Gastric Sleeve Surgery

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Gastric sleeve surgery is a relatively new kid on the block when it comes to bariatric surgery. Technically called gastric sleeve resection, it is typically used to safely jump-start the surgical weight loss process in people who are too obese or sick to have more invasive weight loss surgeries or are not candidates for gastric banding procedures, such as Lap Band surgery or Realize Band Surgery.

Put another way, gastric sleeve surgery lets such people reach a safe weight so they can then undergo the more radical gastric bypass surgery or duodenal switch surgery. The American Society for Metabolic and Bariatric Surgery states that this is the most useful application of gastric sleeve surgery at this time, because it appears to be faster and/or easier than other weight loss surgeries in these high-risk people.

Other names for gastric sleeve resection are sleeve gastrectomy, vertical sleeve gastrectromy, tube gastrectomy and laparoscopic sleeve gastrectomy.

How Gastric Sleeve Surgery Works

During this procedure a bariatric surgeon removes about 60 percent of the stomach so that it takes the shape of a tube or sleeve.

Surgeons Perform First-Ever Weight Loss Surgery Through the Vagina

Surgeons at the University of California San Diego Center for the Future of Surgery recently performed the nation's first-ever bariatric surgery — a gastric sleeve or sleeve gastrectomy — through the vagina.

Typically, gastric sleeve surgery is performed laparoscopically. This means that the surgeon makes small five small incisions in the abdomen and then inserts a viewing tube with a small camera (laparoscope) and tiny surgical instruments into these small incisions to remove part of the stomach. The tube-shaped stomach that's left is sealed and closed with staples.

In contrast, when the procedure is performed through the vagina, fewer incisions are needed because the vagina provides a natural opening. Specifically, one incision is placed in the belly button through which a laparoscope is placed to view the abdomen. The second incision is placed just below the sternum to insert an instrument used to retract the liver.

The gastric sleeve surgery is then performed by entering the vagina and making a small incision behind the uterus through which the abdomen and stomach could be accessed with surgical tools. The stomach is reduced in size using conventional surgical staplers. The excess stomach is then pulled down through the abdomen and out of the vagina.

The process of performing surgery through a natural opening such as the vagina is known as natural orifice translumenal endoscopic surgery.

Advantages of Gastric Sleeve Surgery Through the Vagina

"We are trying to tease out the benefits of doing the surgery transvaginally," says Garth Jacobsen, MD, an assistant professor of surgery at the University of California at San Diego. "There are fewer incisions, so there will be a better cosmetic result, a lower rate of hernia and presumably less pain."

Two kinds of hernias may develop after bariatric surgery. An incisional hernia is a weakness that sticks out from the abdominal wall's connective tissue and may cause a blockage in the bowel. An internal hernia, however, occurs when the small bowel is displaced into pockets in the lining of the abdomen. These pockets are created when the intestines are sewn together. Fewer incisions mean a lower risk of incisional hernias.

The Wave of the Future

Other bariatric surgeries, such as gastric banding and gastric bypass, likely will not be performed through the vagina at this time, according to Dr. Jacobsen. "With gastric banding, we are placing an instrument through the vagina (the band), so there is some concern about an infection," he says. Still, he adds, "I definitely do believe natural orifice surgery is the wave of the future."

This operation is performed laparoscopically, meaning that the surgeon makes small incisions as opposed to one large incision. He or she inserts a viewing tube with a small camera (laparoscope) and other tiny instruments into these small incisions to remove part of the stomach. The tube-shaped stomach that is left is sealed closed with staples.

It is often followed by a gastric bypass or duodenal switch after the patient has lost a significant amount of weight. Called a "staged" approach to weight loss surgery, this makes the second procedure less risky than it would have been had it been the first and only procedure.

The timing of the second surgery varies according to the degree of weight loss. It usually occurs within six to 18 months.

Who Is a Good Candidate for Gastric Sleeve Surgery?

No reliable statistics exist yet for how many of these procedures have been done, but gastric sleeve resection is typically reserved for people who are super-super obese, meaning they have a body mass index (BMI) of more than 60, or for those who are not in appropriate physical condition to undergo gastric bypass surgery or other more radical weight loss surgeries.

A BMI takes height and weight into account to measure body fatness, and a BMI of 30 or higher in adults is considered obese. [Read more about body mass index, and use our BMI calculator.]

Gastric sleeve surgery may be appropriate also for people who can't return for the follow-up visits required by gastric banding.

What to Do Before Gastric Sleeve Surgery

Before gastric sleeve resection or any bariatric surgery, you must quit smoking, as smoking increases the risk for infections, pneumonia, blood clots, slow healing and other life-threatening complications after surgery. Ideally, quitting smoking should be permanent, but you must quit for at least one month before and one month after bariatric surgery.

Some surgeons require patients to go on special diets in the week(s) before the procedure.

What to Expect After Gastric Sleeve Surgery

The non-reversible surgery is performed under general anesthesia and takes about one to two hours. Afterward you would probably stay in the hospital for one or two days, and recovery from gastric sleeve surgery may last a few weeks.

The abdomen is often swollen and sore for several days. Your surgeon may prescribe pain medication for the discomfort. Some scarring may occur, but this can be covered with clothing.

You would need to become re-used to eating solid foods. Normally this starts with two weeks on a liquid-only diet, two weeks of semi-solid, pureed foods and then solids.

As far as weight loss goes, most people who have gastric sleeve surgery lose 30 to 50 percent of their excess body weight over six months to one year. Studies have shown that after the gastric sleeve resection procedure people show improvement in diabetes, high blood pressure, high cholesterol and sleep apnea within one to two years. These improvements are comparable with those seen after other weight loss surgeries.

As this is a relatively new procedure, no data is available yet on long-term weight loss or overall health improvements.

Certain lifestyle changes and follow-up care occur afterward; people who have gastric sleeve surgery must:

Exercise regularly.
Learn behavior modification techniques.
Follow very specific dietary instructions, including eating very slowly, consuming only small quantities of food at a time, chewing thoroughly and swallowing food only when it is mashed, and not eating and drinking at the same time.

Gastric Sleeve Surgery Risks and Complications

Risks and complications include:

Leaking of the sleeve. The operation requires staples to be inserted into the stomach, and there is always a chance that the staples will tear apart, resulting in a leak. The leaking stomach acids frequently become infected and can cause serious problems that may require another operation or a drainage tube.
Blood clots
Weight may be regained over time, because the stomach can stretch.
Unlike gastric banding surgeries, no foreign objects are left in the body during the procedure. With gastric banding, the band may slip, erode or become infected.
Unlike gastric bypass or duodenal switch, there is no bypass of the small intestines with the gastric sleeve, so all nutrients are absorbed and very little chance exists of absorption issues.
Wound infection

Since this procedure is relatively new, long-term risk and benefits are not known.

Cost of Gastric Sleeve Surgery

Because this procedure is new, it is still considered experimental. Insurers are beginning to cover the cost of gastric sleeve surgery. In particular, Aetna and United Healthcare now cover this procedure. The average cost of gastric sleeve surgery may be upward of $10,000.

Please visit our weight loss surgery cost page for an overview of cost information or you can review specific information about lap band cost, realize band cost or gastric bypass cost.

Plastic Surgery After Massive Weight Loss

Although the full extent of weight loss may not occur until after a second procedure has been performed, such as gastric bypass, it is important to know that plastic surgery after massive weight loss may be necessary to remove excess skin and fat and create a more shapely body profile. Arm lift surgery and body lift are common post-bariatric procedures.