Sleeve Gastrectomy

Sleeve gastrectomy is currently the most common bariatric surgical procedures performed worldwide. This operation takes 60-90 minutes to perform through key-hole means with 4-5 1cm incisions. The surgery aims to remove 75-80% of the stomach volume. It is a restrictive bariatric surgery to treat patients with a high BMI of 30 and above.

It encourages weight loss by restricting the stomach size in order to reduce oral intake. This helps patients to eat less without hampering the normal digestive process. The operation also removes the top part of the stomach which houses hunger hormones (ghrelin) in order to promote early satiety.

Sometimes sleeve gastrectomy is carried out as a first stage of a 2-stage operation in patients with a very high BMI of 60 or more. This is done to achieve a considerable amount of weight loss so it is safer for the patient to undergo a second bariatric surgery if needed.

Weight loss benefits

• Proven method of long-term weight loss – averaging 70% of excess body weight loss (25-35% of their total body weight) in the first 12-24 months.
• Aids in reducing the burden of obesity related metabolic and physical disease like diabetes, hypertension, obstructive sleep apnoea, musculoskeletal disease etc.

Who is suitable for the sleeve?

• Patients with BMI >30 with obesity related conditions or;
• Patients with BMI >35 with or without any obesity related conditions.

How is the recovery and diet post procedure?

Patients routinely stay in hospital for 1-2 days after the surgery before discharge. The main aim in the immediate post operative period is to get used to having a smaller stomach size, while working towards a daily fluid volume of 700-1000mls. You will also be prescribed anti-nausea and pain medications to keep you comfortable.
On discharge, most patients will remain on a high-energy protein liquid diet (pre-determined by the dieticians) for a duration of 2-3 weeks before progressing to a solid diet compressing of soft foods. You will also be on an anti-reflux medication along with commencement of a multi-vitamin tablet. It is important to maintain an adequate level of hydration throughout this period.

Typically, patients will feel that they can tolerate one quarter to one third of their previous meal quantity in the first 1-2 months post-surgery. Progressively over the first 12 months, the quantity of oral intake that patients can tolerate will increase, although there will always be a level of food restriction following the sleeve operation.

Is the operation safe and what are some of the side effects

Gastric sleeve is a safe operation especially in expert hands with 380,000 cases performed each year worldwide. Post operative complications associated with sleeve gastrectomy are thankfully rare. It is still important to understand these risks before proceeding with the operation. Some of these risks include blood loss, infections, problems associated with anaesthesia, and deep vein thrombosis (blood clot in the leg). The other uncommon, but major complication following sleeve gastrectomy is occasional staple line leakage of the gastric contents (i.e. sleeve leaks) or sleeve narrowing (i.e. sleeve stenosis) which can occur in 0.1% of operations respectively.

In the medium to long term, 10-15% of patients may experience some degree of reflux. Weight re-gain can be an issue for a small proportion of gastric sleeve patients, highlighting the importance of regular specialist follow up and optimum dietary/ lifestyle modifications. Dumping syndrome, although very rare, can theoretically occur post sleeve gastrectomy with symptoms of light-headiness and sweating following large carbohydrate meals.

The listed complications are not intended to worry you, but simply inform you about the range of possible complications, regardless of how rare some of them may be. Our team takes measures directly aimed at reducing these risks, but if complications occur, additional treatment may be necessary.