What is the Sleeve Gastrectomy?

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1 What is the Sleeve Gastrectomy? The Sleeve Gastrectomy (also referred to as the Gastric Sleeve, Vertical Sleeve Gastrectomy, Partial Gastrectomy, or Tube Gastrectomy) is a relatively new procedure for weight loss. It involves the permanent removal of 85-90% of the stomach, performed under a General Anaesthetic using advanced laparoscopic keyhole surgery. Although the physical size of the stomach is reduced, the normal direction of the food stream through the stomach and the rest of the intestinal tract is not altered. This means that all nutrients including vitamins, minerals and protein will continue to be absorbed normally. It simply reduces the holding capacity from about 1.5 litres of food and liquid to approximately 200mls. This allows a person to feel comfortably satisfied and full with a meal size approximately equivalent to a cup of food. Despite being smaller, the stomach sleeve still functions normally; food and nutrients continue to enter and leave in the same way, acid continues to be made to assist in digestion, and essential vitamins and minerals can be absorbed normally.

2 How does it work? The Sleeve Gastrectomy appears to work in three distinct ways: 1. The major reduction in stomach capacity allows patients to become full and satisfied with a much smaller meal, providing portion control. 2. Levels of the hunger hormones are reduced by 50-65%, as the removed part of the stomach is rich in cells that make these hormones. Patients consistently report feeling less hungry between their meals as a result of this. 3. There appears to be a change in way that fatty foods are handled by the digestive track - patients frequently report losing their taste for foods high in sugar and fat such as chocolate, fried food and soft drinks. Dietitians like this aspect of the Sleeve- it helps patients adopt healthier eating habits. Advantages Easier, simpler, safer than gastric bypass. No dumping syndrome or risk of intestinal obstruction such as occurs in gastric bypass. Little or no malabsorption or risk of malnutrition so there is no need to take vitamin or mineral pills for life. No foreign body to get infected as sometimes occurs with gastric banding. No need for intensive follow up - is essential for gastric bandingmaking it ideal for those living in remote areas. Can be converted to a gastric bypass in the event of complications or poor weight loss.

3 Disadvantages Irreversible procedure. You cannot put the removed stomach portion back! It is not as safe as gastric banding. Cannot be converted to a gastric band procedure. It can sometimes make acid reflux problems worse. Weight gain will occur if the tube stretches up and this is a concern for longer-term weight control. Being relatively new, the longer-term results for weight loss are unknown. Am I Eligible? The Sleeve Gastrectomy procedure may be suitable if: You have a BMI of at least 35 You have not been able to control your weight despite several genuine attempts at diet and exercise Your weight problem is not caused by an underlying endocrinological disorder or medication You are at least 16 years of age (note there is no upper age limit) If you also have type-2 diabetes, high blood pressure, sleep apnoea, or other obesity related medical disorders, or have a family history of these problems, weight loss surgery may be especially beneficial in improving your health and longevity. The Sleeve Gastrectomy procedure may not be possible if you have had some types of surgery on your stomach organ in the past. Examples of surgery that may make it impossible to have a Sleeve include anti-reflux or hiatus hernia surgery, and removal of part of your stomach to treat cancer or an ulcer. Please check with us if you have a history of any procedures on your stomach organ.

4 Converting from a Band to the Sleeve It is possible to convert to the Gastric Sleeve if you have a Gastric Band, or have had one in the past, and have not succeeded in losing enough weight. The risks in converting from one type of procedure to another are higher than for the original procedure. This increased risk has to be balanced against the perceived benefits of changing. It is important to understand why the Band has not worked for you. Everyone s circumstances are unique, and Dr Wright and the team will meet with you to go through your situation and explain your options. What are the risks of Gastric Sleeve? Because the stomach itself has to be divided, there are some additional risks over Gastric Banding in the early post-operative period. One problem is that gastric fluid may leak through the staple line if healing along the staple line is not perfect. This causes infection around the outside of the Gastric Sleeve, and can be quite serious. Recovery may take several weeks, and treatment usually involves the use of antibiotics, surgical drains, and gut rest. Additional procedures such as re-operation and endoscopy are also commonly needed. The risk of this complication is around 2%, and is suspected if a patient develops fevers or abdominal pain in the early post operative period. Early treatment is the key to managing this problem successfully, so it is important to be on the watch for these symptoms and return back to the hospital without delay if concerns exist. Excessive narrowing of the stomach tube can occur in rare cases (1%), which can also require further procedures such as endoscopy or even surgery to prevent too much weight loss. Other complications that can occur include internal injuries, bleeding, blood clots in the leg veins or lungs, infections in the abdomen, chest or wounds, and allergic reactions to anaesthesia or medication.

5 These problems may occur following any surgical procedure, and precautions are taken in all patients to reduce these risks to the absolute minimum. Obviously this is not a complete list of all the possible complications but includes the commonest ones and the rare but more serious ones. Speak to Dr Wright about any specific complications that you may be at risk of.

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