Procedure and Risks of Sleeve Gastrectomy | Endocrinology

Sleeve Gastrectomy

What is sleeve gastrectomy?

Sleeve gastrectomy, also entitled vertical sleeve gastrectomy, is a weight-loss surgical procedure. This process is usually done laparoscopically, which involves inserting small instruments through multiple small incisions in the upper abdomen. For the duration of sleeve gastrectomy, about 80% of the stomach is removed, leaving a tube-shaped stomach the size and shape of a banana.

Limiting the size of your stomach restricts the amount of food you can eat. In addition, the procedure causes hormonal changes that help you lose weight. These same hormonal changes also help alleviate conditions associated with being overweight, such as high blood pressure or heart disease.

It is different from gastric bypass

In a gastric bypass, the surgeon creates a small pouch that bypasses most of the stomach and goes directly into the intestine.

Gastric sleeve surgery is best for persons who have a BMI (body mass index) of at least 40. That means you weigh 100 pounds or more above your ideal weight. Some people are too heavy for gastric bypass surgery, so it can be a good alternative.

People generally lose 60% of their extra weight in a 12 to 18 month period. So if you are 100 pounds overweight, you will lose about 60 pounds, although some lose more and some less. Of course, exercising and eating right adds to weight loss.

Risk factors of sleeve gastrectomy

Infections, bleeding, and, in rare cases, a leak along the staple line is possible. Right after surgery, you may feel nausea, vomiting, or constipated.

Some foods may not suit you right now. You can also develop nutrition problems after surgery, so you must take vitamins and supplements for life. Your doctor will advise you precisely what you need.

  • Excessive bleeding
  • Infection
  • Adverse reactions to anaesthesia
  • Blood clots
  • Breathing or lung problems
  • Escapes from the cut edge of the stomach

Complications of sleeve gastrectomy

Complications associated with sleeve gastrectomy are rare; though, when they do occur, they are more serious than those related to other weight-loss strategies, such as the lap band. If a leak develops, for example, it can take months to resolve the problem. Another downside is that sleeve gastrectomy is a relatively new procedure and there is a dearth of long-term data on the success of weight loss using this procedure over time.

As is the case with any operation, sleeve gastrectomy is associated with a number of risks and, although rare, some of the complications that can occur are described below.

  • Bleeding: If postoperative bleeding occurs, which occurs in about 0.5% of cases, a blood transfusion may be necessary.
  • Infection: An infection can occur, in which case antibiotics and sometimes repeat surgery are needed. Coiled infection is more common in people with a higher body mass index.
  • Staple line leaks: This occurs in about 1% of cases and can be life-threatening. A leak may require repeated surgery, and a persistent leak may lead to a fistula or recurrent infection within the abdomen. A leak can result in the patient having to stay in the hospital for weeks or even months after surgery.
  • Inability to tolerate food intake: This is tremendously rare, but since sleeve gastrectomy touches digestive function, some people find that they cannot tolerate adequate food intake. This may mean that they need long-term intravenous nutrients.
  • Organ damage: Accidental injury to organs near the operation site is always a risk in keyhole surgery, and if it occurs, additional surgery may be required to correct any damage to the organs.
  • Deep venous thrombosis: Blood clots in the veins or lungs are also a potential risk.
  • Long-term complications: Any intra-abdominal surgery involving the gastrointestinal tract can be complicated by the formation of scar tissue in the intestine or the formation of a hernia as a result of the sealing of the wound, which could mean that additional surgery is needed.

Sleeve gastrectomy process

Sleeve gastrectomy was initially performed as a modification of another bariatric procedure, the duodenal switch, and later as the first part of a two-stage gastric bypass process in extremely obese patients for whom the risk of gastric bypass surgery is increased. deemed too large. The initial weight loss in these patients was so successful that it began to be investigated as an independent procedure.

Sleeve gastrectomy is the most frequently performed bariatric surgery in the world. In many cases, sleeve gastrectomy is as effective as gastric bypass surgery and includes improvements in glucose homeostasis before substantial weight loss occurs. This independent benefit of weight loss is related to decreased gastric volume, changes in intestinal peptides, and the expression of genes involved in glucose absorption.

Sleeve gastrectomy surgery

The procedure involves a longitudinal resection of the stomach starting from the antrum at the point 5-6 cm of the pylorus and ending at the fundus near the cardia. The remaining gastric sleeve is calibrated with a spark plug. Most physicians prefer to use a bougie between 36 and 40 Fr with the procedure and the ideal approximate residual size of the stomach after the procedure is approximately 150 ml.

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