Sleeve gastrectomy

Sleeve gastrectomy is a procedure in which a large portion of the stomach (approximately 80%) is removed and a part whichcontains around 100-150ml of food is left. As the name suggests, during the surgery the stomach is shaped into a sleeve. Initially, it was believed that the restriction, i.e. a mechanical limitation of the amount of consumed food, isprimarily responsible for the result of the surgery. Now we know that the procedure has a very strong metabolic effect. The removed part of the stomach is the main source of the hormone responsible for the feeling of hunger (ghrelin), therefore, the treated patients do not feel hunger at all or do not feel it so strongly.It does not apply to the period preceding the menstruation when female hormones stimulate appetite regardless of ghrelin production.

Who is the sleeve gastrectomy for?

Sleeve gastrectomy is recommended for individuals with higher degrees of obesity, i.e. for those whose body mass index (BMI) exceeds 40kg/m2 or falls between 35 and 40 kg/m2 if the obesity is accompanied by diabetes, hypertension, heart and joint diseases or sleep apnoea.

To check your BMI use the calculator on the right side.

The course of the surgery

All surgeries, due to obesity of the patients, are performed by means of minimally-invasive – laparoscopic – methods. Their benefits include fast recovery to full physical capacity, optimal wound healing and hardly noticeable scars. The sleeve gastrectomy is conducted in general anaesthesia. The patient is connected to numerous monitoring devices (cardiac monitor, monitor of oxygen and carbon dioxide concentration in patient’s breath, monitor of the oxygen saturation of the arterial blood), which are designed to control all necessary life parameters, and to a medical ventilator which provides breathing for the patient.

The surgery itself is commenced with 5 incisions through which specializedinstruments are inserted: camera, grasper, harmonic knife, stapler, liver retractor (it is used to move away the liver from the operating field), needle holder, clip suture apparatus. The instruments are inserted in a determined order, depending on the stage of the surgery. The stomach is excised approximately 4 cm from its bottom part called pylorus. The stapler – a device which simultaneously sutures and cuts tissues, enables the surgeon to gradually excise the stomach according to the line designated by the stomach tube along thelesser curvature.

The incision is made as far as to the fundus, i.e. the upper part of the stomach, and that leaves a narrow tube whose shape resembles a banana. The pyloric part – the further part of the stomach which regulates its evacuation – remains intact, so food can normally be passed from the stomach to the duodenum (the first part of the intestine).

The excised part of the stomach is removed through one of the incisions made earlier in order to place the stapler.
To ensure effectiveness and safety of the performed surgeries, the surgeon of the EurObesity Clinic additionally reinforces the excision line with a special suture, particularly in the area of the cardia and thegastric angle. These are the regions where the leakage might occur. Such procedure minimizes the risk of the complications.

The last step of the surgery is the closure of the incisions of the abdominal walls. As a standard, we suture deeper walls (fascia) to prevent the postoperative bleeding and avoid hernia in the wound which might require a surgical treatment. Due to such precautions,in the EurObesity Clinic we have never had any problems with wound healing.

Benefits of the sleeve gastrectomy

1. Decreasedappetite
2. Average loss of 55% of the overweight
3. No foreign bodies in the organism
4. Great chancesof eliminating the hypertension and diabetes
5. Intestines remain intact
6. Moderate number of follow-up visits
7. Moderate risk of deficiency of vitamins and minerals
8. High level of patients’ satisfaction

Risk involved in the operation

Each interference with the human body entails certain risk. Italso applies to the sleeve gastrectomy. The laparoscopic method, however, decreases the risk. Each person is slightly different, also when it comes to the size, location and possible lesions of the internal organs. There may occur some difficulties particularly in individuals who have been operated before and have suffered from extensive inflammatory conditions within the abdominal cavity. The resulting technical problems may cause some adverse effects.

The after-effects and threats related to the sleeve gastrectomy include, for example:

1. Gastroesophageal reflux causing the feeling of heartburn.
2. Damage to the neighboring organs (liver, spleen, intestines), nerves and blood vessels. This is almost always surface damage which may be treated by means of the laparoscopic technique.
3. Bleeding which may require blood transfusion.
4. Skin damage caused by disinfectants or electrical current.
5. Formation of clots or emboli in the blood vessels.
6. Infection of the operated area. May result from the leakage in the stomach and entail the limited (abscess) or diffuse peritonitis requiring immediate invasive treatment.
7. Impaired wound healing which may cause hernia.
8. Narrowing of the stomach.
9. Adhesions in the abdominal cavity which even after many years may cause intestinal obstructions.They occur much less frequently after the laparoscopic surgeries than after traditional surgeries.
10. Loss of appetite, nausea, vomiting on rarer occasions.
11. Postoperative hypertrophic scars. May result from individual susceptibility;

Partial success of the surgery (loss of 50% of the overweight after 5 years) is usually associated with consumption of high-calorific liquids and must not be deemed a postoperative complication.

Due to meticulously standardized surgical method and special care for the safety of the patient, none of the above complications have been observed in the EurObesity Clinic. Only a hypodermic bruising which usually does not entail permanent effects may occur. Temporary possible after-effects of the laparoscopic surgery may include minor swelling, pain in shoulders, stomach and neck as well as skin crepitation. They subside within a few hours to a few days after the surgery.

A complete normalization of the body weight is usually not achieved in individuals with higher classes of obesity despite the considerable reduction of the body weight after the sleeve gastrectomy. In rare cases it might be recommended thatthe patients, especially with the BMI >50 kg/m2, consider further stages of surgical treatment ordinarily involving the exclusion of the part of the alimentary tract from the digestion and absorption process.

You can contribute to the reduction of the risk involved in the surgery.How to do that?

1. By reducing the body weight prior to the surgery. Research proves that preoperative reduction of the body weight decreases the risk of postoperative complications. It is even more relevant as most surgeons refuse to perform the surgery if during the preparation period the patient fails to lose at least 5% of the body weight (for example, 7.5 kg for a person weighing 150 kg). A diet very low in calories (800-1000 kcal daily, depending on the height) is particularly conducive to that process. Patients can buy products with a determined calorific value, for example cocktails, soups, low-calorific bars. They may not only help to lose weight in a controlled manner but also provide necessary portion of protein and vitamins needed for the proper wound healing.
2. By quitting smoking. Individuals not addicted to smoking are much less susceptible to pulmonic and general complications. Even a one month without cigarettes before the surgery increases its safety. A lot of our patients do not return to the addiction after the surgery. It is an additional success which is within your reach and you capabilities. We will enjoy it with you.
3. By leading an active lifestyle before the surgery. We recommend regular walks prior to the procedure (5 times a week for 30 minutes) in a pace adjusted to your physical capacity. It may be a really slow walk – the regularity is more important. Such activity will substantially decrease the risk of rarely occurring, although potentially severe postoperative complications. The continued activity after the surgery will ensure a long-term success in the treatment of obesity.