The Gastric Sleeve aides in weight loss by restricting the amount of food that the stomach can hold. 

It was initially performed as part of a much bigger operation called Biliopancreatic Diversion with Duodenal Switch.  This procedure is sometimes used to treat truly Super Obese patients. However, for the majority of patients it is not necessary to re-route the small intestine.  The reduction in the size of the stomach, accomplished with the Gastric Sleeve is sufficient to produce significnat weight loss.




The Gastric Sleeve is similar to the LAP-BAND in that following both proccedures patients are unable to eat very much at a time. With the Gastric Sleeve the narrow tube of stomach will only hold a small amount of food.  But to achieve success, Gastric Sleeve patients,  must learn to choose high qualty foods to ensure adequate nutrition. They must also learn to eat differently: eat slow, take small bites, chew everything well, and avoid drinking with meals. In other words, you must... 

 ...change from "living to eat" to "eating to live." 

Changing a lifetime of eating habits requires commitment and perserverence, as well as regular follow-up by a team of trained professionals.  


Advantages of the Gastric Sleeve

Unlike the LAP-BAND, the Gastric Sleeve does not involve the implanting of a foreign object involved. Instead the procedure involves physically reducing the size of the stomach by removing approximately 3/4 of the stomach. This is also in striking contrast to the Roux-en-Y Gastric Bypass, in that it does not re-route or rearranged the intestinal tract in any way. 

Perhaps the biggest benefit offered by the Gastric Sleeve is the reduction in the sense of hunger. By physically removing a large part of the stomach there are fewer signals being sent to the brain, which normally create the feeling of hunger. Even when patient do have a sense of hunger it is not generally extreme, and takes very little food to satisfy it. Many patients relate they actually have to remind themselves that it is time to eat.

Potential Problems with the Gastric Sleeve

The laparoscopic removal of part of the stomach is performed using a specialized device which seals-off both sides of the stomach with overlapping rows of staples and cuts between them.  

Staple-line Leak

While the staples are typically very secure, it is possible for a leak to occur along the line of resection.  Stomach contents leaking into the abdomen is a serious problem and may require additional surgery to repair the leak.  

If a significant leak is not recognized promptly, it may lead to an overwhelming infection and even death.  Typically if a staple-line leak is to occur it will happen within the first week to 10 days following the procedure. For this reason,  Gastric Sleeve patients are maintained on a liquid diet only for the first couple of weeks to minimize the stress on the staple-line. After a couple of weeks there is very little risk of a leak. 


Bleeding from the Staple-line

Bleeding can be a problem following the Gastric Sleeve procedure because the stomach is one of the most highly vascularized organs in the body. Again, the staples are quite effective for controlling bleeding from the cut edge of the stomach, but if significant bleeding should occur it could require a blood transfusion or re-operation.

To help ensure against either a leak or unexpected bleeding, the Gastric Sleeve procedure includes both the careful laparoscopic inspection of the outside of the gastric tube and an internal examination with a flexible endoscope. During this part of the procedure the stomach is inflated with air and examined from the outside for any evidence of air leaking through staple-line. 


Dilation of the Gastric Sleeve

Over time, dilation of the Gastric Sleeve can occur due to persistent over-eating.  




Eventually the stomach can stretch and the result is a gradual increase in weight as the patient returns to old eating habits.  If this occurs the sleeve can be revised, but this requires another operation.  This situation is best avoided through vigilant attention to eating small portion sizes until new eating habits are well established.


Summary

It is extremely important for any potential patient to recognize that obesity is a complex disease and the Gastric Sleeve alone will not cure this problem. The procedure should be veiwed merely as a tool that is most effective when combined with a comprehensive weight management program.  Only by combining weight loss surgery with dietary counciling, behavior modification and regular exercise is it possible to acheive optimal success.


Optimally, Gastric Sleeve patients can expect to lose up to 75-80% of their extra body weight over the course of 12 to 18 months after the surgery. However, results vary dramatically from individual to individual.