Sleeve Gastrectomy Weight Loss Surgery

Why Sleeve Gastrectomy Is Now a Stand-Alone Bariatric Surgery

Surgeons performing open heart surgery

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The sleeve gastrectomy, or vertical sleeve gastrectomy, is a type of bariatric surgery that isolates a small section of the stomach for processing food, limiting the size of meals to approximately one ounce after surgery. In addition to causing weight loss through food restriction, sleeve gastrectomy also decreases levels of an appetite-stimulating hormone called ghrelin—so people feel less hungry and eat less.

The surgery used to be considered a starting point for people who were so morbidly obese that they were not candidates for gastric bypass surgeries, like Roux-en-Y or biliopancreatic diversion, with the expectation that a second surgery would be performed once weight had been lost. Now, research shows that patients can lose a significant amount of weight with sleeve gastrectomy alone and not require a second weight-loss surgery. 

With that, the surgery has gained popularity, as it's considered less radical. In fact, according to a 2013 study in Obesity Surgery, behind Roux-en-Y, sleeve gastrectomy was the second most common bariatric surgery worldwide in 2011. 

The Vertical Sleeve Gastrectomy Procedure

The surgery is typically performed in a hospital or a surgery center, using general anesthesia. Surgeries are performed laparoscopically, which allows the surgeon to work using long instruments placed in the body via incisions a few centimeters long. In some cases, the surgery will be performed “open,” with the larger traditional incision, or a surgery that begins laparoscopically may be converted to the open procedure when the surgeon determines it is necessary.

The surgery begins with multiple half-inch long incisions in the area of the stomach. The instruments are inserted through these incisions, and the surgeon begins by removing up to 80% of the stomach. The sides of the stomach are then joined by staples, leaving the stomach smaller and tubular in shape, but retaining the sphincter muscles at the top and the bottom of the stomach.

Once the surgeon determines that the staples are holding the stomach closed and no areas are leaking, the instruments are withdrawn and the incisions are closed, typically with absorbable sutures and sterile tape. 

Typical Outcomes After Sleeve Gastrectomy

In terms of weight loss outcomes, the good news is that research shows the average weight loss to be over 50%, even after more than six years post-surgery.

The downside is that some people do regain weight after the surgery, mostly when they consume large quantities of food that stretches the pouch. Acid reflux is another potential side effect of this surgery. 

The Bottom Line

The patient who undergoes this procedure must make radical changes in his food intake and lifestyle in order for the procedure to have a successful long-term outcome. Because the stomach has the ability to stretch to accommodate food, the stomach can expand greatly from the one-ounce capacity the surgery allows for. Meals should be small—less than half a cup—and drinking fluids with meals can fill the pouch, preventing the intake of solid food at that time.

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  2. Karmali S, Johnson Stoklossa C, Sharma A, et al. Bariatric surgery: a primerCan Fam Physician. 2010;56(9):873–879.

  3. Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252(2):319-24. doi:10.1097/SLA.0b013e3181e90b31