Laparoscopic Vertical Sleeve Gastrectomy
How does the Sleeve Gastrectomy Work?
The two main mechanisms for which the gastric sleeve works - restriction and decreased ghrelin hormone. As with the other surgeries already mentioned, restriction occurs because of the gastric tube that is created limits the amount of food eaten. Therefore, feel full quicker, eat less, take in less calories, and lose weight.
Another mechanism for weight loss is the decreased amount of a hunger hormone called ghrelin. This hormone is produced cells in the stomach. When the body loses a percentage of excess fat, this hormone gets produced. It acts on the brain to signal starvation mode - thus induces people to have the overwhelming need to eat or overeat. Well, with over 2/3 of the stomach being removed, less cells to produce ghrelin. So not only will people eat less from feeling full quicker, but they will also feel hungry less.
How is the Sleeve Gastrectomy performed?
The sleeve gastrectomy is performed laparoscopically. After patients are asleep from anesthesia, a special tube is placed in the mouth that extends past the stomach and into the small bowel. This tube is important to help guide the appropriate amount of stomach to be removed. Several firings of a special stapling device is placed along this tube. Each firing of stapler is lined with re-enforcement material to help further prevent bleeding and leaks.
After completely separating the larger portion of the stomach from the gastric tube created, it will eventually be completely removed from the body. After the tube that was placed as a guide is removed, a gastroscope will be introduced to evaluate this staple from the inside. During this evaluation, the staple line from the is evaluated for any signs of leak
Advantages to the Sleeve Gastrectomy
Unlike the gastric bypass or the biliopancreatic duodenal switch, there are no anastomoses or intestinal bypasses. Typically, this procedure can be performed consistently quicker than a gastric bypass, but only slightly longer than the gastric band. Current studies show that the sleeve gastrectomy has similar low complication rates as the gastric band, but very comparable weight loss results as with the more aggressive gastric bypass.
As with its early design, the sleeve gastrectomy can be used as a staged procedure for the high risk patients or the super morbid obese (BMI >60). The sleeve gastrectomy can be done quickly and easily in these people. After a significant amount of weight is loss or reasonable BMI to operate with is achieved, the gastric bypass or biliopancreatic duodenal switch can then be performed. With the success of the initial stage, many people are choosing not to proceed with the second stage of the process.
Other advantages include allowing a procedure for patients with a history of inflammatory bowel disease or history of chronic steroid use would not be candidates for the gastric bypass because of the high associated risks on the small bowel. This procedure has been shown to also help improve and resolve many obesity related medical issues. The incidence of mineral and vitamin deficiencies is rare compared to the bypass and biliopancreatico duodenal switch.
Risks of the Sleeve Gastrectomy
Risk of death is always a possibility, but in comparison to the bypass, it is much less and very comparable to the gastric band. Although also very rare is disruption of staple lines and causing leakage of gastrointestional fluid. Similar to the bypass, our protocol is to check the gastric sleeve intraoperatively with a gastroscope to rule out any leaks as well as checking an x-ray the following day to further check for a leak. Serial labs are also drawn to help pick up any subtle signs.
Long-term problem that could arise is a stricture of the created gastric tube. Early post-operatively, that is usually from the swelling and edema of the surgery on the stomach tissue itself. Weeks later, it is due to the natural healing and scarring process. Rarely, do these occur and even more rarely is surgery required to fix the problem. Endosocpic dilation may be required to help alleviate the problem.
Because of no intestional bypass, deficiencies in fat soluble vitamins, folate, iron, calcium, and Vitamin B12 may occur much less often when compared to the gastric bypass. They may occur due to the overall decreased intake. Scheduled lab work and in addition to any related symptoms will help identify deficiencies. Typically, supplementation will be all that’s required to fix these problems.
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