements afterwards, as your food intake will be greatly reduced. Once you are comfortable with a more healthy diet, these may not be necessary in the longer term.

Who can benefit?

A gastric sleeve operation is not normally considered for patients with a BMI of less than 35. Mr Alhamdani recommends a gastric balloon or gastric band if you have less weight to lose. A gastric sleeve is suitable for people who are morbidly obese and need a weight loss solution that will lead to more rapid results.

This procedure can also be used as the first step for people who are very obese – with a BMI of more than 60, for example. It allows a relatively rapid weight reduction, bringing down the BMI to allow a gastric bypass to be done safely. This procedure can be done, if required, as a second stage operation.

Problems and complications

As well as the usual risks of major surgery, there is a small chance that the stomach can bleed or leak  at some point along the cut surface. This happens in around 2-3% of patients who have this procedure in the UK. None of Mr Alhamdani patients have ever developed this complication but he always highlights the risk in his consultations before surgery.

The other main problem that can arise tends to affect some patients much later after surgery. If you have found it difficult to restrict your food intake in the past, the effect of sleeve gastrectomy can be temporary. It is possible to eat more over time and to stretch the pouch so that it will take more food. Also, if your diet is high in fat and processed foods, it is possible to take in more calories, slowing down or even reversing your weight loss.

 

References

The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO)

The Whittington Hospital

American Society for Metabolic & Bariatric Surgery

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