Laparoscopic Sleeve Gastrectomy

The sleeve gastrectomy is also known as the gastric sleeve, or vertical sleeve gastrectomy. (Or VSG in the USA). It is a weight loss procedure in which surgeons resect (remove) more than 75% of the stomach. This is currently the most common weight loss procedure worldwide. Last year there were more than 750, 000 sleeve gastrectomies performed across the globe.

History of the laparoscopic sleeve gastrectomy procedure

The gastric sleeve procedure arose during the development of another procedure, the BPD-DS (biliary pancreatic diversion- duodenal switch). A two stage procedure designed for the super morbidly obese patient. Stage one was the formation of a gastric tube, or sleeve. The sleeve was to facilitate early weight loss and make the second stage of the operation more achievable. The original surgeons found that the weight loss with the sleeve alone was very impressive. So much so, that they found patients didn’t require the second stage of the surgery. So the sleeve gastrectomy became a stand alone procedure. Its popularity grew rapidly to its current status as the weight loss surgery surgeons perform most often.

How do surgeons perform gastric sleeve surgery?

Surgeons perform the procedure laparoscopically (keyhole) using the following steps-

  1. Your surgeon will make five small incisions 5-12mm in size in the abdominal wall and place ports into the gas filled abdominal cavity. They use these ports to pass through a camera (laparoscope) and tools the surgeon uses to carry out the procedure.
  2. Surgeons free the stomach from its connections including the greater omentum. Then they pass a bougie (sizer) through the oesophagus and into the stomach.
  3. A specialised stapler then removes the greater curve of the stomach using the bougie as a guide.
    The remaining stomach is tube or sleeve shaped.
  4. Surgeons then reconnect the sleeve to the greater omentum to create a nice gentle curved stomach.
    They then remove the resected stomach through one of the port incisions.
  5. Lastly they release the gas and remove the ports, and then close the skin.

How does the sleeve gastrectomy work?

The intact stomach can normally stretch up and accommodate a volume of around 1.5 litres of solids and liquids. The new constructed sleeve reduces this volume to around 150-180 mL. Also, the ‘sleeved’ stomach cannot distend (stretch up). This further limits the amount of food or liquid you can consume.

Volume reduction is only one factor. A more important feature of the sleeve operation is the metabolic changes that occur after the surgery. By removing the fundus (top part of the stomach which can stretch up), we also remove a large cell mass. These cells send hormones and chemical signals to the brain which determine a person’s hunger or fullness. The net effect of this surgery is hunger suppression (decreased hunger). As well, early satiety (feeling full after a very small amount of food). This effect is in play for around 9-24 months after surgery and varies from patient to patient. Most patients will lose around 70% or more of their excess weight.

How do I give myself the best chance of success?

Follow up

To really get the most out of the sleeve surgery, patient participation is vital. This means listening to, and working with the team. Your surgeon, bariatric physician, dietitian, psychologist and exercise physiologist. In fact, anyone involved in your care.

Nutrition and Hydration

Dietary intake is very important. Patients who adopt a protein based diet, with some healthy fats, and minimal carbohydrates, typically do very well. You should also drink plenty of water throughout your day. Take extra fibre (psyllium derivatives), and multivitamins every day.

Exercise

You should also complete 30 minutes of load bearing exercise 3-4 times each week. Maintaining and building muscle mass helps you burn more calories. It also helps to counteract the muscle loss caused by rapid weight loss. So it’s really important to keep up a regular exercise routine in the weeks and months post-surgery. 

Mindset

Another characteristic of successful weight loss surgery patients is their “mental fitness.” The long term success of any weight loss program centres around adopting lifestyle changes. As well as maintaining those changes and good habits in the long run. There are many ways to do this. The help of a psychologist is invaluable. As are self help and personal growth books. Or having a mentor, joining a supportive Facebook page or going it alone. Whichever you choose, you should feel confident that it will take you where you want to go in your new, healthy lifestyle.

Do I qualify?

Would you like to know more about whether the sleeve gastrectomy is right for you? If at any stage, you’d like to talk to me in person I am happy to meet with you. This is absolutely no-obligation. Just a chance for you to discuss your suitability and I can answer any questions you might have.