Sleeve Gastrectomy – Draft

What is a sleeve gastrectomy?

Sleeve gastrectomy is an obesity surgery that restricts the volume of the stomach to 15-20% of its original size. The Sleeve is very effective at causing weight loss. Studies have shown that people can lose on average of 20-35% of their total body weight (i.e. they can lose up to a third of their weight). We have been performing this operation since 2004. Worldwide it is now the most popular procedure, but we don’t know as much about longer-term outcomes (beyond 5-10 years).

How is the surgery performed?

The Sleeve Gastrectomy is performed as a keyhole procedure (laparoscopic), through 4-5 small incisions in the abdomen. These enable the surgeon to remove a large portion of the “stretchy” part of the stomach. The resulting gastric tube resembles a thin banana of approximately 150mL capacity. Over time, softening of the stomach wall will usually increase the volume to about 250mL.

How the sleeve gastrectomy causes weight loss

The Sleeve itself does not make you lose weight. Instead, it is a tool to help restrict the amount of food you eat, by affecting your hunger, capacity and rate at which you consume food. Due to the smaller stomach size, patients find that after eating a much smaller quantity of food than usual, they have a feeling of satisfaction (satiation) or a sense that they have eaten enough.

Furthermore, removing part of the stomach alters the hormones released after eating; this prolongs appetite suppression between meals. If a patient uses their operation to eat healthily meals (i.e. low-energy) three times a day, they will use more energy than they consume and will lose weight.

Effectiveness of the sleeve gastrectomy in causing weight loss

Studies have shown that people with a sleeve gastrectomy experience 20-35% total body weight loss (TBWL) after two years. However, it is impossible to predict precisely how much weight each person will lose, as this depends on many factors, including chance, age, starting weight, medical illness, ability to exercise and resilience. In the end, most people get to a stage where they feel that further weight loss comes at the expense of too much effort and settle at a weight that more or less suits them.

Suitable candidates for sleeve gastrectomy

As with all obesity surgeries, the sleeve gastrectomy should only be performed on people with a BMI greater than 40, or those with a BMI over 35 with other medical co-morbidities such as diabetes or high blood pressure. Occasionally patients with BMI under 35 may also undertake this operation; however, the balance between risk and benefit is harder to gauge. Patients who are lighter than this run the risk of losing weight but at the expense of complications that can make them worse off. They should have tried other weight loss therapies beforehand but been unable to keep the weight off. Patients with eating disorders such as binge eating or a nocturnal eating disorder, and patients who habitually graze or emotionally eat, need to seek treatments for these disorders as well, otherwise the surgery will fail after being initially successful.

The sleeve gastrectomy is non-reversible, unlike the Gastric Band and Gastric Bypass, so should only be undertaken by well-motivated people with acceptable operating risks, who are committed to improving their health through substantial weight loss. Furthermore, these candidates should be well informed about the effect the Sleeve will have on their lifestyle, through accepting advice on eating and exercise practices. Although the operation is permanent, the impact it has on eating and weight loss may not last, even if the side effects of surgery do (such as reflux).

If you are considering a sleeve gastrectomy as a potential bariatric surgery and would like more information, please contact our clinic today, and one of our expert team will be happy to discuss this further with you. You should also download (below) our Laparoscopic Sleeve Gastrectomy Information document.