Sleeve gastrectomy

Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach along the greater curvature. The result is a sleeve or tube like structure. The procedure permanently reduces the size of the stomach, although there could be some dilation of the stomach later on in life. The procedure is generally performed laparoscopically and is irreversible.

Sleeve gastrectomy
Diagram of a gastric sleeve
ICD-9-CM43.89

A meta-analysis of 174,772 participants published in The Lancet in 2021 found that bariatric surgery was associated with 59% and 30% reduction in all-cause mortality among obese adults with or without type 2 diabetes respectively.[1] This meta-analysis also found that median life-expectancy was 9.3 years longer for obese adults with diabetes who received bariatric surgery as compared to routine (non-surgical) care, whereas the life expectancy gain was 5.1 years longer for obese adults without diabetes.[1]

Procedure

Sleeve gastrectomy was originally performed as a modification to another bariatric procedure, the duodenal switch, and then later as the first part of a two-stage gastric bypass operation on extremely obese patients for whom the risk of performing gastric bypass surgery was deemed too large. The initial weight loss in these patients was so successful it began to be investigated as a stand-alone procedure.[2]

Sleeve gastrectomy is the most commonly performed bariatric surgery worldwide.[3][4] In many cases, sleeve gastrectomy is as effective as gastric bypass surgery, including improvements in glucose homeostasis before substantial weight loss has occurred. This weight-loss independent benefit is related to the decrease in gastric volume, changes in gut peptides, and expression of genes involved in glucose absorption.[5][6]

Sleeve gastrectomy surgery.

The procedure involves a longitudinal resection of the stomach starting from the antrum at the point 5–6 cm from the pylorus and finishing at the fundus close to the cardia.[7] The remaining gastric sleeve is calibrated with a bougie. Most surgeons prefer to use a bougie between 36 and 40 Fr with the procedure and the ideal approximate remaining size of the stomach after the procedure is about 150 mL.[8]

Requirements

Sleeve gastrectomy is not for everyone. The following requirements should be fulfilled in order to qualify as a candidate for sleeve gastrectomy.

  1. BMI (body mass index) for gastric sleeve should be 40 or higher[9]
  2. BMI should be 35 or higher if they have obesity-related conditions such as diabetes, hypertension, sleep apnea or fatty liver disease.

Use in children and adolescents

Endorsed by the International Federation for the Surgery of Obesity and Metabolic Disorders[10] and the American Society for Metabolic and Bariatric Surgery,[11] sleeve gastrectomy is gaining popularity in children and adolescents. Studies by Alqahtani and colleagues have found that sleeve gastrectomy causes large weight loss in children and adolescents aged 5 to 21 years.[12] Moreover, they compared weight loss with adults and found comparable weight loss.[13] Recent reports from the group show that growth progresses unaffected after sleeve gastrectomy in children younger than 14 years of age.[14] Depression following the procedure has been noted in some individuals. Another side effect is insomnia. After this surgery many people can only sleep when they take melatonin or sleeping medications.[15]

Complications

Sleeve gastrectomy may cause complications; some of them are listed below:[16]

