Gastric Sleeve

Innovative and safe, a Laparoscopic Sleeve Gastrectomy reduces the stomach capacity as well as introducing neurohormonal changes in the patient resulting in weight reduction. Compliance to diet is key to successful weight reduction. No malabsorption or abnormal alimentary tract is created.

Laparoscopic Sleeve Gastrectomy

The Sleeve Gastrectomy procedure (also referred to as Gastric Sleeve, Vertical Sleeve, Greater Curvature Gastrectomy, or the Parietal Gastrectomy) is a weight loss surgery where the stomach is divided lengthwise with a line of sutures to form a long narrow tube similar in shape to a banana. The outer portion of the stomach (about 60% to 80% of the stomach) is then separated and removed leaving the small stomach tube or sleeve. Although the stomach volume is reduced in the gastric sleeve surgery, the new pouch still functions normally so most food items can be consumed in small amounts.

Stats
BMI w/o co morbidity40
BMI w/0 co morbidity35
Reduced Size200cc (15/20% of size)
Weight Loss
Average60-100 lbs.
Percentage33-83%
Time Frame 6 mo. – 3 years

Additionally, the removed part of the stomach is responsible for secreting the hormone ghrelin which stimulates hunger. By removing this hunger hormone, appetite is easier to control.Sleeve gastrectomy is a restrictive bariatric surgery. During this procedure, the surgeon creates a small, sleeve-shaped stomach. It is larger than the stomach pouch created during Roux-en-Y bypass—and is about the size of a banana.

Sleeve gastrectomy is typically considered as a treatment option for bariatric surgery patients with a BMI of 60 or higher. It is often performed as the first procedure in a two-part treatment. The second part of the treatment can be gastric bypass.

Co-morbid condition resolution 12 to 24 months after sleeve gastrectomy has been reported in 345 patients.24 Sleeve gastrectomy patients experienced resolution rates for type 2 diabetes, high blood pressure, high cholesterol, and obstructive sleep apnea that were similar to resolution rates for other restrictive procedures such as gastric banding.

Like gastric band procedures, such as LAP-BAND® & REALIZE band, sleeve gastrectomy is a restrictive weight loss surgery that reduces the capacity of the stomach and feelings of hunger. Unlike gastric band surgery, sleeve gastrectomy is achieved by removing a portion of the stomach so it is not reversible.

Historically the sleeve gastrectomy was performed as a two stage bariatric procedure for patients with very high body mass index (BMI >55). The gastric sleeve surgery is performed first followed several months later by a duodenal switch or gastric bypass procedure.

In recent years, sleeve gastrectomy has been performed as a single surgery for patients as an alternative to other weight loss surgeries. The gastric sleeve surgery is offered as an alternative surgery for people who do not wish to have gastric band surgery or the more invasive weight loss surgeries such as gastric bypass. The sleeve gastrectomy is also a great option for patients with medical conditions such as anemia, Crohn’s disease and various other health conditions that make them a poor candidate for other types of bariatric surgery.

More information about the Sleeve Gastrectomy procedure can be found at the website of the American Society for Metabolic and Bariatric Surgery (ASMBS) and review the ASMBS Position Statement on Sleeve Gastrectomy As a Bariatric Procedure.

Watch this video to learn more about gastric sleeve surgery.

Biliopancreatic Diversion with Duodenal Switch

Biliopancreatic diversion with duodenal switch (BPD/DS) is very similar to gastric bypass. Instead of a small stomach pouch, the surgeon creates a sleeve-shaped stomach. The surgeon then attaches the final section of the small intestine to the stomach sleeve. The small intestine absorbs calories and nutrients. So, bypassing all but the last section of the small intestine ensures that far fewer calories are absorbed.

Life After BPD/DS Surgery

Excess Weight Loss

BPD/DS patients typically lost 70.1 percent of their excess weight4.

Health Benefits Studies found that BPD/DS:

  • Resolved type 2 diabetes in 98.9% of patients4
  • Resolved high blood pressure in 75.1% of patients4
  • Improved high cholesterol in 99.1% of patients4
  • Resolved obstructive sleep apnea in 91.9% of patients4

Quality of Life

One meta-analysis stated that for bariatric surgery patients who experienced significant weight loss1:

  • Overall quality of life improved greatly
  • They experienced improved appearance and physical functioning
  • They experienced improved social and economic opportunities

Potential Concerns of BPD/DS

  • Abdominal bloating and foul-smelling stool or gas may occur.
  • Patients also need to supplement with daily multivitamins and calcium and may be prescribed vitamin B12 and iron by their healthcare professional.

view references

The Surgeons’ Group, P.C.
Dr. John L. Mathews
D.M.D., M.D., F.A.C.S.
Diplomate, American Board of Surgery