The sleeve gastrectomy, also referred to as gastric sleeve surgery, is a very effective operation that can be done laparoscopic with small incisions and allows patients to lose weight and reduce hunger.
The weight loss with the sleeve gastrectomy has been in the range of 50% to 60% of the excess body weight. This operation is the only bariatric procedure that has no malabsorption (as the gastric bypass Roux-en-Y and Duodenal Switch do) and no foreign body (as the gastric banding does). It has a lower risk compared to the Gastric Bypass, and the relative invasiveness of the procedure is in between the bypass and the banding procedure.
A primary reason people lose weight with the gastric sleeve is because of the significantly smaller stomach size. The reduction of the size of the stomach, to about 60 – 80 cc in volume results in a powerful restrictive weight loss. This is about 7–80% smaller than the normal stomach size. As a result, patients feel full after a very small amount of food, and therefore lose weight because they eat less, and they are happy eating less.
There are also significant effects on the hunger mechanisms that make the weight loss seen with the sleeve gastrectomy even better than would be seen just with a small stomach pouch. Hunger is favorably affected because there is a reduced capacity to produce ghrelin, a substance that plays a role in how you feel, and relieves hunger.
Preservation of Pyloric Valve
Another important fact about the sleeve is that it preserves the pylorus, which is the valve that regulates emptying of the stomach. This acts as a “natural band” and allows food to hold up in the stomach for a while, making the person feel full while the food trickles out. Coupled with the fact that there is no rearrangement of the bowel, it also means dumping and marginal ulcers are not a problem. The normal satiety mechanism (feeling of fullness) is enhanced by this mechanism.
The sleeve gastrectomy (gastric sleeve surgery) operation is done with 5 small incisions, and takes about an hour to do. The stomach is restricted by dividing it vertically and removing more than 85% of it. This part of the procedure is not reversible.
The stomach that remains is shaped like a banana and measures from 1-2 ounces (40-80cc). The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the functions of the stomach while reducing the volume.
By comparison, in a Roux-en-Y gastric bypass, the stomach is divided, not removed, and the pylorus is excluded. There is no intestinal bypass with this procedure, only stomach reduction.
Having the laparoscopic sleeve gastrectomy involves an overnight stay in the hospital. There is no nasogastric tube, and you are able to return to work, resume heavy lifting and strenuous activity, in most cases, in about two weeks from the time of surgery. If you are able to do light duty at work, there is the possibility of going back to work sooner than two weeks for some patients.