Sleeve gastrectomy

Overview

Sleeve gastrectomy is a surgical weight-loss procedure that involves removing about 80% of the stomach, leaving a tube-shaped stomach about the size and shape of a banana. Sleeve gastrectomy is sometimes called a vertical sleeve gastrectomy. This procedure is typically performed laparoscopically, which involves placing small instruments through multiple small cuts in the upper part of the belly.

Limiting the size of your stomach restricts the amount of food you are able to consume. In addition, the procedure prompts hormonal changes that assist with weight loss. These same hormonal changes also help relieve conditions associated with being overweight, such as high blood pressure or heart disease.

Why it's done

Sleeve gastrectomy is done to help you lose excess weight and reduce your risk of possibly life-threatening weight-related health problems, including:

• Heart disease.
• High blood pressure.
• High cholesterol.
• Obstructive sleep apnea.
• Type 2 diabetes.
• Stroke.
• Cancer.
• Infertility.

Sleeve gastrectomy is typically done only after you've tried to lose weight by improving your diet and exercise habits.

In general, sleeve gastrectomy surgery could be an option for you if:

• Your body mass index (BMI) is 40 or higher (extreme obesity).
• Your BMI is 35 to 39.9 (obesity), and you have a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea. In some cases, you may qualify for certain types of weight-loss surgery if your BMI is 30 to 34 and you have serious weight-related health problems.

You also must be willing to make permanent changes to lead a healthier lifestyle. You may be required to participate in long-term follow-up plans that include monitoring your nutrition, your lifestyle and behavior, and your medical conditions.

Check with your health insurance plan or your regional Medicare or Medicaid office to find out if your policy covers weight-loss surgery.

Risks

As with any major surgery, sleeve gastrectomy poses potential health risks, both in the short term and long term.

Risks associated with sleeve gastrectomy can include:

• Excessive bleeding.
• Infection.
• Adverse reactions to anesthesia.
• Blood clots.
• Lung or breathing problems.
• Leaks from the cut edge of the stomach.

Longer term risks and complications of sleeve gastrectomy surgery can include:

• Gastrointestinal blockage.
• Hernias.
• Gastroesophageal reflux.
• Low blood sugar, known as hypoglycemia.
• Malnutrition.
• Vomiting.

Very rarely, complications of sleeve gastrectomy can be fatal.

How you prepare

In the weeks leading up to your surgery, you may be required to start a physical activity program and to stop any tobacco use.

Right before your procedure, you may have restrictions on eating and drinking and which medicines you can take.

Now is a good time to plan ahead for your recovery after surgery. For instance, arrange for help at home if you think you'll need it.

What you can expect

Sleeve gastrectomy is done in the hospital. Depending on your recovery, your hospital stay may last 1 to 2 nights.

During the procedure

The specifics of your surgery depend on your individual situation and the hospital's or surgeon's practices. Some sleeve gastrectomies are done with traditional large cuts in the belly. This is known as open surgery. But sleeve gastrectomy is typically performed laparoscopically. This technique involves placing small instruments through multiple small cuts in the upper belly.

You are given general anesthesia before your surgery begins. Anesthesia is medicine that keeps you asleep and comfortable during surgery.

To perform a sleeve gastrectomy, the surgeon creates a narrow sleeve by stapling the stomach vertically and removing the larger, curved part of the stomach.

Surgery usually takes 1 to 2 hours. After surgery, you awaken in a recovery room, where medical staff monitors you for any complications.

After the procedure

After sleeve gastrectomy, your diet begins with sugar-free, noncarbonated liquids for the first seven days, then moves to pureed foods for three weeks, and finally to regular foods approximately four weeks after your surgery. You will be required to take a multivitamin twice a day, a calcium supplement once a day and a vitamin B-12 injection once a month for life.

You'll have frequent medical checkups to monitor your health in the first several months after weight-loss surgery. You may need laboratory testing, bloodwork and various exams.

You may experience changes as your body reacts to the rapid weight loss in the first 3 to 6 months after sleeve gastrectomy, including:

• Body aches.
• Feeling tired, as if you have the flu.
• Feeling cold.
• Dry skin.
• Hair thinning and hair loss.
• Mood changes.

Results

Sleeve gastrectomy can provide long-term weight loss. The amount of weight you lose depends on your change in lifestyle habits. It is possible to lose approximately 60%, or even more, of your excess weight within two years.

In addition to weight loss, sleeve gastrectomy may improve or resolve conditions related to being overweight, including:

• Heart disease.
• High blood pressure.
• High cholesterol.
• Obstructive sleep apnea.
• Type 2 diabetes.
• Stroke.
• Infertility.

Sleeve gastrectomy surgery also can improve your ability to perform routine daily activities and can help improve your quality of life.

When weight-loss surgery doesn't work

It's possible to not lose enough weight or to regain weight after weight-loss surgery. This weight gain can happen if you don't follow the recommended lifestyle changes. If you frequently snack on high-calorie foods, for instance, weight loss may stall. To help avoid regaining weight, you must make permanent healthy changes in your diet and get regular physical activity and exercise.

It's important to keep all of your scheduled follow-up appointments after weight-loss surgery so that your doctor can monitor your progress. If you notice that you aren't losing weight or you develop complications after your surgery, see your doctor immediately.