Gastric Sleeve Surgery (Sleeve Gastrectomy):


Overview:


Gastric sleeve surgery, or sleeve gastrectomy, is a bariatric procedure where approximately 75-80% of the stomach is removed, leaving a narrow gastric "sleeve." This new stomach is much smaller, holding less food, which leads to weight loss by reducing both the amount of food intake and the production of hunger-stimulating hormones like ghrelin.


Procedure:


  • The surgeon removes a large portion of the stomach along its greater curvature using a stapling device.

  • The remaining stomach is shaped like a tube or sleeve, which significantly reduces its volume.


Indications for Gastric Sleeve Surgery:


  • BMI Criteria:

    • A BMI of 40 kg/m² or higher.

    • A BMI between 35-39.9 kg/m² with at least one obesity-related comorbidity like type 2 diabetes, hypertension, sleep apnea, or heart disease.

    • For some populations, like those of Asian descent, a BMI of 27.5 kg/m² or higher with comorbidities might qualify.

  • Health Comorbidities:

    • Patients with obesity-related health conditions that are poorly controlled with lifestyle changes and medication might benefit from surgery. This includes conditions like severe joint disease, non-alcoholic fatty liver disease, or polycystic ovary syndrome.

  • Unsuccessful Weight Loss:

    • Patients who have tried and failed to lose weight through diet, exercise, and other non-surgical methods.

  • Medical Conditions Making Other Surgeries Risky:

    • Sleeve gastrectomy might be preferred over other surgeries like gastric bypass for patients who have conditions that increase the risk of complications with intestinal rerouting.

  • Age:

    • Generally performed on adults, but can be considered for adolescents who meet specific criteria for severe obesity.

  • Patient Suitability:

    • Patients must be psychologically prepared for the significant lifestyle changes post-surgery, including diet modification and commitment to follow-up care.


Advantages of Gastric Sleeve Surgery:


  • Can result in significant weight loss, often 60-70% of excess body weight.

  • Does not involve rerouting or reconnecting the intestines, reducing some surgical risks.

  • Less malabsorption compared to procedures like gastric bypass or duodenal switch.

  • May improve or resolve obesity-related conditions like diabetes, high blood pressure, and sleep apnea.


Considerations:


  • It's irreversible since part of the stomach is removed.

  • Requires lifelong commitment to nutritional guidelines and vitamin supplementation due to the reduced stomach size.

  • Potential risks include leaks at staple lines, strictures, and the need for further surgery if weight loss is inadequate.


For detailed information on outcomes, risks, and long-term effects, consulting with bariatric specialists and reviewing guidelines from institutions like the American Society for Metabolic and Bariatric Surgery (ASMBS) would be beneficial.