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Obesity

Sleeve Gastrectomy

Sleeve gastrectomy is also known as Tube gastrectomy or Vertical gastrectomy, and is a relative newcomer to the field of weight loss surgery. It has evolved from several earlier operations, and is not yet used widely nor is it's long term results yet known. Unlike the adjustable gastric band, this operation is not reversible. However, there are several promising features, and selected patients may benefit more from this operation than others.

How does it work?

Laparoscopic (keyhole) surgery is used to remove most of the stomach, leaving a narrow tube with a capacity of 150 ml, but no obstruction to the passage of food other than the normal muscles. Because the stomach is now much smaller, the person feels full after a much smaller meal, but can usually eat any kind of food. The stomach is mainly a storage facility. Most of the nutrients are absorbed in the small intestine, which remains completely normal. Of course, because all the food that is eaten is absorbed normally, it is still important to choose healthy foods and avoid caloriedense ones. Some studies suggest that because the outer curve of the stomach is removed, a hormone called Ghrelin is no longer secreted, and this might reduce appetite, too. However, this will not reduce the desire to eat when it is driven by emotions such as boredom, loneliness or social expectations. Any operation to help with weight loss is only as effective as the lifestyle changes that go with it.

What are the risks?

Laparoscopic surgery is generally safe compared with open surgery, but there are potential hazards. The procedure requires a general anaesthetic, and patients are usually in hospital for one to two days.

Specific risks of the operation include:

  • Deep vein thrombophlebitis (clots in the legs) 0.5%
  • Non-fatal pulmonary embolus (PE) 0.5%
  • Gastric leak and fistula 1.0%
  • Postoperative bleeding 0.5% to 16%
  • Strictures 2%
  • Splenectomy 0.5%
  • Pneumonia 0.4%
  • Death 0.25%

These risks are higher when the surgery is done in patients who have had previous gastric operations, or have a BMI greater than 50 kg/m2

Long term risks and side effects include:

  • Vomiting in 20%
  • Reflux (some surgeons suggest this occurs in all patients)
  • Anemia
  • Vitamin D deficiency
  • Inadequate weight loss, or late weight re-gain can occur.

Our goal is to lose 60% or more of excess weight.

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