A sleeve gastrectomy is an operation to reduce the size of the stomach by removing about 80% of it. This is achieved by stapling the stomach along its length and removing the excised portion, leaving a long tube or sleeve. Generally, it is a technically more straightforward operation than a gastric bypass so is associated with a lower complication risk.

The operation takes about 1.5 hours and is done under general anaesthesia, which means you will be asleep during the procedure. Sleeve gastrectomy is usually performed using keyhole (laparoscopic) surgery. In most cases, you will be able to go home two to three days after your operation but it usually takes between two to three weeks to make a full recovery from a sleeve gastrectomy operation. 

 

 

 

How does the sleeve gastrectomy work?

The Sleeve gastrectomy serves three purposes: 

1. It is a restrictive procedure, meaning that it achieves weight loss by restricting the amount of food that can be eaten at a meal due to the small size of the new stomach ‘sleeve’. 
2. It removes part of the stomach that produces some of the hormones that stimulate appetite and hunger. The removal of these hormones results in a significant reduction in appetite and a change in taste and food preferences.
3. It reduces the body’s fat set point, increasing sensitivity to leptin, making people feel full and possibly increasing metabolism.

 

Expected weight loss

• Much of the excess weight is lost over the first year after surgery. 
• On average, people lose about 50 – 60% of their excess weight, although this varies from person to person. That is, 50-60% of the extra weight you are carrying over and above your ideal weight for your height.
• A recent study showed that a large number of patients kept at least 55% of the excess weight off 5 years after surgery. 
• It can help with remission of type 2 diabetes. Many patients come off or reduce their medication soon after the operation as they lose weight.
• It reduces the risk of heart disease, stroke and death from obesity.
• Many obesity-related conditions such as obstructive sleep apnoea, high blood pressure and joint pains are either completely resolved or substantially improved following surgery. 
• Long-term sustained weight loss and improvement in obesity-related health conditions will only occur with healthy eating and regular exercise. 

Things to consider

• The amount of food you can eat is reduced. It is therefore important to eat a healthy, balanced and varied diet for a healthy body
• It is important to remember the operation will not stop you from craving certain foods or eating what you fancy
• Sleeve gastrectomy is best seen as a tool that makes healthy lifestyle changes sustainable
• You will need to take multivitamin and mineral supplements daily to avoid nutritional deficiencies
• Nausea and vomiting may occur particularly in the first few days after surgery. Vomiting is common if you eat a lot too quickly or don’t chew properly.
• Acid reflux can be a persistent problem in a minority after sleeve gastrectomy
• Some people experience hair thinning; this is usually temporary and associated with weight loss in the first few months.

What are the advantages of a sleeve gastrectomy?

• The average excess weight loss over the first 3 years after a sleeve gastrectomy is similar to gastric bypass.
• It is a technically more straightforward operation in a gastric bypass and can usually be offered to most patients, including those were a gastric bypass may not be possible.
• Its complication risk is about half that of a gastric bypass.

 

What are the risks of a sleeve gastrectomy? 

As with all major surgery sleeve gastrectomy has some risks. These risks vary according to your age and other illnesses you may have but up to 5% of people may have a complication following surgery. For most people, the benefits in terms of losing excess weight are much greater than the disadvantages of experiencing any discomfort. In order to make an informed decision, you need to be aware of the possible risk of complications which include:

 

 

In summary

The sleeve gastrectomy is an effective tool which can help you lose at least half of your excess weight and improve diseases related to obesity such as type 2 diabetes, high blood pressure, sleep apnoea and asthma. However, if you do not make healthy lifestyle choices you may regain some of the weight lost. Although there are risks associated with the surgery, if you have severe obesity, the benefits usually outweigh the risks. It is important however to understand that the gastric sleeve is permanent and cannot be reversed. You are advised to do as much research as you can and perhaps speak to people who have had surgery about their experience and lifestyle after surgery so you can make an informed decision about whether surgery is the right treatment for you.