VERTICAL SLEEVE GASTRECTOMY

Vertical Sleeve Gastrectomy is a very effective Bariatric Surgery weight loss operation, in which a thin vertical sleeve of stomach is created using a stapling device with keyhole surgery.


The human stomach is a distensible pouch-shaped organ. It can hold as much as two, to three litres.  During a Sleeve Gastrectomy, the stomach is changed from a pouch to a thin, vertical sleeve by using a stapling device to remove up to 90% of the stomach. The newly created gastric sleeve will only hold between 50-150ml, which is about the size of a banana.


Despite being smaller, the stomach sleeve still functions in a normal manner:


  • Food passes through the digestive tract in the usual order

  • Acid continues to be made to assist digestion

  • Vitamins and nutrients continue to be fully absorbed into the body




A Sleeve Gastrectomy allows you to eat much less but still enjoy your food and feel satisfied by:


  • Portion control: It allows you to feel full and satisfied with smaller meals and prevents overeating

  • Hunger control: You feel less hungry in between meals. This operation not only reduces the stomach capacity, but also alters appetite by changing the patient's biochemical response to food.

  • Healthier food choices: It changes the way the gut handles sugary and fatty foods, causing reduced desire for these foods and making healthier food choices easier for the individual.

  • Altered metabolism: It changes the blood levels of metabolically active gut hormones and affects the complex biochemical pathways - regulating appetite and metabolism. For example, this leads to changes in blood sugar metabolism independent of weight loss.


Patients typically lose 65-70% of their excess body weight. By comparison, non-surgical weight loss options achieve an average weight loss of 10%. Keep in mind, these are only the average weight loss figures.

The best results are achieved when a multidisciplinary team supports patients though both surgical and lifestyle options.

WHAT ARE THE POTENTIAL BENEFITS OF CHOOSING A SLEEVE GASTRECTOMY?

It is an effective weight loss operation


Patients lose more weight after a Sleeve Gastrectomy, than after a Gastric Band. The weight loss is equal to that seen after a Gastric Bypass, but with fewer complications. After a Sleeve Gastrectomy, people typically lose 65-70% of their excess weight.


• It effectively resolves obesity related health problems


Once again, it resolves obesity related health problems more effectively than a Gastric Band. The results are equivalent to those seen after Gastric Bypass, but there are fewer complications.

For instance: Eight out of ten people with Type 2 Diabetes go into remission and are able to stop taking diabetic medication.


• It requires fewer follow-up appointments


A Sleeve Gastrectomy has fewer potential post-operative problems than a Gastric Bypass and therefore requires fewer follow up appointments during the first few months after surgery.

In the long-term, a Sleeve Gastrectomy is expected to cause fewer nutritional deficiencies than Gastric Bypass and therefore would require less frequent monitoring.

In contrast to a Gastric Band, a Sleeve Gastrectomy does not require follow-up appointments for adjustments. It also has fewer potential long-term problems or weight regain that requires monitoring months to years after surgery.

Typically, once patients have recovered from the Sleeve Gastrectomy procedure, few things tend to go wrong down the track. It can almost be called a “set and forget” operation.

WHAT COULD BE POTENTIAL DISADVANTAGES WHEN CHOOSING A SLEEVE GASTRECTOMY?

Fewer patients develop complications after a Sleeve Gastrectomy than after a Gastric Bypass. However, when complications do occur they can potentially be harder to fix.


• Staple line leak.


A leak from the staple line can occur in 1% of cases. Early detection and management is crucial to give the patient the best chance of a quicker, smoother recovery. However, in some cases if a leak occurs the recovery time can be lengthy. If leaks are going to occur, they typically present in the first two weeks after the operation. Once past this point, few things can go wrong.


• Reflux


Severe pre-existing reflux and heartburn may not be well controlled by this operation. In some cases, a Gastric Bypass may control these severe symptoms more effectively.


• Limited long-term data about weight loss maintenance


People tend to have some weight regain a few years after their weight loss operation, regardless of the type of operation chosen.


A Sleeve Gastrectomy is a relatively new weight loss procedure. The first long term studies showing results beyond five years are becoming available.

Weight regain after a Sleeve Gastrectomy seems to be same as with after a Gastric Bypass. Fortunately, after a Gastric Sleeve or Bypass, the patients’ weight does not return to previous levels. This is not the case with patients who choose a Gastric Band. If the restriction provided by a Gastric Band is removed, the patient typically regains the lost weight and sometimes more.

In the event of weight regain, patients can elect to undergo a second procedure such as; Re-do Sleeve Gastrectomy, Gastric Bypass or a duodenal switch with biliopancreatic diversion. This second surgery is safer to do because they have a lower BMI and fewer co-morbidities than before their Sleeve Gastrectomy.

WHAT IS THE POSTOPERATIVE COURSE LIKE?

n laparoscopic surgery the postoperative recovery is short as the bodily pain from the abdominal wall is minor due to the absence of a long incision. Low doses of painkillers are usually sufficient. Also the inner organs start their work and recover sooner after laparoscopic procedure, which allows quick re-alimentation and an early discharge from hospital.


Nausea and vomiting are usual in most patients during the first couple of postoperative days.

At night after the operation and the first day after the Gastric tea, water and liquids only are offered, on the second day soup and yogurt. 

Usually one night after the operation is spent at the ICU, hospitalization at the ward lasts a further two days.


The removal of external stitches (10th- to 20th day) could be done either by a family doctor (GP) a NHS Walk-in Centre or at the surgical outpatient department. You will be given a letter for your GP explaining him/her your surgery. It is recommended that patients should visit their GP for a blood test and general health check twice at least in the first year, to ensure there are no problems with mineral and vitamin deficiencies which could possibly occur during any period of rapid weight loss. Thereafter it is recommended that an annual test should be carried out. Some nutritional supplements of some minerals esp. calcium and iron and vitamins, especially B, D and folic acid are suitable in form of one multivitamin tablet a day especially within first months after the surgery. We strongly suggest Gastric patients take 1 x multivitamin with minerals and iron, 1 x calcium (not at the same time as the iron), and 1 x Vitamin B12 supplement daily after surgery

At least written email, text message or telephone information on post -operative weight loss and progress has to be sent to BodyClinique, for onward transmission of statistical data to Dr M.Cierny.

Immediate check-up is necessary anytime in case of any problems either at home country or in Breclav Hospital.

WHAT IS THE LENGTH OF THE HOSPITALISATION?

The operation is scheduled to be performed by a minimally invasive approach, therefore if everything goes normally the discharge should be on the third postoperative day.

ARE THERE ANY SIDE EFFECTS?

Heartburn and other signs of gastro-oesophageal reflux occur frequently and have tendency to decrease. The lifelong change in eating habits has to be accepted and kept, otherwise some deglutination problems may occur. Within the phase of rapid weight loss especially within the first year after the WLS it is recommended to women not to become pregnant. Some temporary hair loss can be quite common during periods of rapid weight loss (whether the weight loss is as a result of surgery or “conservative” means). These effects can be minimised or avoided by following a protein-rich diet and ensuring daily oral vitamin & mineral supplements are taken.

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