References
  1. Syn, Nicholas L.; Cummings, David E.; Wang, Louis Z.; Lin, Daryl J.; Zhao, Joseph J.; Loh, Marie; Koh, Zong Jie; Chew, Claire Alexandra; Loo, Ying Ern; Tai, Bee Choo; Kim, Guowei (2021-05-15). "Association of metabolic-bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants". Lancet. 397 (10287): 1830–1841. doi:10.1016/S0140-6736(21)00591-2. ISSN 1474-547X. PMID 33965067. S2CID 234345414.
  2. "The History of Sleeve Gastrectomy : Bariatric Times". Archived from the original on 2020-11-01. Retrieved 2020-10-09.
  3. Chung AY, Thompson R, Overby DW, Duke MC, Farrell TM (August 2018). "Sleeve Gastrectomy: Surgical Tips". Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 28 (8): 930–937. doi:10.1089/lap.2018.0392. PMID 30004814. S2CID 51625639.
  4. Spiegel HU, Skawran S (January 2011). "From longitudinal gastric resection to sleeve gastrectomy--revival of a previously established surgical procedure". Journal of Gastrointestinal Surgery. 15 (1): 219–28. doi:10.1007/s11605-010-1293-9. PMC 3023025. PMID 20725800.
  5. Hutch CR, Sandoval D (December 2017). "The Role of GLP-1 in the Metabolic Success of Bariatric Surgery". Endocrinology. 158 (12): 4139–4151. doi:10.1210/en.2017-00564. PMC 5711387. PMID 29040429.
  6. Cavin JB, Couvelard A, Lebtahi R, Ducroc R, Arapis K, Voitellier E, Cluzeaud F, Gillard L, Hourseau M, Mikail N, Ribeiro-Parenti L, Kapel N, Marmuse JP, Bado A, Le Gall M (February 2016). "Differences in Alimentary Glucose Absorption and Intestinal Disposal of Blood Glucose After Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy". Gastroenterology. 150 (2): 454–64.e9. doi:10.1053/j.gastro.2015.10.009. PMID 26481855. S2CID 5214667.
  7. Paluszkiewicz R, Kalinowski P, Wróblewski T, Bartoszewicz Z, Białobrzeska-Paluszkiewicz J, Ziarkiewicz-Wróblewska B, Remiszewski P, Grodzicki M, Krawczyk M (December 2012). "Prospective randomized clinical trial of laparoscopic sleeve gastrectomy versus open Roux-en-Y gastric bypass for the management of patients with morbid obesity". Wideochirurgia I Inne Techniki Maloinwazyjne = Videosurgery and Other Miniinvasive Techniques. 7 (4): 225–32. doi:10.5114/wiitm.2012.32384. PMC 3557743. PMID 23362420.
  8. Karmali S, Schauer P, Birch D, Sharma AM, Sherman V (April 2010). "Laparoscopic sleeve gastrectomy: an innovative new tool in the battle against the obesity epidemic in Canada". Canadian Journal of Surgery. 53 (2): 126–32. PMC 2845949. PMID 20334745. Archived from the original on 2020-02-16. Retrieved 2014-04-11.
  9. "What is VSG Surgery". Jet Medical Tourism. 23 July 2020.{{cite web}}: CS1 maint: url-status (link)
  10. "International Federation for the Surgery of Obesity and Metabolic Disorders". Archived from the original on 2020-11-29. Retrieved 2021-01-20.
  11. "Bariatric Surgery Procedures". The American Society for Metabolic and Bariatric Surgery (ASMBS). Archived from the original on 2014-06-10. Retrieved 2014-03-12.
  12. Alqahtani AR, Antonisamy B, Alamri H, Elahmedi M, Zimmerman VA (August 2012). "Laparoscopic sleeve gastrectomy in 108 obese children and adolescents aged 5 to 21 years". Annals of Surgery. 256 (2): 266–73. doi:10.1097/SLA.0b013e318251e92b. PMID 22504281. S2CID 5977126.
  13. Alqahtani A, Alamri H, Elahmedi M, Mohammed R (November 2012). "Laparoscopic sleeve gastrectomy in adult and pediatric obese patients: a comparative study". Surgical Endoscopy. 26 (11): 3094–100. doi:10.1007/s00464-012-2345-x. PMID 22648112. S2CID 22587054.
  14. Alqahtani A, Elahmedi M, Qahtani AR (February 2016). "Laparoscopic Sleeve Gastrectomy in Children Younger Than 14 Years: Refuting the Concerns". Annals of Surgery. 263 (2): 312–9. doi:10.1097/SLA.0000000000001278. PMID 26496081. S2CID 32909515.
  15. "Depression after Gastric Bypass Surgery". Psychology Today. Archived from the original on 2021-01-20. Retrieved 2019-04-18.
  16. "What is VSG?". Mexico Bariatric Center. 2020-10-08. Archived from the original on 2020-10-21. Retrieved 19 October 2020.
  17. "Gastric Sleeve Surgery: Common Risks and Complications". Gastric Sleeve Diet Guide. 2016-10-11. Archived from the original on 2017-03-16. Retrieved 16 March 2017.
  18. "Gastric Sleeve Complications Post Surgery". BSIG. Archived from the original on 23 July 2013. Retrieved 5 August 2013.
  19. "Depression after Gastric Bypass Surgery". Psychology Today. Archived from the original on 2021-01-20. Retrieved 2019-04-18.

Further reading
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