Sleeve Gastrectomy

In a sleeve gastrectomy, a large part of the stomach (the greater curvature) is removed, leaving a tube-shaped stomach. It is an irreversible procedure in which the capacity of the stomach is drastically reduced from 1500-2000 ml to an average of 150 ml. This procedure works restrictively because less food can be ingested, but it also has a hormonal effect that greatly reduces the feeling of hunger.

The sleeve can serve as a definitive standalone procedure but can also, in very high weight categories, be used as the first stage of a SADI or duodenal switch.

Patients undergoing this procedure are usually admitted on the day of the procedure. A few hours after the operation, the patient may already drink a few sips of water and carefully get out of bed. The next day, a liquid diet can be started and the patient may go home again. The length of the hospital stay can of course vary depending on the clinical circumstances.

Results

Studies show that after a sleeve gastrectomy, patients can expect a loss of 60-80% of their excess weight. The weight loss usually occurs in the first 12-18 months. These values can vary from patient to patient and depend on lifestyle, age, adherence to the post-operative guidelines, comorbidity and genetic predisposition.

Advantages of this procedure

• Because the gateway of the stomach remains intact, there is less chance of dumping syndrome.
• Taking vitamin supplements is often not necessary.
• Access to the duodenum is preserved.
• A feeling of fullness sets in quickly, causing you to stop eating. This is particularly important for volume eaters.

A sleeve gastrectomy also has a beneficial effect on comorbidity. Diseases such as diabetes, sleep apnoea and high blood pressure can improve considerably as a result of this procedure.

Complications

Every operation can be accompanied by complications. People who are overweight have a greater chance of complications than people of a normal weight. There are standard post-operative complications that can occur after any operation, such as bleeding, infection, abscess formation, incisional hernia, thrombosis of the leg or a pulmonary embolism.

The most common risks directly associated with a sleeve gastrectomy are:

• Stomach ulcer or narrowing of the sleeve (greatly increased risk in smokers).
• Gastro-oesophageal reflux (this is why, in the case of pre-existing reflux or a hiatal hernia, a gastric bypass is more suitable).
• Stomach rupture.
• Leakage or bleeding along the staple line.