Gastric Sleeve
SLEEVE GASTRECTOMY/VERTICAL SLEEVE GASTRECTOMY/VSG
What is a Gastric Sleeve?
The Sleeve Gastrectomy is the most performed weight loss procedure both in Australia and worldwide. It is also a commonly performed procedure by Morphē Clinic, along with the gastric bypass.
It involves significantly decreasing the stomach size – from around 1.5L to approximately 200mls, by removing approximately 80% of the stomach over a 36F bougie (plastic tube). Although the physical size of the stomach is reduced, the normal direction of the food stream through the stomach and the rest of the intestinal tract is not altered. This means that nutrients including vitamins, minerals and protein will continue to be absorbed in the small intestine normally.
The procedure appears to work in three different ways:
- Portion control – 80% of the stomach is removed, decreasing the capacity of the stomach, which means patients are full and satisfied with a much smaller meal.
Dietitians recommend patients to usually have between 4-6 small meals per day as a way of avoiding big swings in insulin levels and achieving a more even intake of calories. - Hunger Reduction – The fundus of the stomach is removed, which is the part of the stomach rich in cells that produce Ghrelin. Ghrelin is a ‘hunger hormone’ and patients experience less following a sleeve gastrectomy.
- Metabolism – There are a number of other changes that may be part of the benefits of a sleeve gastrectomy, including changes to your gut bacteria and gut hormones.
The procedure is performed laparoscopically (‘keyhole’) or robotically under a general anaesthetic.
The surgical procedure involves using a bougie, or plastic tube, inserted through the mouth to guide the creation of a small stomach pouch. This pouch is created with multiple firings of a titanium stapler.
How is it performed?
The procedure is performed laparoscopically (‘keyhole’) or robotically under a general anaesthetic.
The surgical procedure involves using a bougie, or plastic tube, inserted through the mouth to guide the creation of a small stomach pouch. This pouch is created with multiple firings of a titanium stapler.
Who is eligible for sleeve gastrectomy?
Guidelines for sleeve gastrectomy include:
- Age 18-65
- BMI 30 with weight related comorbidities
- Or BMI ≥ 35 with no comorbidities needed
- Patient who has tried other avenues without success
- No alcohol or drug dependency
- No untreated psychiatric disorders
- Is committed to a healthy lifestyle and lifelong care
Note: these are guidelines, and all patients require a discussion regarding sleeve gastrectomy surgery.
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How much weight can I expect to lose?
Sleeve gastrectomy has proven highly effective at achieving durable weight loss and co-morbidity reduction over the short and intermediate terms.
Patients can expect to lose around 65-75% of excess weight or 30-35% of Total Body Weight, with the majority occurring in the first year.
For example, a 176cm patient who weighs 140 kgs, has a BMI of 45. Their ideal weight is 78 kgs (for a BMI 25), which means an excess weight of 62 kgs.
This means that this patient can expect to lose around 43 kgs and end up at around 97 kgs as a rough guide.
Are there any risks or side effects?
The main risk of a sleeve gastrectomy is a leak from the staple line, as the stomach is divided and removed. This is very rare, at < 0.5% for high volume surgeons in Australia.
Treatment for this condition may include the use of antibiotics, endoscopy, radiological procedures or even further surgery.
Smoking is a major risk factor for a leak and cannot be undertaken for at least 6 weeks prior to the operation, and for at least 6 weeks after.
Other risks include bleeding, internal injuries, blood clots in leg veins, intestines or lungs. They can also include infection of the abdomen, chest or wounds and reaction to the anaesthetic. These are problems that can occur with any surgery, and all safety measures are taken to minimise these risks.
Your surgeon will discuss all risks and possible side effects with you.
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Diagram
An illustrated view of a gastric sleeve in place.
Video
Hear more from Dr Balalis about gastric sleeve surgery.
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