The ‘Sleevectomy’ or ‘Laparoscopic Sleeve Gastrectomy’ procedure is advised for patients with a BMI of 35 or more, although this does depend on the patient and, of course, the surgeon’s recommendations.
A gastric sleeve is an operation to convert the stomach into a long thin tube. This is done by stapling it along its length and then removing the excess, so that the newly formed smaller stomach is the shape of a sleeve. The new stomach will have a smaller capacity. In addition, the production of “hunger hormones” is inhibited, so that patients’ appetite is reduced.
The procedure is carried out under general anaesthetic and is normally keyhole surgery. It is performed for helping very overweight patients achieve substantial weight loss because it restricts the amount that someone can eat – it is a stomach reduction procedure, so works to reduce the size and capacity of the stomach. The sleeve is a tool to help the patient manage their food intake.
Average excess weight loss is 60 to 70%. Weight loss can be faster or greater (depending on weight pre-surgery) for those that follow these 3 rules:
- Sensible diet (low fat, low sugar, high fruit/veg)
- Smaller portions
- Higher activity level, integrating moderate exercise into their lives.
It may be used as a stand-alone operation or the first part of a two stage operation for very large patients. The second stage is carried out a number of months later when the patient has lost a significant amount of weight. This means that the risks of needing further surgical procedures are much less.
What Does the Gastric Sleeve Operation Involve?
The operation is carried out laparoscopically, which is also known as keyhole surgery. The surgeon makes five small incisions (cuts) in the abdomen (belly) to get to the stomach, rather than one large cut (an ‘open procedure’). However, occasionally, the surgeon may decide to convert to an open procedure (the traditional way of carrying out this operation through a longer incision) if they think it would be safer.
The procedure is carried out under general anaesthetic and is normally keyhole surgery.
Up to 75% of the stomach may be removed in a sleevectomy procedure. The smaller stomach naturally reduces patients’ appetite, so that they only want small portions of food and therefore eat less and lose weight.
In addition, the portion of the stomach that is removed is the area responsible for secreting the hormone “Ghrelin”, which is responsible for appetite and hunger – the near elimination of this “hunger hormone” results in a significant reduction or loss of appetite, especially when combined with the smaller stomach capacity.
The operation takes up to two hours. For some patients, the surgery can be technically difficult depending on body-build or previous surgery. In these circumstances the operation can take longer.
Benefits of gastric sleeve surgery
This surgery is a proven method of weight loss. When combined with a supervised diet, increased activity and behaviour modification, it can lead to long-term weight loss and the associated health benefits.
Weight loss is more than with non-surgical programmes alone and can be more than other gastric bypass surgery. Average excess weight loss is 60 to 70% (for example, if a patient is 10 stone over weight then we would expect him/her to lose on average 6 to 7 stone).
As a result of the combined effects of weight loss and surgery many obesity related diseases such as high blood pressure, Type 2 Diabetes Mellitus, sleep apnoea and many others have gone in to remission. It keeps the pyloric valve intact (a stomach muscle) which avoids some of the complications of other types of bypass surgery such as:
- ‘dumping’ (when sweet foods cause you to sweat and feel faint)
- strictures (a restriction or tightening)
It is important for patients to have a clear view of the commitments and risks associated with this surgery. However, these have to be balanced against the longer-term risks of remaining severely overweight. We advise that you discuss these issues carefully with your surgeon at the time of your consultation.