Sleeve Gastrectomy surgery ...the procedure

This is a simple enough procedure which takes less than an hour to complete. It is performed laparoscopically (keyhole surgery) and under a general anaesthetic.

Your surgeon will make a series of small incisions in the abdomen. He/she will then insert a series of instruments which also includes a small camera. This camera is attached to a thin viewing tube and is able to relay what it focuses on onto a large video screen in the theatre. This screen enables the surgeon to have a close up view of the operation site. This is also useful for the placement of the instruments and the stapling of the stomach.

Your surgeon will then remove a large portion of the stomach: the remaining section is stapled together to form a banana shaped tube or sleeve. He/she does not interfere with the small intestine – no cutting or bypassing so food absorption is not affected. It is unlikely that you will have to take any dietary supplements although this will be discussed with you in your aftercare sessions.

There are no changes to the normal digestive functions of the stomach: food will travel down the gullet through to the stomach before carrying on through the small and large intestines.

Your much smaller stomach will mean smaller portions of food so weight will start to be lost. And there’s another bonus as well: the large portion of your stomach that has been removed contained the ‘hunger hormone’ ghrelin. This hormone is directly responsible for stimulating your appetite. This has now been removed which means that you will not experience hunger pangs!

This will reduce your appetite which means you will eat smaller meals so calorie intake will drop. And this drop means weight will be lost.

It can be the case that this surgery alone will achieve your weight loss goals. Many patients have reported that the surgery has so well that they do not need any more procedures. However, there are those patients who require further surgery, in the form of a gastric bypass or duodenal switch. In these cases they are advised to wait for a year before having further surgery. This is what as known as a ‘two stage’ approach.

It is also considered much safer: obesity surgery can be risky and for those patients who are severely or morbidly obese the risks are even greater. So, rather than undergoing what could be a potentially life threatening procedure due to the complexity, time and physical demands on the patient, breaking this down into two individual procedures is a better option. Less risky for the patient and the surgeon.

Sleeve gastrectomy with duodenal switch or gastric bypass

This is the name given to the full, two stage procedure. The first stage, the sleeve gastrectomy is performed first and the second stage, either a bypass or a switch is performed a year later. This is seen as one way of reducing the risks for the obese patient. This is not to say that both aren’t performed at the same time: in some cases the full procedure will be undertaken but surgeons often prefer to do it in two stages.

This is classed as a combination or restrictive/malabsorption procedure.

The duodenal switch is a much more technically demanding procedure and can take around 3 hours to complete. The sleeve gastrectomy is the restrictive element and that is fairly straightforward.

The more complex part is the bypass or switch. The reason for this is that involves dividing the small intestine and then rerouting the passage of food through the digestive system. This affects food absorption, with the result being that the patient has to take a daily nutritional supplement for the rest of his/her life.

The duodenal switch (DS) element is very similar to the biliopancreatic diversion (BPD/DS) with one difference: the surgeon will leave a larger portion of stomach than for the BPD/DS.

What this means for the patient is that they face a complex procedure with a higher degree of risk. This equally applies to the gastric bypass. The risks are greater for those patients with a high BMI but if we keep it in perspective, they only account for 2% of cases.

On the plus side, weight loss can be as much as 80%, or even 90% has been known. It can resolve or even cure Type 2 diabetes and, improve or reduce the risks from other obesity-related conditions. As a greater portion of the stomach is left this does mean that the patient is able to consume bigger portions of food than those who have had the sleeve, bypass or gastric band. They do still need to follow a sensible eating plan, take exercise and attend the follow up sessions on a regular basis.

Sleeve Gastrectomy surgery guide sections

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