• Dr. Jaydeep Palep

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Vertical Sleeve Gastrectomy

What Is It?

The vertical sleeve gastrectomy, or sleeve gastrectomy, is a type of restrictive weight loss surgery. It causes weight loss by restricting the amount of food that a person can consume before feeling full.

How is it performed?

Vertical Sleeve Gastrectomy is a surgical procedure that can be performed by minimally invasive surgery. Usually 4-5 small cuts of 0.5 – 1 cm are made on the abdomen. The Sleeve Gastrectomy is then performed Laparoscopically or Robotically, using highly advanced technology to make it safe. In a Sleeve Gastrectomy, the size of the stomach is reduced to less than 10% of its original volume, leaving behind a stomach measuring 80-100 ml. This results in a limited capacity of food intake. In a Sleeve Gastrectomy, the left side of the stomach is surgically removed from the body by cutting and stapling. This results in a new stomach which is roughly the size and shape of a banana.

How does a Sleeve Gastrectomy help me lose weight?

In a Sleeve Gastrectomy, the amount of food you can eat in one sitting is reduced. Because of this, the brain utilises the fat stored in your body for its energy needs. This burns the excess fat in your body, thus helping you lose weight. Also, in a Sleeve Gastrectomy, the fundus of the stomach is cut. This is the area of the stomach which produces the hunger hormone Ghrelin. Since the source of your hunger hormone is removed in a Sleeve Gastrectomy, you do not feel hungry all the time, and are satisfied with the small amount of food you eat without feeling tired or weak.

Does a Sleeve Gastrectomy help with my medical diseases like Diabetes?

Recently, there have been multiple reports in medical literature proving the beneficial effects of a Sleeve Gastrectomy not only in losing weight, but also in the improvement of medical diseases such as Diabetes, Hypertension, Sleep Apnea and many more. The mechanisms are complex, and involve favourable hormonal alterations in the gut. With a Sleeve Gastrectomy, the doses of medications are reduced, and there is no need for medications in a significant number of patients.

Who can undergo this procedure?

Anybody with a BMI of > 37.5 kg/m2 (Asian population) or >32 kg/m2 with medical diseases can undergo a Sleeve Gastrectomy. Sleeve Gastrectomy is typically performed on individuals who do not suffer from severe co morbidities and are young. A Sleeve Gastrectomy is also done as first line surgery on patients who are too heavy to tolerate other types of weight loss surgeries (like the Gastric Bypass) with the expectation that a second surgery will be performed once weight has been lost.

How much weight will I lose after a Sleeve Gastrectomy?

The amount of weight loss you achieve differs with every weight loss procedure. Typically, in medical literature, it has been reported that patients lose upto 60% of their excess body weight after a Sleeve Gastrectomy. This is adequate to maintain a healthy lifestyle without any medical diseases. However, patients who stick to a regular exercise pattern post weight loss surgery may achieve even greater amounts of weight loss.

How soon will I lose weight after a Sleeve Gastrectomy?

Weight loss after any weight loss procedure is a gradual process. It starts within the first week of surgery, and continues for upto 10-12 months post weight loss surgery. By this point, most of your excess weight is lost, and you become fitter and healthier.

Can I lose too much weight after a Sleeve Gastrectomy?

This is very unlikely after a Sleeve Gastrectomy, since the body knows when it has lost the excess weight required to be healthy, and the weight loss stops.

Are there any side effects of a Sleeve Gastrectomy?

Apart from possible early complications (within a week of surgery), there are practically no delayed side effects of a Sleeve Gastrectomy. Some patients may have nutritional deficiencies post weight loss surgery, but these are easily preventable by taking regular multivitamin and multi mineral supplements as prescribed soon after surgery. The chances of nutritional deficiencies after a Sleeve Gastrectomy are lesser as compared to those after a gastric bypass.

Can a Sleeve Gastrectomy be reversed?

This is a permanent irreversible surgery.

Advantages of a Sleeve Gastrectomy

  • It does not require disconnecting or reconnecting the intestines. Your body’s anatomy remains intact.

  • It is technically a simpler operation than gastric bypass.

  • It may be used as the first stage of a 2-stage operation.

  • The operation eliminates the portion of stomach (fundus) that produces the hormone ghrelin which stimulates hunger.

  • Vitamin and mineral supplementation maybe needed for a shorter duration as compared to gastric bypass.

Disadvantages of a Sleeve Gastrectomy

  • Irreversible

  • Possibility of weight gain after a few years due to stretching of stomach muscles.

  • Possible late dilatation (strectching) of stomach pouch

Can I regain weight after a Sleeve Gastrectomy?

The chances of you regaining weight after a Sleeve Gastrectomy are higher than with a Gastric Bypass. However, maintenance of a healthy lifestyle is of the utmost importance after any type of weight loss surgery. Having good control over your diet, i.e. eating protein rich food, and exercising regualrly will help ensure that you do not regain weight after the surgery. Outcome depends on long-term adherence to diet and lifestyle changes and requires frequent monitoring and adjustments to achieve ultimate weight loss.

Do I need to follow up after a Sleeve Gastrectomy?

Follow up with your doctor and dietician is the most critical part after any weight loss surgery. With every follow up, certain laboratory tests are needed, which help to gauge the body’s response to the weight loss. At every follow up, we assess you to ensure that you are on track with your weight loss, and motivate you to stick to a healthy lifestyle. This has been found in many studies across the world to be the most important in achieving long-term weight loss.

Any surgery performed on the stomach or intestines has certain risks. Some of the possible dreaded complications of Sleeve Gastrectomy are:

1. Staple line leak – this usually occurs at the topmost portion of the staple line in Sleeve Gastrectomy. It may occur due to a technical fault the mechanical stapler, or due to poor blood supply to the stomach. In most cases, this leads to a localized area of fluid collection around the stomach, which can be managed with antibiotics. In certain cases, a second surgery maybe needed to drain the fluid leaking from the stomach. In either case, it prolongs the hospital stay. Fortunately, the incidence of a leak is 1 in a 1000 patients, making it rare. We ALWAYS test for a mechanical fault in the staple line by doing a Methylene Blue dye test on the operating table, so that a defect, if any, can be repaired immediately.

2. Deep Vein Thrombosis – This is a complication that can occur in any morbidly obese patient irrespective of whether they undergo a surgery or not. In this condition, blood in the deep veins of your calves can form clots. These clots may then dislodge from the veins, reaching the lungs and leading to Pulmonary embolism, which if not treated quickly may be fatal. It is treated by giving injectable anticoagulant medications (blood thinners) to the patient. The incidence of DVT is also rare, being seen in 1 patient out of a 1000. We ALWAYS give preventive injectable anticoagulants to the patient for 28 days after a Sleeve Gastrectomy. In addition, if the patient is well mobilized and is walking daily as advised after the surgery, the chances of DVT are very remote.

3. Bleeding – This is again a complication that can occur with any surgery in any patient. All possible sites of bleeding are checked at the end of surgery, and it is ensured that bleeding does not occur in the post operative period.

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