Gastric Sleeve (Sleeve Gastrectomy)
The gastric sleeve (or sleeve gastrectomy) procedure was originally introduced to reduce weight (and thus risk) in very obese (BMI >60) high risk patients undergoing a staged Roux-en-Y gastric bypass or a duodenal switch (the second part of the operation was completed twelve months later). Nowadays it is also used as a standalone procedure to treat morbid obesity and type 2 diabetes.
The procedure is carried out laparoscopically (keyhole surgery). Special equipment is used to mobilise and remove the bulk of the stomach. This in effect turns the stomach into a long, thin, banana-shaped tube which is a fraction of its usual volume.
This procedure has two main effects. One is that the reduction in volume of the stomach restricts the amount of food which can be eaten. The other important effect is that the levels of an appetite-stimulating hormone (called ghrelin) are reduced. With less ghrelin, you just don’t feel as hungry, so you eat less.
The expected weight loss after a sleeve gastrectomy is to lose about 65% of excess weight, so it’s somewhere between a band and a bypass in terms of weight loss.
Early complications which can occur include staple line leakage, bleeding, injury to other internal structures, and gastric reflux. On rare occasions a stricture (narrowing) of the re-sized stomach can cause troublesome vomiting. Gradual over-stretching of the sleeve results in weight regain in some individuals and about 20-30% of sleeve patients require a revision (re-do) procedure to maintain good long-term weight loss. The chances of these complications arising can be minimised by ensuring the procedure is carried out by experienced surgeons with a good multi-disciplinary team.