Sleeve Gastrectomy

Sleeve Gastrectomy (Gastric Sleeve)

Sleeve gastrectomy, often called the Gastric Sleeve, is a permanent weight-loss surgery that involves removing approximately 75–80% of the stomach. The remaining portion is joined together to form a narrow tube or "sleeve" about the size and shape of a banana. This procedure provides a powerful tool for long-term weight management by physically and hormonally changing how the body processes hunger and food intake.

How It Works

• Physical Restriction: The significantly smaller stomach capacity limits the amount of food you can eat at one time, making you feel full much faster.

• Hormonal Changes: By removing the upper portion of the stomach (the fundus), the surgery drastically reduces the production of Ghrelin, known as the "hunger hormone."

• Appetite Suppression: The reduction in Ghrelin leads to a decreased appetite and significantly improved blood sugar control.

• Natural Digestion: Unlike a gastric bypass, the intestines are not re-routed, meaning the natural digestion process remains largely intact.

When You Should Consider a Sleeve Gastrectomy

• Body Mass Index (BMI): Typically recommended for individuals with a BMI of 40 or higher, or a BMI of 35 or higher with obesity-related health conditions.

• Type 2 Diabetes: If you are struggling to manage blood sugar levels through diet and medication alone.

• Hypertension: When high blood pressure persists despite medical intervention and lifestyle changes.

• Obstructive Sleep Apnea: If excess weight is causing significant breathing interruptions during sleep.

• Failed Weight Loss Efforts: For those who have been unable to achieve sustained weight loss through traditional diet and exercise programs.

How Is Performed

• Anesthesia: The surgery is performed under general anesthesia and typically takes between 60 to 90 minutes.

• Laparoscopic Approach: This is a minimally invasive "keyhole" surgery where the surgeon makes 4–5 small incisions in the abdomen to insert a camera and specialized instruments.

• The Resection: The surgeon uses a surgical stapler to divide the stomach vertically, removing the outer curved portion of the organ.

• Staple Line Reinforcement: The edges of the new stomach sleeve are securely stapled to ensure a watertight and airtight seal.

• No Re-routing: The connection between the stomach and the small intestine is preserved, allowing for normal nutrient absorption.

Pre-Procedure Preparation

• Nutritional Counseling: Working with a dietitian to understand the strict dietary phases required before and after surgery.

• Psychological Evaluation: To ensure you have a strong support system and a clear understanding of the lifelong lifestyle changes required.

• Medical Screening: A comprehensive review of heart and lung health to ensure you are a safe candidate for general anesthesia.

• Pre-Op Liquid Diet: Most patients must follow a specific high-protein, low-calorie liquid diet for 1–2 weeks before surgery to shrink the liver.

• Smoking Cessation: You must stop smoking at least 6 weeks before surgery to reduce the risk of staple line leaks and breathing complications.

Tests Before Sleeve Gastrectomy

• Upper Endoscopy (EGD): To check the health of the stomach lining and rule out significant hiatal hernias or ulcers.

• Abdominal Ultrasound: Specifically used to check for gallstones, which can be affected by rapid weight loss.

• Blood Panels: Comprehensive testing of vitamin levels, blood sugar (HbA1c), and kidney function.

• Sleep Study: To identify and treat undiagnosed sleep apnea prior to the administration of anesthesia.

Life After Sleeve Gastrectomy

• Hospital Stay: Most patients remain in the hospital for 1 to 2 nights for monitoring and pain management.

• Strict Dietary Phases: You must follow a multi-phase transition to allow the staple line to heal:
  Weeks 1–2: Clear liquids only.
  Weeks 3–4: Pureed and soft foods.
  Week 5+: Gradual introduction of solid, high-protein foods.

• Lifelong Supplements: You must take daily vitamin and mineral supplements forever to prevent nutritional deficiencies.

• Activity Restrictions: Most people return to work within 2 weeks but must avoid heavy lifting or core-straining exercise for a full 6 weeks.

• Small Meals: You will transition to eating small, nutrient-dense meals throughout the day, as the stomach can no longer hold large volumes.

Why Specialized Treatment Is Highly Effective

• Substantial Weight Loss: Most patients lose 60–70% of their excess body weight within the first 12–18 months.

• Disease Resolution: The procedure can significantly improve or even resolve conditions like Type 2 diabetes, high blood pressure, and fatty liver disease.

• Increased Longevity: By reducing the strain of obesity on the heart and joints, the surgery contributes to a longer, more active life.

• Minimally Invasive: The laparoscopic technique results in less pain, smaller scars, and a much faster recovery than traditional open surgery.

• Simpler Mechanism: Because the intestines are not re-routed, there is a lower risk of long-term malabsorption or "dumping syndrome" compared to other weight-loss surgeries.